1. brought to you by Understanding Agitation

2. brought to you by Understanding Agitation What is Agitation? Agitation is defined as "excessive verbal and/or motor behavior" that can be loud, disruptive, hostile, sarcastic, threatening, hyperactive, and/or combative” Can be caused by a mental health condition such as depression or bipolar disorder, or may be related to intoxication. Many other medical conditions can cause someone to become agitated, such as a head injury. Only a small number of patients experiencing agitation become aggressive. Agitation is experienced on a spectrum and it is best to intervene in the earlier stages to help a person to calm.

3. brought to you by Understanding Agitation What Agitation Feels Like People experiencing agitation are often in distress, frightened, and vulnerable. They may have paranoia or racing thoughts. These experiences lead people into a “fight or flight” response, which accounts for behaviors such as irritability, pacing, and argumentativeness. Because this is such a distressing experience, many patients want help and will respond best to a compassionate, empathetic approach.

4. brought to you by Understanding Agitation The Old Treatment Model Primarily medication focused Patients would often end up physically restrained and sedated without any prior attempted interventions This approach can be dehumanizing or traumatizing to both patients, staff, and those in the surrounding area This type of trauma can have long-term impact on the individual Additionally, as many as 2/3 of staff injuries occur while physically restraining a person

5. brought to you by Understanding Agitation One Young Adult’s Perspective “Being restrained costs a lot! I was abused before I was in psychiatric care. Being restrained made me feel the same way – except staff are supposed to help you, right? It made me worse and took away my self-esteem. How is that supposed to make me feel better? I don’t get it. Wouldn’t it be cheaper if staff just listened?” -Juliana

6. brought to you by Understanding Agitation Background on Project BETA Regulatory agencies and peer advocacy groups have called for a reduction in coercion and the use of restraints. The American Association for Emergency Psychiatry embarked on Project BETA to disseminate guidelines for the Best practices for the Evaluation and Treatment of Agitation in the emergency setting. Project BETA was a collaboration between dozens of seasoned experts in psychiatry, emergency medicine, and patient advocates. Guidelines for treatment include the entire agitation clinical spectrum, including triage, diagnosis, and interpersonal calming skills, as well as medicine choices.

7. brought to you by Understanding Agitation Project BETA Recommendation Highlights De-escalation can work far more often than many clinicians may be aware It is nearly always worth attempting verbal calming as part of an agitation treatment approach Patients should be encouraged to take oral medications voluntarily, as opposed to forcible involuntary injections. This will enhance the therapeutic alliance Second-generation antipsychotics are as efficacious as first-generation antipsychotics in agitation, and preferable because of side effect profiles Agitation from stimulant intoxication should be treated with benzodiazepines alone Myth: emergency programs frequently have fewer staff assaults and injuries Source: psychiatrictimes.com/psychiatric-emergencies/best-practice-guidelines-agitated-patients

8. brought to you by Understanding Agitation Benefits to Your Facility, Staff, and Patients Based on results from a California psychiatric ER implementing Project BETA recommendations, you can expect: Decrease in assaults and injuries Lowered insurance costs Increase in patient satisfaction and long-term outcomes Improved staff satisfaction and retention A shift towards less restrictive interventions These results have been replicated and sustained over time. To view the evidence, visit DBSAlliance.org/UnderstandingAgitationKit

9. brought to you by Understanding Agitation How Can DBSA Help? Resources for Your Facility Educational de-escalation poster Treatment cards convenient to fit on a lanyard Video series and webinar on agitation DBSAlliance.org/UnderstandingAgitationKit Resources for Your Patients and their Families Your local DBSA support group Understanding Agitation brochure Personal crisis planning cards DBSAlliance.org

10. brought to you by Understanding Agitation Thank You! Your Name DBSA [Chapter Name] Phone number Email Website