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Breakaway training is a mandatory training programme for mental health staff in both NHS and private services. However, the question that remains outstanding from the recent guidance on the management of short‐term violence published by the National Institute for Clinical Excellence (NICE) (NICE, 2005a; 2005b) is whether breakaway training is effective?This paper provides a history of and evidence for breakaway training, and a study examining the content of breakaway training in one English high secure hospital is provided.

This paper aims to examine the nature and prevalence of violence in a medium secure unit and to evaluate a personal defence training programme for staff working with mentally disordered offenders.

The paper identifies an existing training gap associated with traditional breakaway techniques and describes a process of piloting a new educational module known as the spontaneous protection enabling accelerated response (SPEAR) system. Structured questionnaires were used to collect demographic data and analyse staff confidence and perceptions of the training module. Clinician confidence in coping with patient aggression was measured before, immediately after and at three months following participation in the new programme.

A significant change in staff confidence was observed at two time scales after the training had been administered when compared with the pre‐test baseline total scores. Over 90 per cent of staff either agreed or strongly agreed that training in the new personal defence module provided a credible defence against sudden episodes of high‐risk violence.

The paper describes a proposed module of training that may provide a credible tertiary strategy for those frontline clinicians currently exposed to the risk of sudden, spontaneous episodes of close proximity violence where traditional breakaway techniques are likely to be ineffective. This paper would interest managers, trainers and specialist practitioners that are involved in the preparation and delivery of violence reduction initiatives aimed at promoting safer and therapeutic services.

Traditional methods of addressing workplace violence have relied almost solely on reactive measures. Methods of de‐escalation, strategies to calm the already distressed person down by means of positive communication, or responding to an actual or potential act of violence by means of physical control have formed the focus of training initiatives provided for staff. This approach has suggested an acceptance of the premise that violence in certain services is an inevitable problem that must be managed. This paper proposes that many incidents can be prevented and outlines the emerging evidence to support a structured, holistic approach. Additionally, it provides an overview of the recent policy agenda, the evidence base and examples of some recent and ongoing development work that attempts to change practice.

Since the early 1980s, breakaway training has been synonymous with many prevention and management of violence and aggression (PMVA) training programmes in social care and NHS settings. However, for almost three decades, this community has continued to accept a training approach that has been largely unsupported by a robust underpinning methodology or evidence base. The validity of this historical training approach will be examined in context with the available literature, and will seek to identify the fundamental flaws that have been inherent in the traditional system. This paper will conclude by making some practical suggestions on how the efficacy of personal protective training may be improved, based on the emerging findings from other scientific fields.

Staff must have an appreciation of legal and ethical issues associated with the people they care for, particularly when physical restraint to manage aggression or violence is being considered. This article examines legal and ethical issues related to the management of aggression and violence, and considers the inclusion of this material in training courses.

Much of the research related to experiences of violence at work in intellectual disability services has focused on paid carers, with very little exploring the experiences of staff in community intellectual disability teams (CIDT). This study aims to address this issue.

This study began with a brief survey sent to staff across six CIDTs in South East England. These experiences were further explored with in‐depth interviews with a sub‐sample of the respondents.

The results of the survey indicated that 34 per cent of the respondents (n=105) had experienced some form of verbal or physical aggression at work during the previous six months. Emerging themes focused on the types of risks faced by this staff group; factors that helped with risk assessment and management (and why these things do not always happen); and how workers develop the skills in managing these risks.

Implications are discussed in terms of gaps in current formal training and the role of more informal learning processes in addressing the specific needs of staff working with this client group.

Managing violence is an important clinical and managerial responsibility within contemporary mental health practice and there have been considerable developments across the country to pave the way for a more ‘standardised’ approach to conflict resolution. Many trusts employ someone to lead on ‘conflict resolution’ but the precise nature of the lead role and the responsibility attached to it vary greatly between organisations. Similarly, some trusts have sophisticated systems for delivering and monitoring conflict training and updates, whereas others do not. The project described here sought to clarify how training for conflict resolution is organised within a sample of mental health trusts in England. Data was generated by questionnaire and telephone interview with trust leads, and the audit findings were then analysed and used to inform an inter‐professional training pilot in one local trust. It is now expected that frontline staff will enter into conflict resolution training as defined by the NHS Security Management Service (2004) and be trained in accordance with a national syllabus of training standards. Audited opinion suggests that the training co‐ordinator role is associated with improved governance in relation to conflict‐resolution training. Arguably, if national benchmarks and standards are to be met in relation to conflict resolution, trusts need to invest in training infrastructure and at least consider the merits of funding a dedicated co‐ordinator role and inter‐professional training.

The fallout from numerous inquiries into the death of patients, as well as the timely development of various pieces of anti‐discrimination and human rights legislation have all led to a major shift in the way physical restraint techniques are now used. Even so, techniques remain potentially harmful, with danger present in every application. This paper seeks to discuss this issue.

A review of the relevant literature revealed a large number of the psychiatric population are uniquely vulnerable to harm. The paper then examined how the way that this risk is managed could be enhanced.

The literature review revealed that a significant minority of patients in forensic settings engage in the types of damaging or injurious behaviours that may, as a last resort, require physical intervention. Physical intervention systems, some of which have migrated across into forensic settings from police and prison training portfolios, are often comprised of generic techniques which are applied in an unmodified form to patients; this mismatch can increase risk. The authors draw on a developing body of literature that examines how physiotherapists and manual handling experts can be used to enhance risk management strategies by formulating patient screening systems, applying bio‐mechanical knowledge to the configuration of holds, as well as developing technique risk assessment procedures and supporting trainers.

This discussion paper enriches the current debate on how risk can be managed within the context of restraint, as well as that of how best NHS resources can be used in practice.