It can be difficult or impossible to manage services during an escalated event. Therefore, it is important for everyone on the team to understand that they have a role when there is an escalated event…

Your staff should be trained in basic CPR and first aid including identifying common medical emergencies like seizures, heart attacks, or strokes. Space Hacks can not list every potential scenario in which someone might need to have 911 called or go to the hospital.

Though less common at harm reduction sites than opioid overdose, overamp can happen to people who use stimulants at any time in any place, so it’s important that you first recognize and know how to respond in case it comes up at your site.

Your protocol for dealing with overdose will vary depending on the physical layout of your site and variables like how far you are from the nearest hospital.

The decision as to whether or not you are able to continue services during an escalated event is incredibly important and should be given thought before such an event takes place.

Mental health first aid is a set of techniques developed by mental health providers in Australia in the early 2000s. They developed this methodology as a way of diffusing basic mental healthcare techniques to the general population so that they could be better equipped to respond to emotional problems—especially depression, anxiety, and suicidality.

Because participants experiencing psychosis aren’t in touch with consensual reality, they may be easily confused and frightened. For this reason, it is important to be as concrete and clear with the participant as possible.

What is a bathroom blockade? That’s when somebody refuses to leave the restroom. Bathroom blockades happen for many different reasons, mostly because people become agitated and confused and/or they are in desperate need of privacy.

Though no one knows exactly where this practice originated, this group response to escalated situations seems to have emerged somewhere in the radical health scene on the West Coast. Both nascent harm reduction workers in the San Francisco Bay Area and harm reduction workers in Seattle have been using this method to diffuse escalated people successfully since at least the 1960s at the Berkeley Free Clinic.

It’s essential that if boundaries need to be enforced or reiterated, they should be addressed in a calm and clear way.

One of the main goals of active listening with an agitated person is reaching affirmation and accord. You are looking to try and find ways to agree with the person who is agitated. Even if you don’t entirely agree with the person, try to find at least a small way in which they may be right, or in which you can be on the same page, or team, with them.

In terms of verbal communication, it is most important that harm reduction staff or volunteers remain as calm and centered as possible during the event. Remember the primary purpose of de-escalation is to make the exchange safe for everyone by reducing agitation and tension.

When someone is agitated or in distress, how we carry ourselves can make a huge difference. Non-verbal cues—like posture, breathing, and personal space—can either calm a situation or escalate it further. The following tips offer guidance on using body language to reduce tension, show respect, and create a safer, more grounded interaction.

Obviously, this reflective technique is not always appropriate to the circumstances and to your needs or purposes. At times you may want to be more directive and less reflective in your interactions. You may want to argue, advise, or confront.

Once you have grounded yourself during an escalated situation, next engage in active listening with the person who is agitated. This can seem counterintuitive or difficult when you are dealing with somebody who is, for example, screaming at you, and it may feel like you’re rewarding them for being completely irrational. But it is key to getting them more centered and grounded so they’re less agitated and less likely to become a danger to themselves or others.

The cycle of violence was originally developed as a model for intimate partner or domestic violence. Over time experts have come to recognize that the cycle of violence applies to almost all forms of violence, including violence that might erupt in harm reduction spaces.

STAMP (Staring, Tone and volume of voice, Anxiety, Mumbling, and Pacing) is a set of assessment criteria created for emergency room nurses at the City College London based on their observations of violent patient behavior.

Most of us are relatively familiar with the physical signs of escalation, but they include a few you may be less familiar with.

Recognising early signs of agitation or distress can help prevent conflict and keep harm reduction spaces safer for everyone. While every situation is different, there are some common behavioural cues that may signal someone is beginning to escalate.

As discussed in the part of the site on preventing escalation, it is essential for harm reduction workers to stay present and remain centered and relatively calm during escalated events. This is one of the hardest things to do, but staying present and centered during any kind of escalated situation at your harm reduction site is essential to de-escalation.