De-escalation and limit-setting in forensic mental health units

Limit-setting and de-escalation are commonly used nursing interventions that are critical to the effective maintenance of the therapeutic milieu and the prevention and management of aggression in forensic mental health units. However, despite their purported importance, the techniques used in these interventions are rarely described. Further, these techniques are seldom based on empirical research or derived from a theory or model of aggression or interpersonal behavior. The purpose of this review is to examine the extant literature on limit-setting and de-escalation and consider how these activities could be enhanced. In concluding, this review emphasizes the potential benefits of drawing upon (1) a model of aggressive behavior and (2) a theory and literature examining interpersonal behavior, to enhance limit-setting and de-escalation skills.