I’ve often been asked to address how to help a person with a mental illness or a substance misuse issue who is very symptomatic and who may be displaying unusual, disruptive or challenging behaviors.
This is an important topic to address because the situation can be very uncomfortable and the person’s behavior may be unpredictable and could become potentially harmful to themselves or others. Let’s take a look at this issue and begin to understand some basic strategies to manage this type of situation.
First, what do we mean by “challenging behaviors?” Challenging behaviors are behaviors that are seen as problematic by others noticing the behavior or by the person displaying the behavior. Challenging behaviors may also involve actions that come into conflict with what is accepted by the individual’s community.
Challenging behaviors often isolate the person from their community or they can be barriers to the person living or remaining in a community.
Challenging behaviors vary in seriousness and intensity, and can include any of the following:
- Yelling, cursing, or threats
- Responding to voices or visions
- Physical aggression
- Intoxication
- Property damage
- Hyperactivity or mania
- Inappropriate sexual behavior
- Unable to follow directions
- Self-injurious behaviors
- Severe withdrawal or depression
- Severe anxiety or panic
- Extreme delusions
- Medical emergencies
- Extreme confusion
- Inability to care for self
An ounce of prevention
One of the best ways to manage challenging behaviors is to keep them from developing in the first place. By addressing common behaviors early, they are less likely to escalate into challenging behaviors. Here are 10 common behaviors and simple strategies which can often help the people stay calm and in control.
If the person:
- …is hungry, provide a snack or meal.
- …is thirsty, provide water or another suitable drink.
- …is hot or cold, alter the environment or assist them into more comfortable clothing.
- …is sad, talk with them about what is making them sad.
- …is bored, talk with them about what they want to do; help them identify and locate activities or resources necessary to feel occupied and productive.
- …is uncooperative, provide incentive for cooperation or offer choices.
- …is being annoying, try ignoring the behavior or see if you can figure out what is behind the behavior.
- …needs to get away from stimulation, support them in finding a quiet place.
- …cannot concentrate during an activity, see what you can do to structure the activity to be more manageable for them.
- …is not feeling well and does not want to participate, permit them to leave or try to figure out how to help them feel better.
Do’s and Don’ts
Sometimes, despite our best efforts, the person’s behavior will escalate and it will become challenging. In these circumstances, here are some important do’s and don’ts which may be helpful to consider.
Do This:
- Stay calm. Move and speak slowly, quietly and project confidence. Watch your own body language, voice pattern, facial expressions and rate of speech.
- Maintain a relaxed posture. Make sure there is at least 3 to 6 feet between you and the person with whom you are speaking.
- Adjust your position so you are communicating with the person at the level of their physical height so their eyes can look at your eyes without difficulty.
- Acknowledge the other person’s feelings even if you disagree. Let them know it is clear that what they are saying is important to them.
- When acknowledging a person’s feelings, use words like “frustrated,” “upset” or other words that describe a softer version of the emotion displayed.
- Maintain a pleasant, open and accepting attitude.
- Ask for small, specific responses from them such as moving to a quieter area or lowering their voice. Focus on small requests.
Don’t Do This:
- Don’t touch the person if the person is not harming himself or herself or someone else. Touching escalates behaviors at the moment.
- Don’t invade another person’s personal space. Don’t stand directly face-to-face, hands on hips, crossing arms, finger pointing, or hard stare eye contact. These are very challenging behavioral messages.
- Don’t tower over a shorter person or a person in a chair or wheelchair.
- Don’t challenge, threaten or dare the other person. Never belittle or make fun of them.
- Don’t use words that are emotionally charged, like “angry” or “pissed off.” If the emotion that you named is not on target, allow the individual the control of naming the emotion.
- Don’t argue back to or over the person. Don’t try to change their mind about something.
- Don’t use a style of communication that suggests apathy, “the brush-off,” coldness, sarcasm, condescension, minimizing concerns, or giving them the run-around.
- Don’t position yourself where you are blocked by the person from having access to an exit if need be.
Safety First!
Remember that sometimes these challenging behaviors will continue to escalate and can quickly evolve into true psychiatric or medical emergencies where risk of harm to you, the challenging person or others may be imminent. If you feel the least bit unsafe or uncertain about how to manage the situation, don’t hesitate to call immediately for professional intervention (mental health professionals, police, ambulance, crisis response teams, etc.). Safety for all involved should always be the primary goal.
Here’s a question: What types of challenging behaviors have you seen that have been difficult to manage? Please leave a comment. Also, please subscribe to my blog and feel free to follow me on X (formerly Twitter), “like” my Facebook page, or connect on LinkedIn. Thanks!
Reference: Guidelines for Supporting Adults with Challenging Behaviors in Community Settings.