Handling Crises on Inpatient Mental Health Units: How Music Therapy Influences the Process of De-escalation

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Castro-Pacheco, Melanie
Master of Arts in Music Therapy
Patients in psychiatric facilities with severe mental health symptoms may endanger the safety of themselves or others. Healthcare staff may utilize de-escalation techniques and crisis management skills to resolve the conflict. However, if these methods are ineffective physical restraints are used to restrict the patient’s movement and prevent further injury. The use of physical restraints in psychiatric facilities has raised ethical concerns. Recent studies have shown that restraints may be traumatic and countertherapeutic for the patient. The purpose of this study was to demonstrate how music therapy influences the process of de-escalation for adults receiving care on inpatient mental health units. Three music therapists described their experiences of using music to de-escalate a psychiatric patient in one individual interview. Transcripts of the interviews were analyzed using the procedures and techniques of Interpretative Phenomenological Analysis. These interviews provided detailed and insightful accounts demonstrating the successful use of music therapy as a de-escalation technique. The participants described a de-escalation scenario from their clinical work including patient symptoms, music therapy techniques, and the patient’s response to music therapy. Thematic material related to the interaction between each participant and their patient, benefits of rapport, and the musical behaviors of each patient were extracted from the data. The results revealed that music therapy can significantly improve the process of de-escalation. Music therapy allowed the patients to play an active role in the de-escalation process. Each patient was encouraged to participate in musical interactions that promoted self-regulation and self-expression. The effectiveness of music therapy as a de-escalation technique can be used to reduce the use of physical restraints.