Responding to challenging behaviour

It is likely that whether you work in a health setting or not will be confronted with people who exhibit unacceptable behaviour.

What is challenging behaviour?

Challenging behaviour can be defined as any behaviour of an individual which has the potential to cause physical or psychological harm to themselves, another person, or to property around them. It does not have to be deliberate acts – some patients who suffer from mental health conditions can express challenging behaviour unintentionally. Whether intentional or not, the behaviour can be a barrier for service providers to deliver high quality care and support.

What triggers challenging behaviour?

To better understand how to respond to challenging behaviours, you should recognise the factors which are triggering to the individuals with BPD. Challenging behaviours of BPD are expressed due to intrinsic or extrinsic factors:

  • Intrinsic: Dysregulated emotions, depersonalisation, negative thoughts, paraonoia
  • Extrinsic: interpersonal relationships and environment

It is recommended that a safe and comfortable environment can be offered to minimise chances of angry, fear or depressive states.

MARSHA LINEHAN – Why so few talented therapists treat clients with challenging disorders
To see more BPD interview footage see Borderliner Notes.


Dealing with challenging behaviours

Depending on the intensity of the situation and behaviours displayed, the following techniques can be employed to de-escalate the situation:

Preventing escalation involves verbal communication with the individual.

  • It is important to keep your own behaviour in check by remaining calm and objective so that you can assess the situation clearly and respond appropriately.
  • Use active listening and undivided attention find out what the problem is and acknowledge the emotions of the person.
  • Use positive language and avoid negative language.
  • Keep communication open to allow individual to calm down and gain trust with you.

Physical intervention and restraint should only be considered after de-escalation has been ineffective.

  • Keep time period short as possible to maintain dignity of the individual and minimise physical and psychological harm to all those involved.
  • Staff to be regularly trained

For more information

Health Times – Managing challenging behaviour: Mental health


Download Project Air Strategy – Responding to challenging behaviour in the school. A guidance for teachers and staff members at school.

Develop skills in facilitating responsible behaviour by completing free comprehensive online training developed by Community Door. The course covers three topics: monitoring client behaviour, communication strategies to de-escalate conflict and managing conflict.

SA Health – Taking care of challenging behaviour

Take an online course Royal College of Psychiatrists – Managing challenging behaviour.

Watch this webinar  Mental Health Professionals’ Network – Personality Disorders and Substance Use: Tips on Effective Treatment Approaches.


SA Health – Taking care of challenging behaviour

Health Times – Managing challenging behaviour: Mental health