Reducing challenging behaviours with sensory modulation strategies: a quality improvement project in an acute mental health service

Background : Challenging behaviours are common in acute mental health settings, causing strain on therapeutic relationships and increased use of restrictive practices. Sensory modulation offers a non-restrictive alternative but evidence of its effectiveness in high-acuity settings is limited. In 2023–2024, the ‘Sensory Strategies’ project was conducted on a female acute mental health ward where the average monthly rate of violence and aggression (VA) was 21.2 incidents in the three months prior. The project aimed to reduce the mean number of incidents by 10% over 12 months. Method : Using quality improvement methodology, a sensory modulation intervention package was designed. Changes were implemented through iterative Plan-Do-Study-Act (PDSA) cycles during which staff and patient feedback was gathered to inform improvement. Monthly incidents of challenging behaviours were tracked using a Shewhart Individuals Chart. Results : After 12 months, incidents of challenging behaviour had decreased: VA by 45.3%; other challenging behaviours (OCB) and self-harm by 28.4%. Three months later, reductions in VA and OCB were sustained while a 38.8% increase in self-harm incidents was probably linked to an increase in admissions of individuals with personality disorders. Patients (n = 9) reported high satisfaction, highlighting improved emotional awareness and understanding of grounding techniques. Staff (n = 7) felt confident using sensory strategies but requested more hands-on training and easier access to materials. Conclusion : The target for reducing challenging behaviours was exceeded, highlighting the strong potential to reduce restrictive practices and improve patient experience. Future work should explore strategies for long-term sustainability, including phased implementation.