Broadening the Understanding of De‐Escalation in Acute Mental Health Units: From Individual Nursing Skill to Relational Responsiveness

We read with great interest the article by Daguman et al. (2026) on nurses' perspectives and experiences of implementing the Safe Steps for De-Escalation in acute mental health units. This study makes an important contribution to contemporary mental health nursing by showing that de-escalation is not simply a procedural response to conflict or distress, but also a nursing practice built on rapport and shared effort within the ward team. An especially valuable insight from this study is that de-escalation depends on more than the relational skills of individual nurses. The nurses' accounts show that de-escalation is shaped by rapport-building, role negotiation, mutual support and the ability to adjust responses to the immediate interpersonal and situational context (Daguman et al. 2026). In this respect, the paper highlights de-escalation as a collective nursing practice rather than a skill located solely within one practitioner. This has important implications for how de-escalation interventions are supported in acute mental health settings. Training and structured frameworks remain necessary, but the findings suggest that implementation also depends on whether ward teams can sustain the conditions needed for therapeutic alternatives to coercion (Price et al. 2024). These conditions include support between colleagues, flexibility in who leads the interaction, opportunities for reflection and a shared commitment to therapeutic engagement during periods of escalating distress (McAllister et al. 2021). The study also raises a more specific implementation question. Safe Steps includes several linked components, including a structured framework, training, online learning and restrictive practice review meetings. However, the nurses' accounts suggest that not all components may be equally influential in everyday practice. In particular, the elements that appear most useful are those that help nurses build rapport quickly, negotiate who is best placed to take the lead in a deteriorating situation, reflect on difficult interactions after the event and adapt responses to the person and context rather than follow the framework rigidly (Mullen et al. 2022). Future work could therefore move beyond examining the intervention as a whole and instead identify which components are consistently experienced by staff as most helpful in routine inpatient care. It would also be valuable to examine how these components can be embedded into everyday ward processes, such as handover, post-incident review, clinical supervision and team discussions, so that de-escalation is sustained as an ongoing ward practice rather than relying primarily on one-off training or individual staff commitment. Overall, this study offers a timely and practice-oriented contribution to the literature on reducing restrictive practices in acute mental health care. Extending the discussion from individual nursing skill to the team conditions that support de-escalation may help strengthen more humane and sustainable approaches in acute mental health units. The authors have nothing to report. The authors declare no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.