During a crisis where an inpatient client stands up, paces, and yells, what is an appropriate OT response?

• A. Acknowledge that she is upset and let her vent
• B. Immediately restrain
• C. Ignore the behavior
• D. Change the topic to a different task

Answer: (B)

Safety and calming the situation through de-escalation is the guiding principle in inpatient crises. When someone stands up, paces, and yells, the first goal is to reduce arousal and protect everyone’s safety by interacting in a calm, supportive way. Acknowledging what the person is feeling and inviting them to express themselves helps validate their experience and lowers defensiveness, which can prevent the situation from escalating further. Use a steady voice, open posture, and respectful language, and offer brief, concrete options or grounding strategies to help them regain a sense of control.

Restraint is not the initial or preferred response. It can increase fear, harm rapport, and escalate danger, and it requires specific policies, training, and authorization. It’s only considered when there is imminent risk of harm and all less restrictive strategies have been attempted or are not feasible. If safety becomes an immediate concern, follow the facility’s crisis protocol and call for help from staff trained to implement such measures.

Ignoring the behavior or abruptly changing the topic does not address the person’s distress or safety and can worsen agitation, so those options are not appropriate first-line responses. The emphasis is on calm, empathic engagement and steps to de-escalate, with restraint reserved only for the rare, verified emergencies under proper protocol.