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Although de\u2010escalation is widely promoted as a first\u2010line, non\u2010coercive response to distress and behavioural escalation, its implementation remains inconsistent and the evidence base is fragmented across relational, educational, organisational and policy literatures. This paper reports a structured critical narrative synthesis of United Kingdom\u2010relevant empirical, theoretical, policy and practice literature examining de\u2010escalation, staff training, restrictive\u2010practice reduction and organisational responses to aggression and violence in adult inpatient mental health care. Literature published between January 2014 and March 2024 was identified through searches of Scopus, CINAHL, PubMed\/MEDLINE, ProQuest and Web of Science, supplemented by reference\u2010list screening and targeted grey\u2010literature searches. Sources were selected for their relevance to adult inpatient mental health settings and their contribution to understanding how de\u2010escalation is enacted, supported and sustained. Given the heterogeneity of the evidence, design\u2010appropriate appraisal principles informed by the Critical Appraisal Skills Programme and Mixed Methods Appraisal Tool were used to support interpretation. The synthesis identified three interdependent domains shaping de\u2010escalation practice: People, Capability and Context (PCC). Therapeutic relationships, communication, emotional intelligence and service\u2010user involvement underpinned early recognition of distress and relationally attuned responses. Workforce capability was strengthened through simulation, reflective learning, team rehearsal and practice\u2010proximal evaluation. Organisational context, including staffing, leadership, ward environment, safety culture, equity safeguards and wider structural determinants, shaped whether de\u2010escalation could be enacted consistently and safely. These findings generated the PCC framework as a practice\u2010facing model that conceptualises de\u2010escalation as an emergent practice arising from alignment between relational processes, workforce capability and organisational conditions. The framework offers a practical basis for guiding restrictive\u2010practice reduction, quality improvement, equity\u2010sensitive monitoring and future empirical research in inpatient mental health care.<\/jats:p>","DOI":"10.1111\/inm.70364","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T08:36:23Z","timestamp":1790152583000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["De\u2010Escalation in United Kingdom Inpatient Mental Health Care: A Structured Critical Narrative Synthesis of People, Capability and Context"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-0826-0971","authenticated-orcid":false,"given":"Ndukwe Walter","family":"Ugwuocha","sequence":"first","affiliation":[{"name":"Mersey Care NHS Foundation Trust  Liverpool UK"},{"name":"School of Allied Health Professions and Nursing, Institute of Population Health University of Liverpool  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7569-2605","authenticated-orcid":false,"given":"Simon","family":"Neilson","sequence":"additional","affiliation":[{"name":"School of Allied Health Professions and Nursing, Institute of Population Health University of Liverpool  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7305-0007","authenticated-orcid":false,"given":"Alexander","family":"Challinor","sequence":"additional","affiliation":[{"name":"Mersey Care NHS Foundation Trust  Liverpool UK"},{"name":"Faculty of Health Sciences University of Liverpool  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3023-1140","authenticated-orcid":false,"given":"Chengeto","family":"Shoko","sequence":"additional","affiliation":[{"name":"Mersey Care NHS Foundation Trust  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6939-5547","authenticated-orcid":false,"given":"Deborah","family":"Aluh","sequence":"additional","affiliation":[{"name":"School of Health, Science and Society University of Greater Manchester  Bolton UK"},{"name":"Department of Clinical Pharmacy and Pharmacy Management University of Nigeria Nsukka  Nsukka Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8247-2508","authenticated-orcid":false,"given":"Oladayo","family":"Bifarin","sequence":"additional","affiliation":[{"name":"Mersey Care NHS Foundation Trust  Liverpool UK"},{"name":"Faculty of Health, Innovation, Technology and Science Liverpool John Moores University  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/978-3-030-65106-0_5","volume-title":"Empathy, Normalization and De\u2010Escalation","author":"Accinni T.","year":"2021"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apnu.2020.03.002"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjo.2019.19"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.avb.2018.02.004"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140\u20106736(17)30569\u2010x"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.3109\/08039488.2014.996600"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.3310\/UDBQ8402"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2019.103412"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apnu.2022.09.011"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjo.2026.11040"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjc.12082"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2026.1711274"},{"issue":"6","key":"e_1_2_12_14_1","article-title":"The Therapeutic Relationship as Reflected in the Experiences of Hospitalised Psychiatric Patients: An Explorative\u2010Descriptive Study","volume":"85","author":"Bohmer M. 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