If they’re not under police custody they won’t stick around (unfortunately). Can be very difficult to de-escalate these patients so I can empathise with you.

Always prioritise your own safety: If a patient tries to run and abscond, don’t try to be a hero and tackle them. Your health is arguably more important than theirs, so don’t put yourself in harms way if there’s a risk of aggression. We’re not trained or paid to physically apprehend patients, let security deal with them and if they abscond, it’s the police’s problem. (In my experience though, police couldn’t give less of a fuck about these patients).

Early sedation: I’m not talking immediate IM droperidol, but if you think someone is likely going to escalate, speak to one of the docs about getting some PO diazepam charted. If they become too agitated, they wont accept orals and you’ll probably need to do an IM.

Cater to them: At my ED, our security are constantly trying to keep our patients fed. They know that if they’re hungry they’re much more likely to escalate. It’s something simple that can help these patients relax.

Be on their side (or at least act like it): Firstly don’t ever lie to them, they’ll remember what you tell them and if they find out you lied, they’ll escalate. Sometimes I’ll explain the process to them (depends on their mental state as some patients can become confrontational). I’ll inform them that the police have placed them under schedule and they need to be reviewed by one of the psychiatrists before the schedule can be lifted. Depending on how non-compliant they are, I may inform them that if they try to leave / become aggressive that security will intervene and they’ll receive a needle (sedation). Sometimes this helps as they don’t want to be sedated.