Patients presenting with acute behavioural disturbance pose a significant challenge in terms of management of risk to the patient (particularly when there is potentially life-threatening illness and/or injury) and to others. The consultation-liaison (CL) team offers acute advice and expertise across the general hospital setting and has a key role in policy development in collaboration with medical colleagues to ensure timely and effective intervention for patients presenting with acute behavioural disturbance. This chapter explores aetiological factors contributing to presentations of acute behavioural disturbance and approach to assessment. Behavioural and pharmacological interventions are outlined along with guides for optimising assessment and management of patients with acute behavioural disturbance in the emergency department (ED).

This chapter is an updated version of a previous article on the use of simulation in psychiatry training (Dave 2012). Professor Dave’s observation that changes in the delivery of psychiatric care, such as ward closures and the creation of specialist teams, might limit the availability of direct patient contact for trainees was prescient. What was, however, unimaginable at the time of writing the article was the effect that a global pandemic such as COVID-19 would have on the provision of clinical training by limiting access to clinical placements (Lucey and Johnston 2020). These factors have increased the urgency and pressure for those concerned with the delivery of training to create and deliver simulation-based learning (SBL), often online. Many educators may have found themselves wishing for a guide on how to produce psychiatry-orientated SBL experiences.

Broadly speaking, virtual learning refers to the delivery of education via the use of digital technology. It encompasses a broad range of learning techniques, communication methods and electronic media to provide a learning experience that is flexible, engaging and learner centred (Ellaway and Masters 2008).

Virtual learning has been possible since the invention of the Internet in the late twentieth century. In 1969, the Open University pioneered the use of emerging digital technologies to increase the accessibility of higher education. Since its inception, the Open University has provided remote learning opportunities for over two million students (The Open University 2021). Over the past few decades, virtual teaching and learning have become increasingly popular within medical education, but their use has been particularly accelerated by the COVID-19 pandemic (He et al. 2020). Since the onset of coronavirus, medical educators have used virtual learning to safeguard the delivery of medical curricula, whilst also abiding by social distancing precautions and protecting staff and students from disease transmission. This has been akin to the global upsurgence in the use of telehealth and remote delivery of physical and mental healthcare (Monaghesh and Hajzadeh 2020)