Hospitals and psychiatric institutions reduce their activity to de-escalation measures in such cases and should only intervene in emergency situations if this is absolutely necessary to protect the staff from existing, direct, imminent danger. The NPM is fully aware that, due to the increase in dangerous situations, there is a greater need for security for the health care staff including employee protection aspects. The presence of private security personnel in itself is therfore viewed as support. This is understandable but falls short of the mark. It is important to understand how aggression emerges, as this provides information for preventive measures. Staff-related, organisational and patient-related strategies have to intertwine here. Time constraints, the much lamented work overload and staff shortages continue to provide the breeding ground for a tense communication atmosphere. If the needs and feelings of persons who subjectively consider themselves to be in a health emergency are not sufficiently appreciated, their annoyance can erupt as an overreaction in order to get attention. In most cases, the facilities concentrate on secondary prevention, which only sets in after escalation has started. Specifically focusing on primary intervention measures that prevent crises from occurring in the first place would be just as important. These include training in verbal and non-verbal deescalating behaviour and communication strategies but also other measures that demonstrably reduce the number of conflicts: bright waiting areas with sufficient possibilities to be alone and have privacy, two entrances and exits per room, emergency buttons or silent alarms, easily understandable orientation systems etc. For the purpose of tertiary prevention, it is also necessary to develop clear instructions on what to do after an incident. Staff who are traumatised by a violent incident need personal support in order to work through what they have experienced. An inadequate prevention strategy thus fosters those emergency situations which cannot be countered with security services alone. The NPM continues to expressly object to private security companies being routinely deployed on the threshold to nursing and care whereas effective alternatives (e.g. specially trained professional crisis teams) are not taken into consideration. 45