Consumer recommendations for enhancing the Safewards model and interventions

Abstract

This paper critiques the Safewards model through the lens of lived experiences of psychiatric hospitalization, diagnosis of mental illness, and distress. Special focus is given to the model's tested 10 interventions and to five lesser known interventions, identifying the impact they can have on hospitalized consumers. We highlight the role and prevalence of trauma, as well as the need to prevent harm in hospital settings. We draw upon notions of hospital as a sanctuary for people and the importance of providing a safe ward. ‘Sanctuary harm’ and ‘Sanctuary trauma’ are thus defined, with emphasis placed on the Safewards interventions as means by which sanctuary can be achieved. Finally, the consumer‐perspective authors propose expansions to the model, critiquing the defining literature and moving towards a consumer experience of safety that is beyond the model’s original intention: to reduce seclusion and restraint practices. Throughout the paper, the term ‘consumer’ is used in this context to mean people who have experienced or are experiencing psychiatric inpatient care.

Consumer Perspectives of Safewards Impact in Acute Inpatient Mental Health Wards in Victoria, Australia

“…In times of high acuity, consumers have reported that having predictable services contributed to a feeling of safety (32); in this light, Clear Mutual Expectations was viewed by participants in this study as beneficial. Furthermore, in their critique of Safewards from the perspective of consumers, Kennedy et al (38) report that Know Each Other could increase consumers’ sense of safety through holding some everyday knowledge about staff.…”

“…This challenge can be addressed in the first instance by changing language used for interventions, such as Calm Down Methods, and by providing consumers with the opportunity to choose the tools available for this intervention. There is considerable scope for consumer perspectives to be foregrounded using coproduction processes, when Safewards interventions are reworked and new interventions are developed (38). Furthermore, the astute consumer critique of staff language and intent makes clear the need to ensure that the implementation of Safewards and other interventions is not undermined by a superficial approach that misses the intent of an intervention or strays from the model and underpinning evidence (41, 42).…”

“…Also, there is scope, based on this evidence and other consumer expert contributions (38), to refine specific language in the interventions, including changes to “Calm down.” Steps have been taken already in different local settings such as “Chill kit” in some adolescent units.…”

“…To keep Safewards relevant, we now need to engage with the current day and critical perspective from consumers, to codesign ongoing development and evolution of the interventions based on evaluation findings. To this end, we look to suggestions made by Kennedy et al (38) to extend Safewards to include varied interventions from the original 30, to maintain the momentum of change.…”

Understanding how personhood impacts consumers’ feelings of safety in acute mental health units: a qualitative study

“…Most of these restrictions are implemented by nursing staff (Bowers 2014), along a continuum from individual limit setting and ward rules, to highly coercive practices such as seclusion, restraint, and enforced medication (Kennedy et al . 2019). Autonomy relates to personal freedom and is expressed through the capacity to make choices (Hem et al .…”