Preventing and Reducing Coercive Measures—An Evaluation of the Implementation of the Safewards Model in Two Locked Wards in Germany

Abstract

Introduction Aggression and violence are highly complex problems in acute psychiatry that often lead to the coercive interventions. The Safewards Model is an evidence-informed conflict-reduction strategy to prevent and reduce such incidents. The aim of this study was to evaluate the implementation of this model with regard to coercive interventions in inpatient care. Materials and Methods We evaluated outcomes of the implementation of the Safewards Model in two locked psychiatric wards in Germany. Frequency and duration of coercive interventions applied during a period of 11 weeks before and 11 weeks after the implementation period were assessed through routine data. Fidelity to the Safewards Model was assessed by the Organization Fidelity Checklist. Results Fidelity to the Safewards Model was high in both wards. The overall use of coercive measures differed significantly between wards [case-wise: χ 2 (1, n = 250) = 35.34, p ≤ 0.001; patient-wise: χ 2 (1, n = 103) = 21.45, p ≤ 0.001] and decreased post-implementation. In one ward, the number of patients exposed to coercive interventions in relation to the overall number of Patients decreased significantly [χ 2 (1, 281) = 6.40, p = 0.01]. Furthermore, the mean duration of coercive interventions overall declined significantly [ U (55,21) = −2.142, p = 0.032] with an effect size of Cohen’s d = −0.282 (95% CI: −0.787, 0.222) in that ward. Both aspects declined as well in the other ward, but not significantly. Discussion Results indicate that the implementation of the Safewards interventions according to the model in acute psychiatric care can reduce coercive measures. They also show the role of enabling factors as well as of obstacles for the implementation process.

Violence Prevention Climate in General Adult Inpatient Mental Health Units: Validation study of the VPC‐14

“…Previous research has reported significantly different ratings between staff and patients on climate measures (Baumgardt et al, 2019; Berry et al, 2016; Moos, 1974; Nicholls et al, 2015; Southard et al (2012); ; ; ; ; ; ; ; . While the literature is not without inconsistencies, the weight of evidence across settings and measures is that, relative to patients, staff overestimate their own abilities as active agents for therapeutic change and that patients, relative to staff, perceive a greater role for themselves in determining ward climate.…”

One year prevalence of psychotic disorders among first treatment contact patients at the National Psychiatric Referral and Teaching Hospital in Uganda

“…Future work on necessary components for an early intervention psychosis clinic as well as cost benefit analyses of such a program are recommended [13,22,49,50]. It is also known and often observed that psychotic disorders tend to present with aggression and violence injuring staff and fellow patients [51,52]. Acute psychiatric units or psychiatric intensive care units have been shown to be especially effective in containing such potentially dangerous behaviour [51], hence calling for such care facilities as useful additions to mental hospitals as opposed to just locked seclusion rooms as is the practice at this facility [51,52].…”

One year prevalence of psychotic disorders among first treatment contact patients at Butabika National Psychiatric Referral Hospital in Uganda

“…Future work on necessary components for an early intervention psychosis clinic as well as cost benefit analyses of such a program are recommended (13, 21, 42, 43). It is also known and often observed that psychotic disorders tend to present with aggression and violence injuring staff and fellow patients (44, 45). Acute psychiatric units or psychiatric intensive care units have been shown to be especially effective in containing such potentially dangerous behaviour (44), hence calling for such care facilities as useful additions to mental hospitals as opposed to just locked seclusion rooms as is the practice at this facility (44, 45).…”