Evaluation of safewards in forensic mental health: Analysis of a multicomponent intervention intended to reduce levels of conflict and containment in inpatient mental health settings

Background Safewards is a multicomponent,
evidence-based conflict and containment reduction
intervention that has demonstrated effectiveness in
general acute mental health settings.

Aim To evaluate the effect of Safewards in six wards of
a regional medium secure forensic unit.

Methods A service evaluation was adopted
incorporating a non-randomised controlled design
to analyse the effects of Safewards on conflict and
containment between and within wards. Adherence to
the interventions was measured and informal feedback
sessions with staff were conducted to explore views on
the acceptability of the interventions.

Results Both between and within-ward analysis
found no statistically significant benefit of Safewards.
However, adherence to the interventions was poor due
to prevailing operational priorities, including heightened
acuity in the research sites, demands on staffing
resources, criticism of the process of implementation
and staff attitudinal barriers.

Conclusion The effect of Safewards in this setting
cannot be determined without greater staff acceptance
and adherence to the interventions. The success of
Safewards will be sensitive to prevailing operational
and environmental conditions. On reflection, staff
should have been prepared more extensively
to ensure they understood the rationale for the
interventions more clearly.

Keywords
aggression, conflict, containment, forensic mental
health, safewards, violence