Outcomes of the Victorian Safewards trial in 13 wards: Impact on seclusion rates and fidelity measurement

Abstract

Restrictive practices are used in response to conflict and aggression in psychiatric inpatient settings. Reducing such practices is the focus internationally of policy and legislative change, many initiatives, and a growing body of research. Safewards is a model and a set of 10 interventions designed to reduce conflict and containment in inpatient services. In the current study, we aimed to assess the impact of implementing Safewards on seclusion in Victorian inpatient mental health services in Australia. The study used a before-and-after design, with a comparison group matched for service type. Thirteen wards opted into a 12-week trial to implement Safewards and 1-year follow up. The comparison group was all other wards (n = 31) with seclusion facilities in the jurisdiction, matched to service type. Mandatorily-reported seclusion event data for all 44 wards over a 15-month period were analysed using negative binomial regression. Adherence to Safewards was measured via fidelity checklists at four time points: twice during the trial, post-trial, and at 1-year follow up. Seclusion rates were reduced by 36% in Safewards trial wards by the 12-month follow-up period (incidence rate ratios (IRR) = 0.64,) but in the comparison wards seclusion rates did not differ from baseline to post-trial (IRR = 1.17) or to follow-up period (IRR = 1.35). Fidelity analysis revealed a trajectory of increased use of Safewards interventions after the trial phase to follow up. The findings suggest that Safewards is appropriate for practice change in Victorian inpatient mental health services more broadly than adult acute wards, and is effective in reducing the use of seclusion.

Carers of people from LGBTQ communities interactions with mental health service providers: Conflict and safety

“…The safety initiatives enacted by the Victorian government mental health policy, including the implementation of the Safewards model, have been found to have an evidence base for assisting in modifying environments to reduce conflict (Bowers et al 2015;Fletcher et al 2017). The study findings provide increased information on the characteristics of carers of adult LGBTQ people living with mental illness, or experiencing a mental health crisis, as well as identify a range of modifying activities.…”

“…; Fletcher et al . ). The study findings provide increased information on the characteristics of carers of adult LGBTQ people living with mental illness, or experiencing a mental health crisis, as well as identify a range of modifying activities.…”

“…It was also associated with reductions in use of seclusion on adult and youth wards (Fletcher et al . ). In October 2016, the Victorian Managed Insurance Agency (VMIA) partnered with the Office of the Chief Mental Health Nurse in the Victorian Department of Health and Human Services to expand the Safewards programme across the state of Victoria (Victorian State Government, ).…”

“…Evaluation data from the Safewards trial indicate that Safewards contributes to improved communication and reduces conflict in mental health units (Fletcher et al . ). However, it is dependent upon clinical staff to implement it.…”

“…Safewards was found to contribute to enhancing the atmosphere and culture on mental health units by improving communication and reducing conflict. It was also associated with reductions in use of seclusion on adult and youth wards (Fletcher et al 2017…”