'Safewards' creates compassion for patients

Caring for people in mental health facilities is complex and sensitive. It is difficult and stressful for patients, their families and the nurses to address the specialist needs of those with severe problems.

This article originally appeared in Voice, Volume 11 Number 8. View the original here.

A program aimed at improving the quality of care for mental health patients has been trialled in Victoria, writes Lisa Mamone.

Caring for people in mental health facilities is complex and sensitive. It is difficult and stressful for patients, their families and the nurses to address the specialist needs of those with severe problems.

International research has suggested the use of restrictive practices is not particularly helpful for the long-term recovery of a patient. These practices, considered last resorts in psychiatric wards, include extreme measures such as medication to sedate a patient, straps to physically constrain them, or isolation in locked spaces, are correlated with longer stays. 

Professor Len Bowers, from London's King's College, developed and successfully trialled a model in the UK called Safewards, consisting of 10 interventions designed to improve the quality of care for patients by implementing small community-building changes to nursing practices and patient-to-patient interactions. This model provides the opportunity for wards to address some of the more challenging aspects of acute care facilities for patients and staff without the large bill of new tools and dramatic process change. 

The Safewards model has been a great success with many of the changes easily implemented by staff after specific training sessions. The model included introducing inclusive activities like "discharge messages", often via a tree (above), where patients can leave positive messages to each other in a visually enriching display, a "know each other" folder designed to break down staff and patient silos, and "bad news mitigation" for staff to learn a variety of ways to plan the delivery of potentially bad news with a view to reducing the likelihood of conflict situations arising. 

"Some aspects of the model have been criticised as corny," says Dr Bridget Hamilton from the Centre of Psychiatric Nursing. "But there is real positivity and enthusiasm from our focus groups. Small changes such as using positive words during handover can change the whole shift for patients and nurses."

A long-time collaborator, Hamilton invited Bowers to Melbourne, who persuaded the Department of Health and Human Services to trial the project in Victoria. The Department committed $3 million to fund the trial which saw almost one quarter of wards sign up. The University is monitoring the implementation of the model and will analyse and evaluate its impact. 

The trial period ended in June this year, but many of the wards involved are committed to ensuring Safewards becomes embedded in their service delivery and the University has been able to provide its continuing support and monitoring. 

"Even the people who've been most resistant to the interventions, are not resistant to the whole philosophy and the whole ethos," says a nurse from a Safewards trial.

The attraction of the Safewards model is the community and consumer-driven project where wards are driving the care and practices they believe will work best for them and their patients. 

Through Safewards, the patients and staff created a real sense of belonging and form a small community in their environment. This community setting can positively impact their overall experience, reduce extreme measures of containment and result in a happier work place for all involved as well as their families

"A couple of patients in particular had a tendency to self-isolate but could be drawn out into the wider population through things like the mutual help meetings," says another health practitioner.

The evaluation team is cross-disciplinary, led by the Centre of Psychiatric Nursing in collaboration with the Centre of Mental Health in the Melbourne School of Population and Global Health with mental health and epidemiology experts contributing.

The team is still collecting the data but reports from the wards suggests that the Safewards model makes patients feel part of a community, enriches their stays and allows them to have a better relationship with their carers and other patients. 

All research participants were de-identified in quotes.