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Updated: May 13, 2025

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
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Developing Safewards Secure for Mental Health Prison Units Using a Nominal Group Technique.

Tessa Maguire1,2,3, Maicee Young1,2, Monica Najda2

  • 1Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Victoria, Australia.

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PubMed
Summary

Safewards was adapted for prison mental health nurses to reduce conflict and containment. The adapted model, Safewards Secure-Custodial Mental Health, requires collaboration with correctional services for effective implementation.

Keywords:
Safewardsconflictcontainmentforensic mental health nursingmental healthprisons

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Area of Science:

  • Forensic mental health nursing
  • Correctional healthcare
  • Conflict resolution in secure settings

Background:

  • Safewards model successfully reduces conflict and containment in general mental health units.
  • Adaptations of Safewards exist for secure forensic mental health services.
  • Forensic mental health nurses in prison settings require tailored models for conflict and containment reduction.

Purpose of the Study:

  • To develop an adapted version of the Safewards model for nurses in bed-based prison mental health units.
  • To identify unique features, flashpoints, and staff/consumer modifiers relevant to the prison context.
  • To achieve consensus on necessary modifications for a secure-custodial mental health setting.

Main Methods:

  • Literature review to identify contextual features of prison mental health units.
  • Nominal Group Technique (NGT) with multidisciplinary staff (n=12) from bed-based prison mental health units.
  • Thematic analysis of qualitative data to interpret findings and reach consensus on model adaptations.

Main Results:

  • Identified a significant divergence between custodial and forensic mental health staff values and objectives ('Square peg, round hole').
  • Highlighted the critical need for custodial staff support in implementing any new model.
  • Achieved consensus on all proposed changes and additions to the Safewards model for this setting.

Conclusions:

  • An adapted Safewards model, named Safewards Secure-Custodial Mental Health, is needed for prison mental health nurses.
  • Further development of modifiers specifically for custodial staff is essential.
  • Successful implementation necessitates close collaboration with correctional services.