Developing Safewards Secure for Mental Health Prison Units Using a Nominal Group Technique

The introduction of Safewards has resulted in the reduction of conflict and containment in general mental health units, and an adaptation has been developed for secure hospitals in forensic mental health services. Forensic mental health nurses working in bed-based prison mental health units could benefit from having a model to assist conflict and containment reduction in their unique context. The aim of this study was to develop a version of Safewards for bed-based prison mental health nurses. A literature review was conducted to identify relevant features of bed-based prison mental health units including flashpoints, and staff and consumer modifiers. A summary of the review was presented to participants prior to a Nominal Group Technique (NGT) with nurses and other disciplines (working in bed-based prison mental health units) (n = 12). The NGT was used to elicit feedback about the proposed model and achieve agreement on several questions related to the proposed version. Data collected were analysed thematically. Two themes were interpreted: (1) 'Square peg, round hole': the stark difference between custodial and Forensic Mental Health staff values and aims; and (2) nothing can happen without custodial staff support. Consensus was reached on all suggested changes/additions to the model. Findings support the need for an adapted version of Safewards (Safewards Secure-Custodial Mental Health) to assist nurses working in this setting. However, modifiers for custodial staff require development and collaboration with Correctional services will also be essential for successful implementation in this setting.