The Safewards model and associated interventions identify the causes of behaviours in staff and consumers that may result in harm - such as violence, self-harm or absconding - and reduce the likelihood of this occurring. Independent evaluations of three trials of Safewards within Victoria, across three different healthcare settings, demonstrate that Safewards can be effective at reducing conflict where mental health consumers require care.
Safewards Victoria – the story
The Safewards trial aimed to reduce and, where possible, eliminate the use of restrictive interventions by implementing an evidence-based model of care. Originating in the UK and implemented internationally, the Safewards model was developed from a broad body of evidence, including several large-scale research studies conducted over a number of years based within mental health services. A review of more than 1,000 additional studies reported from around the world were synthesised into the model. A randomised controlled trial of the model of mental health services in the UK, led by Professor Len Bowers, established a decline in conflict at each of the sites using the Safewards model which consists of six originating domains and 10 interventions.
Between 2014 and 2016 Safewards was trialled in seven public mental health services in Victoria, covering a range of inpatient unit age groups and secure setting types (for example, secure extended care units). With the success of the trial, the Office of the Chief Mental Health Nurse in partnership with the Victorian Managed Insurance Authority (VMIA) committed to expand and trial Safewards in three phases:
- Phase one expanding Safewards to 18 public mental health services (2016 – 2019)
- Phase two trial Safewards within three emergency departments (2019 – 2021)
- Phase three trial Safewards within six general health units (2021 – 2022).
All three trials were independently evaluated by the University of Melbourne. The results of the trials demonstrated encouraging results with services showing a decline in conflict and and a positive experience of staff implementing the interventions during the trial period. The evaluation of all three trials received ethical approval from the Melbourne Health Human Research Ethics Committee and the University of Melbourne.
A Collaborative was set up to support the implementation of the Safewards trials and rollout. This included a Faculty, Community of Practice and Consumer Advisory Group. This structure enabled participating services to learn from each other and from subject matter experts to support their improvement activities. If you would like further information and resources to support the implementation of the Safewards model at a health service, please visit the Safewards page within Clinical Guidance.
Research and Evaluation
Safewards Victoria Trials
The evaluation of the Safewards Victoria trials was built on program logic maps that defined the objectives of the trials and conducted across project phases of training, trial and sustainability. The evaluations provided project partners with clear findings regarding acceptability, effectiveness and impact of Safewards. A mixed method design and multiple data sources were used.
- Safewards fidelity measures, based on observation by evaluators
- Several staff and consumer surveys
- Organisation-level diaries of project activity
- State-wide data regarding seclusion events in all inpatient settings.
The first trial of public mental health units was evaluated by the Centre for Psychiatric Nursing, University of Melbourne. The trials in emergency departments and general health units were evaluated by the Department of Nursing, University of Melbourne.
The evaluations found that during the trial period, the Safewards model decreased conflict and improved communication, optimism and relationships among consumers and staff.
The evaluation reports are available below.
Safewards general health trial (2021 - 2022)
Two general health services covering six wards took part in the trial.
Other research and publications
A research project by the RMIT School of Design was completed in 2022 to identify best practice in implementing the Safewards model.
Designing Foundations for the Future: Experiences of mental health staff introducing, learning and implementing the Safewards Model 2022 – RMIT School of Design. This report will be available in late 2022.
For more resources, including information on how to implement Safewards, please head to the Safewards page within Clinical Guidance.
If you are interested in participating in the Community of Practice please contact the Safewards Coordinator within the Office of the Chief Mental Health Nurse via CMHN@safercare.vic.gov.au.