Public Release: 

Low cost interventions can improve patient and staff safety in mental health wards

New study based on 20-year research program outlines 10 low-cost interventions that aim to increase the safety on psychiatric wards


Oxford, July 15, 2015 - A recent study, published in the International Journal of Nursing Studies, reveals a set of ten low-cost interventions that can increase safety on psychiatric wards. This Safewards Model reduces aggression, self-harm and other risky behaviours by 15% and reduces coercive control, such as restraint, by 24%.

The study stems from a 20-year research program led by Professor of Psychiatric Nursing, Len Bowers, at the Institute of Psychiatry, Psychology & Neuroscience, King's College London.

The study reveals that, by using a set of ten small, low cost, Safewards interventions aimed at increase staff skills and improve relationships with patients, conflict and containment rates fall significantly; unpleasant forms of coercion are reduced, making psychiatric wards more peaceful places where both patients and nurses feel safer. "Overall, less time wasted on containment and conflict management means more time can be devoted to the nursing care and support of patients," said Professor Bowers.

The ten Safewards interventions include (1) mutually agreed and publicised standards of behaviour by and for patients and staff; (2) short advisory statements (called 'soft words') on handling flashpoints, hung in the nursing office and changed every few days; (3) a de-escalation model used by the best de-escalator on the staff (as elected by the ward concerned) to expand the skills of the remaining ward staff; (4) a requirement to say something good about each patient at nursing shift handover; (5) scanning for the potential bad news a patient might receive from friends, relatives or staff, and intervening promptly to talk it through; (6) structured, shared, innocuous, personal information between staff and patients (e.g music preferences, favourite films and sports, etc.) via a 'know each other' folder kept in the patients day room; (7) a regular patient meeting to bolster, formalise and intensify inter-patient support; (8) a crate of distraction and sensory modulation tools to use with agitated patients (stress toys, mp3 players with soothing music, light displays, textured blankets, etc.); (9) reassuring explanations to all patients following potentially frightening incidents; and (10) a display of positive messages about the ward from discharged patients.


Notes to editors

"Reducing conflict and containment rates on acute psychiatric wards: The Safewards cluster randomised controlled trial" by Len Bowers, Karen James, Alan Quirk, Alan Simpson, Duncan Stewart, John Hodsoll, (doi:10.1016/j.ijnurstu.2015.05.001, published open access). The article appears in International Journal of Nursing Studies, Volume 52 (September 2015), published by Elsevier.

Interviews with Professor Bowers can be arranged via: Press & Communications Office, Institute of Psychiatry, Psychology & Neuroscience, Room W1.08 (PO 97) King's College London, +44 (0) 20 7848 5377,

About the Safewards Model

Keeping everyone as safe as possible is a basic goal for any community. This is as true for hospitals as it is for schools, towns, workplaces or even families. It is also true for psychiatric hospitals. For more information, go to:

Pictures of the Safewards interventions can be found on the forum pages of under the headings of the individual interventions. Safewards is also supported by groups on LinkedIn, Facebook, a Twitter feed and a Youtube channel.

About King's College London

King's College London is one of the top 20 universities in the world (2014/15 QS World University Rankings) and among the oldest in England. King's has more than 26,500 students (of whom nearly 10,400 are graduate students) from some 150 countries worldwide, and nearly 6,900 staff. The university is in the second phase of a £1 billion redevelopment programme which is transforming its estate.

About the International Journal of Nursing Studies

The International Journal of Nursing Studies (IJNS) provides a forum for original research and scholarship about health care delivery, organisation, management, workforce, policy and research methods relevant to nursing, midwifery and other health related professions. The IJNS aims to support evidence informed policy and practice by publishing research, systematic and other scholarly reviews, critical discussion, and commentary of the highest standard.

About Elsevier

Elsevier is a world-leading provider of information solutions that enhance the performance of science, health, and technology professionals, empowering them to make better decisions, deliver better care, and sometimes make groundbreaking discoveries that advance the boundaries of knowledge and human progress. Elsevier provides web-based, digital solutions -- among them ScienceDirect, Scopus, Elsevier Research Intelligence and ClinicalKey -- and publishes over 2,500 journals, including The Lancet and Cell, and more than 33,000 book titles, including a number of iconic reference works. Elsevier is part of RELX Group plc, a world-leading provider of information solutions for professional customers across industries.

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