Relationships, experience, and support: staff perception of safety in a forensic mental health facility

Abstract

Safety is a primary focus in forensic mental health facilities as aggression and violence related to symptoms of mental illness is an ongoing challenge in these settings. Recovery-oriented strategies to improve safety focus on communication and prevention to reduce the incidence of aggression and violence, but interventions are often challenging to sustain. This may be related to a disconnect between events and staff perceptions. A fuller understanding of staff perceptions of safety may ensure that organizational efforts respond to their perceived needs. This study aimed to provide an in depth exploration of frontline forensic mental health staff’s perceptions of safety on their units. Eighty-eight interdisciplinary staff participated in semi-structured interviews, which were audio recorded, transcribed, and analysed using thematic analysis. The main themes that emerged related to staff’s perceptions of safety on their units were: environment, policies, and practices; teamwork and support; staff experience and knowledge; and patients, patients, patients. Interestingly, most of the themes identified have been addressed by frameworks aimed at reducing conflict, restraint and seclusion; however, positive staff-staff relationships and teamwork were perceived as increasing safety on the unit. This has not previously been addressed by frameworks and could have the potential to improve sustainability of safety initiatives.