Hospital-Based Initiatives
Basal Exposure Therapy (BET) combined with Complementary External Control (CER) – Norway
Basal Exposure Therapy (BET) and Complementary External Regulation (CER) are Norwegian practices with a strong psychotherapeutic focus that are designed for people who do not find success with conventional treatments. BET involves a hospital ward where people are given ‘an opportunity to expose...
Guidelines on Prevention of Coercion and Therapy for Aggressive Behaviour – Germany
In 2018, an expert group of the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) published guidelines on how to deal with ‘coercion and violence’ in adult psychiatric services in Germany. The DGPPN is the largest scientific medical association focussing on mental health...
High and Intensive Care Units – The Netherlands
As part of a national policy to reduce the use of seclusion in the Netherlands, High and Intensive Care (HIC) Units were developed. HIC Units are acute admission wards focusing on ‘restoring and maintaining contact and crisis prevention’ (Submission 27). The Units require a multidisciplinary team...
No Force First – United Kingdom
The ‘No Force First’ initiative aims to change ward cultures from a focus on containment to one of recovery. The ultimate aim is to create coercion-free environments. This approach, which began in th United States, is being adopted by some UK based mental health trusts (Submission 27). The...
Open Dialogue in a High Security Psychiatric Ward: ‘Reflecting Processes in the Care of Persons with Severe Mental Disorders’ – Norway
The Department of Specialised Psychiatry at Akershus University Hospital, which is a high security psychiatric ward in Norway, has undertaken a program based on the ‘Open Dialogues’ practice. (Open Dialogues is discussed more fully under the ‘Community-Based Initiatives’). Open Dialogues is...
Reducing mechanical restraint and seclusion in acute mental health inpatient wards
Across Europe, it is lawful for individuals to be secluded and/or restrained in mental health services and other settings to control or manage their behaviour. Attempts have been made by governments, mental health services and others to reduce and even eliminate the use of restraint and seclusion...
Safewards – International
The ‘Safewards’ model is a program that aims to reduce the restraint and seclusion of people on psychiatric wards, as well as reducing conflict between service users and staff (Submission 25). The model provides staff with practices and concepts to help improve the culture of hospital settings,...
Weddinger Modell – Germany
The Weddinger Modell, developed in 2010 in Berlin, is a model of psychiatric care for acute settings that focuses on recovery, participation, supported decision-making and the prevention of coercive measures on psychiatric wards (Submission 29). There is some evidence that the model decreases an...
Workbook for Hospitals and Wards to Reduce Coercion and Increase Occupational and Patient Safety: Combining Six Core Strategies and Safewards – Finland
In 2016, the Finnish National Institute for Health and Welfare published a working paper to help ‘hospitals and wards providing involuntary psychiatric care to reduce the use of coercion against patients and to increase occupational and patient safety’ (Makkonen et al., 2016, p.6). The Finnish...
‘Open Door Policy’ – Internationally
‘Open door policy’ refers to a policy of maintaining open doors in mental health settings and particularly hospital-based settings that otherwise would be ‘closed’ or ‘locked’. Germany appears to have the most advanced use and evaluation of open door policies in acute psychiatric settings in...
Download the Compendium
