Key messages

  • Creating Safety is a training program to help services reduce restraint and seclusion in acute inpatient units.
  • These training resources apply the best available evidence and clinical best practice.

A comprehensive training program, Creating Safety, has been developed to help Victoria’s mental health services reduce, and where possible eliminate, the use of restraint and seclusion practices in adult acute inpatient units.

The Creating Safety training modules can be used as an entire training program or individually to help managers and staff move away from processes of coercion and control to more recovery-oriented systems of care based on negotiation, empowerment and individual respect.

These training resources apply the best available evidence and clinical best practice in the development of a comprehensive prevention and early intervention approach, which can help all levels of staff to understand and embrace a fundamental culture change in their workplace practices.

Module 1 – Welcome and orientation – setting the stage

Module 1 provides an overview of the training and its underlying principles, including the importance of leadership and culture change, the need for action plans, and the overriding benefits of reducing seclusion and restraint for consumers, staff and the entire treatment environment.

Module 2 – Current assumptions regarding seclusion and restraint use

Module 2 focuses on analysing and rethinking traditional assumptions about seclusion and restraint, and presents compelling evidence of how the reduction of their use can help to reduce the number and seriousness of injuries among consumers and staff.

Module 3 – The experience of seclusion and restraint

Module 3 presents powerful first-hand testimonies from consumers and staff on the often devastating consequences of using or being involved in a seclusion or restraint situation.

Module 4 – Treating traumatised Individuals: neurobiological and psychological effects of trauma

Module 4 looks at the latest research on trauma and post-traumatic stress disorder (PTSD) and their neurobiological and psychological effects, as a foundation for treatment that enables people to maintain calm states and to build cognitive structures that promote individual choices.

Module 5.1 – leadership toward organisational change – a core strategy

Module 5.1 looks at the fundamental role of leadership in reducing the use of restrictive practices and the core leadership competencies and principles required to create a safer patient environment.

Module 5.2 – Consumer roles in inpatient settings – a core strategy

Module 5.2 looks at ways of integrating consumer choices into new workplace cultures, including the use of residents’ advocates, focus groups, and stronger communications with residents to help them understand their rights and negotiate for better care.

Module 6 – Trauma informed care

Module 6 looks at the effects of trauma and its broad prevalence among mental health consumers, what happens to traumatised people when they are secluded or restrained, and the multiple benefits for consumers and staff of trauma-informed care policies and practices.

Module 7.1 – Workforce development: creating a culture of recovery for staff: a core strategy

Module 7.1 provides a strategy to guide a culture of recovery among staff, promoting greater respect and dignity for consumers, less focus on rules and control, greater empowerment, the creation of a ‘warm environment’, staff training, and new organisation-wide values.

Module 7.2 – Elevating the importance of seclusion and restraint: a core strategy

Module 7.2 provides a strategy for elevating the importance of oversight of incidents in which seclusion or restraint is used, the people and staff involved, the need for risk assessments, and policies governing accountability, supervision and the reporting of incidents.

Module 8 – Identifying and managing seclusion and restraint risk factors: a core strategy

Module 8 presents a strategy for identifying and managing the risks of aggression or violence in individuals in order to intervene early and prevent the use of seclusion and restraint, as well as identifying medical risk factors that may increase the risk of injury or death from these practices.

Module 9 – Seclusion and restraint prevention tools: a core strategy

Module 9 presents a number of tools for avoiding the use of seclusion or restraint, including crisis prevention plans for individuals and strategies for recognising the early warning signs of potential crises, identifying coping strategies, restoring calm environments, and reducing risk and trauma.

Module 10 – Debriefing activities

Module 10 presents processes for ‘debriefing’ staff after incidents of seclusion or restraint, analysing why and how the practices were used, meeting with consumers and their advocates, documenting incidents, and developing operational and training plans to avoid the use of these practices in future.