MGH rolls out Safewards model of care to improve safety and patient experience in mental health units

Michael Garron Hospital (MGH) is introducing a new approach to care that will make its inpatient mental health units a safer and calmer environment for both patients and staff.

The new approach, called Safewards, is an evidence-based model of care that has been shown to reduce conflict on mental health units by 15% and containment measures by 24%.  

This model of care has already been introduced in several Ontario hospitals, including specialized centres such as the Centre for Addiction and Mental Health (CAMH) and Ontario Shores Centre for Mental Health Sciences. MGH is one of the first community hospitals to participate.

“This model of care benefits everyone. Not only does it create a more positive experience for patients and their families, but it allows for a safer environment for our teams,” says Yaakov Keilikhis, Director of the Mental Health and Substance Use Program at MGH and Co-Chair of the hospital’s Workplace Violence Prevention Committee.

“Addressing the underlying causes of conflict and aggression, and implementing evidence-based interventions, helps reduce incidents of violence and restraint and enhances patient well-being.

“Additionally, it fosters a culture of collaboration, empathy and communication among healthcare professionals, ultimately improving the quality of care and patient outcomes.”     

The Safewards model has staff members working more closely with patients and their families to prevent and address conflict and violent behaviour.

“Safewards is about shifting a culture on a unit: how we view our patients and how we interact with them,” says Tasha Penney, a trainer who has been leading the Safewards rollout at MGH. “It helps us understand the patient and the reasons behind their behaviours.”

The end goal is to reduce conflict and the need to rely on standard containment measures, such as medication, restraints and seclusion.

“In some cases, these containment measures are still necessary,” Tasha says. “However, Safewards adds more to our toolbox so we’re not automatically jumping to these methods.”

Introduction of calming, uplifting interventions

Safewards includes 10 main interventions that staff members are trained on over the course of several months to a year. Right now, MGH is partway through the rollout on our Inpatient Adult Mental Health Unit and Slaight Family Child and Youth Mental Health Inpatient Unit.

Some of the interventions that have already been adopted on MGH’s units include:

• Calm down methods: Each unit has a Calm Down Box (for adults) or Calm Down Cart (for children and youth) with items and activities that are meant to help patients relax or distract them from distressing thoughts and emotions.
• Transition messages: When a patient is discharged, they are encouraged to write a positive and uplifting message for those remaining on the unit. The messages are written in a public area for all patients to read. 
• Team mentorship meetings: Once a week, staff are invited to join a group session where they discuss Safewards and how they have applied the new methods to their day-to-day work.

Safewards methods already making difference on inpatient units 

According to Kim Kurschinski, Manager of Adult Inpatient Mental Health at MGH, Safewards training is already making a difference on the unit that she oversees.

She points to the discharge messages as a particularly meaningful exercise.

“It’s a way for patients to communicate and support one another,” Kim says. “It’s a simple thing, but it’s been powerful.”

On MGH’s Child and Youth Inpatient Mental Health Unit, the Calm Down Cart has made the most impact on the younger patient population, according to Adina Hauser, Manager of Child and Youth Health Services at MGH.

“This has been an effective non-medication based intervention for our patients who are feeling in distress,” she says. “It instills choice and autonomy for our patients, which is a best practice, especially for children and youth.”

The unit’s Calm Down Cart has a paper menu with images of what is inside the cart, including sensory items (things you can smell, touch and hear), games and items that may provide comfort, such as headphones and face masks.

“Our patients don’t need to verbalize what they need. They can point at a picture of what they want,” Adina says. “It helps the staff, and the youth have really taken to it.”

Supporting staff and patients across MGH

While the Safewards methods are created for inpatient units, MGH is training all of its mental health staff in this model of care, including those who work in outpatient and community mental health services.

MGH is also looking at the possibility of expanding some of the Safewards philosophies and practices to staff in other departments.  

"While the Safewards model initially emerged and was employed in mental health settings, it's widely recognized that conflicts between patients and staff can manifest across various hospital departments," Yaakov explains. "Certain components of this training can readily extend to diverse areas within the organization, promoting a culture of safety and therapeutic care."

Many hospital patients are going through a difficult time, and Safewards provides a way for staff to better support them, Kim adds.

“It takes the focus off a task, making it more about the individual: who the patient is, and what their individual needs are in that moment.”