Assessment brief Level 620 credits Faculty of Health and Social Care
Reducing Restrictive Practice on an Acute Inpatient Ward
Critical case analysis of one episode of seclusion or restraint, evaluated against trauma-informed care and the Safewards model.
| Module | Acute Mental Health Nursing: Assessment and Recovery |
|---|---|
| Level and credit | Level 6, 20 credits |
| Assessment component | CW1, written critical case analysis |
| Weighting | 100 per cent of the module mark |
| Assessment limit | 3,000 words, plus or minus 10 per cent |
| Learning outcomes | LO1, LO2 and LO3 |
| Referencing | Cite Them Right Harvard |
| Formative draft | One side of A4 scenario outline, Friday 27 February, 12:00 |
| Summative submission | Thursday 9 April, 12:00 UK time |
| Provisional feedback | Tuesday 5 May, 09:00 UK time |
Assessment Context
This Level 6 assessment brief sets a written critical case analysis for the acute mental health nursing module, and the task draws on practice hours completed in an inpatient setting during the preceding placement. Structure, terminology and front matter follow the published architecture of the Level 6 nursing assessment brief used at the University of Derby for 6NU580, which sets a 3,000-word analysis, a single component at 100 per cent weighting, three learning outcomes, anonymous marking, internal moderation and external examiner review. The module code is withheld because the target module’s own code sits in the programme handbook rather than on an open page, and candidates should confirm it before submission.
Restrictive practice gives the task its subject because the evidence base is contested rather than settled. Seclusion, manual restraint and chemical restraint remain lawful in England under the Mental Health Act 1983, and the Code of Practice restricts their use to circumstances where less restrictive options have failed or carry greater risk. Reductions recorded by services do not always survive scrutiny, and the published reviews disagree about how much of the improvement belongs to the intervention rather than to staffing, leadership or ward culture. A case analysis therefore suits Level 6 better than a policy summary, since the student has to reach a judgement on contested evidence and defend it.
Learning Outcomes
On successful completion of this assessment and this module, you will have demonstrated your ability to:
- Critically examine the drivers of restrictive practice in acute inpatient mental health settings, including environmental, relational and organisational factors.
- Appraise the evidence base for trauma-informed and relationship-centred alternatives, and justify a recommendation for an individual patient.
- Analyse the legal, ethical and professional duties that govern the use of restrictive interventions, and apply them to a specific episode of care.
Assessment Task
Select one episode of restrictive practice that you observed or took part in during your placement. Analyse it against the four sections below, with the word allocation shown. A narrow episode analysed closely scores higher than a broad account of ward life, because the criteria reward reasoning rather than description.
| The episode, in context |
|
350 |
| Critical analysis of the incident |
|
800 |
| Alternatives, applied to the patient |
|
900 |
| Legal, ethical and professional duties |
|
500 |
| Recommendations and conclusion |
|
450 |
The Episode, in Context
Describe what happened in no more than 350 words. Give the ward type, the patient’s presentation on admission, the events in the hour before the intervention, and the intervention itself. Keep clinical detail sufficient to support later analysis and leave out what does not bear on it. A timeline works better than a narrative here, since the markers need to see the escalation sequence rather than the writer’s reaction to it. Note who was present, what was tried first, and how long the intervention lasted.
Critical Analysis of the Incident
Analyse the escalation rather than restating it. Separate conflict from containment, since the two call for different responses: conflict covers the behaviours that create risk, while containment covers what staff do in response, including observation, medication and seclusion. Safewards was built on that distinction and on six originating domains, which gives a student a framework for locating where prevention failed (Bowers, 2014). Examine environmental triggers such as noise, heat, crowding and lack of activity, then relational triggers such as staff turnover, inconsistent limit setting and the absence of a named nurse. Organisational factors belong in the analysis too, and so does the possibility that the ward had normalised a practice it described as a last resort. Hedge where the evidence is thinner than the confidence of the staff involved.
Alternatives, Applied to the Patient
Evaluate at least two alternatives and apply them to this patient rather than describing them in general. A trauma-informed lens reframes the behaviour as adaptation, and the shift from asking what is wrong with a person to asking what happened to them changes both the assessment and the response (Sweeney et al., 2018). Name specific Safewards interventions where they fit, such as mutual help meetings, calm down plans, soft words and the reassurance of explaining why a decision was made. Discuss sensory modulation, advance statements and reduced observation where the case supports it. Then state what you would have done differently, with the reasoning and the evidence behind the choice, and acknowledge the constraint that staffing, acuity and the physical environment impose.
Legal, Ethical and Professional Duties
Set out the legal framework and apply it. The Mental Health Act 1983 Code of Practice governs seclusion and restraint in England, and the NICE guideline sets expectations for anticipating aggression, using de-escalation first and reviewing every restrictive intervention afterwards (National Institute for Health and Care Excellence, 2015). Consider the Human Rights Act articles engaged, the Mental Capacity Act where it applies, record keeping, debriefing for the patient and for staff, and the professional duty to raise a concern when practice falls short. Ethical reasoning should address proportionality, least restrictive means and the tension between safety and autonomy without resolving it too quickly.
Recommendations and Conclusion
Make two to four recommendations that a ward manager could act on within a quarter, each with an indicator that would show whether it worked. Return to your learning outcome claims in one short paragraph and close on the judgement you reached about the episode. Avoid recommending a whole-service redesign, since a recommendation that cannot be implemented cannot be evaluated.
Submission and Marking Arrangements
- Submit through the module submission point as a single PDF. Word count goes on the cover sheet and excludes the reference list, tables and appendices only where those are not part of the argument.
- Work is marked anonymously. Markers do not see names, and provisional grades are reviewed by an internal moderator and an external examiner before ratification at the assessment board.
- Late submission carries a deduction of ten percentage points for each working day, applied until the mark reaches the pass threshold.
- Academic integrity applies to all sources, including placement documents, trust policies and unpublished audit data.
- Referencing follows Cite Them Right Harvard. Every clinical claim that is not common knowledge needs a citation, and policy sources need a retrieval date.
Marking Criteria
Criteria carry the weightings shown. Band descriptors are written at the threshold for each class, and a script that meets most descriptors in a band but falls short on one sits at the lower edge of it.
| Criterion | First 70 to 100 | Upper second 60 to 69 | Lower second 50 to 59 | Third 40 to 49 | Fail 0 to 39 |
|---|---|---|---|---|---|
| Understanding of restrictive practice30 per cent | Separates conflict from containment and uses that distinction to locate the point where prevention failed. Environmental, relational and organisational drivers are weighed against each other. | Explains drivers clearly and applies the distinction with minor gaps. | Describes drivers accurately but treats them as a list rather than an interacting set. | Offers general description with limited link to the case. | Confuses conflict with containment or misstates what counts as restrictive practice. |
| Application of evidence25 per cent | Applies trauma-informed principles and named Safewards interventions to this patient, and judges where the evidence base is weaker than its reputation. | Applies alternatives to the case with sound use of sources. | Describes alternatives with partial application to the patient. | General account of alternatives with little case detail. | No relevant evidence, or sources that do not support the claims made. |
| Critical appraisal20 per cent | Evaluates study quality and design, notes where findings conflict, and states what the limits mean for the recommendation. | Appraises the main sources and recognises limits. | Some appraisal alongside summary, with limits mentioned but not weighed. | Accepts sources at face value. | No appraisal and no distinction between stronger and weaker evidence. |
| Legal, ethical and professional reasoning15 per cent | Applies statute, Code of Practice and professional standards to this episode, and reasons through the tension between safety and autonomy. | Applies the framework accurately with some discussion of that tension. | States the framework with limited application. | Mentions law and ethics generically. | Legal or ethical errors that would mislead practice. |
| Structure, writing and referencing10 per cent | Economical prose, clear signposting, accurate Cite Them Right Harvard throughout, no formatting slips. | Well organised with minor referencing errors. | Organised but repetitive, with several referencing errors. | Structure unclear and referencing inconsistent. | Disorganised, or referencing absent or inaccurate. |
Sample Answer Writing Help
Both paragraphs show the register and citation density the grid rewards. Replace the episode with the student’s own placement experience and keep the reasoning visible throughout.
Follow-Up Reading
Beyond Ward-Level Enthusiasm
Reported reductions deserve a second look before they are quoted as proof. The umbrella review behind the coercion evidence set out to test the credibility of intervention claims rather than to collect them, and it found that most randomised evidence addresses involuntary admission and restraint with modest effect sizes (Barbui et al., 2021). Studies of ward-level programmes face a specific problem, since seclusion and restraint are recorded as incidents and incident reporting itself responds to attention, training and leadership emphasis. Two implications follow for a student analysis:
- State whether the outcome measured was conflict, containment, or both, because a fall in recorded incidents can coexist with unchanged patient experience.
- Check whether the study reported fidelity to the model, since partial implementation is the norm and unmeasured fidelity makes a null result uninterpretable.
- Note the design, because pre and post studies without a comparison ward cannot separate the intervention from seasonal acuity or a change of ward manager.
NICE guidance expects review after every restrictive intervention, and that review is where a service generates the data its own improvement depends on (National Institute for Health and Care Excellence, 2015). A ward that debriefs honestly accumulates better evidence than one that reports only incidents.
Does Safewards Survive Scrutiny
Students ask this often, and the fair answer is that the model has reasonable support in general adult inpatient settings and thinner support elsewhere. Finch et al. (2022) rated 13 studies, judged seven of moderate quality, and concluded that the empirical base does not yet justify the reach the model has acquired across forensic, older adult and child services. That conclusion argues for careful claims rather than abandonment, since the interventions themselves are low cost and low risk. A second misconception concerns mechanism: Safewards works through staff behaviour and ward atmosphere, so a service that adopts the interventions without changing how staff speak to patients has adopted the packaging. A third concerns measurement, because conflict and containment move independently and a fall in one does not imply a fall in the other. Writing that distinguishes implementation from effect reads as appraisal, while writing that treats adoption as evidence reads as advocacy.
Legal Duties Inside the Ward
Statute and guidance bind the analysis more tightly than students expect. Seclusion in England requires a policy consistent with the Code of Practice, a registered professional in charge, continuous observation, a medical review within set times and a documented account afterwards, and the NICE guideline adds the expectation that post-incident review includes the patient (National Institute for Health and Care Excellence, 2015). The Human Rights Act 1998 engages articles 3, 5 and 8 in restraint cases, and the Mental Capacity Act 2005 governs decisions for patients who lack capacity to consent to the intervention itself. Professional standards add a duty to act on concerns about unsafe practice, and that duty applies to a student who witnessed the episode as much as to the nurse in charge. A common error is describing the law accurately and then recommending something the law would not permit, so the recommendation should be tested against the framework before it is written. Proportionality and least restrictive means are the two tests that most recommendations fail.
What Separates the Bands
Marks turn on the quality of judgement rather than the volume of description. A 2:1 script recounts the episode accurately, cites the right sources and recommends Safewards. A First script shows where prevention failed, weighs the evidence for the model it recommends, and accepts that the evidence is weaker than the enthusiasm behind it. The episode description is the easiest place to lose marks, because candidates spend 700 words on it and then have no room to analyse; hold it to 350 and the rest follows. Legal reasoning is the second place, where accurate statement without application reads as recall. Referencing errors concentrate in policy documents and trust intranet pages, so record retrieval dates when the source is first read. Pick the episode in week two, draft the analysis before reading further, and let the reading complicate the draft rather than produce it.
References
Barbui, C., Purgato, M., Abdulmalik, J., Acarturk, C., Eaton, J., Gastaldon, C., Gureje, O., Hanlon, C., Jordans, M., Lund, C., Nosè, M., Ostuzzi, G., Papola, D., Tedeschi, F., Turrini, G., Uthman, O., van Ommeren, M., Vancampfort, D., Walker, S. and Wancata, J. (2021) ‘Efficacy of interventions to reduce coercive treatment in mental health services: umbrella review of randomised evidence’, The British Journal of Psychiatry, 218(4), pp. 185–195. doi:10.1192/bjp.2020.144.
Bowers, L. (2014) ‘Safewards: a new model of conflict and containment on psychiatric wards’, Journal of Psychiatric and Mental Health Nursing, 21(6), pp. 499–508. doi:10.1111/jpm.12129.
Finch, K., Lawrence, D., Williams, M.O., Thompson, A.R. and Hartwright, C. (2022) ‘A systematic review of the effectiveness of Safewards: has enthusiasm exceeded evidence?’, Issues in Mental Health Nursing, 43(2), pp. 119–136. doi:10.1080/01612840.2021.1967533.
National Institute for Health and Care Excellence (2015) Violence and aggression: short-term management in mental health, health and community settings. NICE guideline NG10. Available at: https://www.nice.org.uk/guidance/ng10 (Accessed: 9 February 2026).
Sweeney, A., Filson, B., Kennedy, A., Collinson, L. and Gillard, S. (2018) ‘A paradigm shift: relationships in trauma-informed mental health services’, BJPsych Advances, 24(5), pp. 319–333. doi:10.1192/bja.2018.29.
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Critical Case Analysis of Seclusion in Acute Mental Health Nursing: Trauma-Informed Care and the Safewards Model
Introduction
Seclusion remains one of the most restrictive interventions used in acute inpatient mental health care. Although staff may consider it necessary to prevent immediate harm, its use can undermine patient autonomy, damage therapeutic relationships and intensify psychological distress. The challenge for mental health nurses involves protecting safety without overlooking the experiences, needs and rights of the person receiving care. Bowers (2014) developed the Safewards model to explain how ward conflict develops and how staff responses can either prevent escalation or contribute to containment. Trauma-informed care offers a complementary perspective by recognising that distress and challenging behaviour may reflect previous experiences of trauma rather than deliberate non-compliance. This case analysis examines an illustrative episode of seclusion involving an adult male patient in an acute psychiatric ward. It argues that although seclusion may become necessary during an immediate threat, environmental and relational failures may have contributed to escalation, making earlier trauma-informed and Safewards interventions preferable. The analysis evaluates alternative responses, examines the legal and ethical responsibilities of nurses in England, and proposes practical recommendations for reducing restrictive practice.
Case Description
The illustrative episode occurred in an adult acute psychiatric inpatient ward. The patient, referred to as Patient A, had been admitted following a deterioration in mental health and increasing difficulties managing distress. During the period before the incident, the ward experienced interruptions to its therapeutic activities, including the cancellation of an occupational therapy session. Patient A repeatedly asked staff about his anticipated leave date but did not receive a clear response.
Approximately ninety minutes before seclusion, Patient A became increasingly agitated and began expressing frustration towards staff. His behaviour escalated in the corridor, where staff interpreted his actions as presenting a potential risk to others. Four members of the nursing team were present. Staff attempted verbal engagement, although the available account does not establish the exact words used or whether they offered specific alternatives. Following further escalation, the team initiated seclusion. The patient remained in the seclusion room for a period that requires confirmation from the actual incident record.
The illustrative account also identifies possible trauma-related responses, including hypervigilance around doors and discomfort when staff approached from behind. These details require confirmation before use in an actual submission. The episode raises questions about whether staff recognised early warning signs, whether they communicated consistently, and whether the ward environment contributed to the patient’s distress. Confidentiality requires the removal or alteration of identifying details without changing clinically relevant information.
Critical Analysis of Escalation: Conflict and Containment
The Safewards model distinguishes conflict, which involves behaviours that threaten safety or ward functioning, from containment, which describes staff responses intended to manage those behaviours (Bowers, 2014). This distinction helps prevent the analysis from treating seclusion as an inevitable consequence of the patient’s presentation. Patient A’s agitation represented a developing conflict, whereas seclusion constituted containment. The central question is whether staff could have interrupted the escalation before the situation reached the point where restrictive intervention appeared necessary.
Environmental conditions may have contributed to the incident. The cancellation of occupational therapy removed a planned opportunity for meaningful activity and emotional regulation. Inpatient environments can expose patients to noise, crowding, uncertainty and limited personal control, all of which may increase distress. Patient A’s repeated questions about leave suggest that uncertainty may have been particularly difficult for him. Staff could have recognised these concerns as potential warning signs rather than interpreting them solely as challenging behaviour. NHS England (2023) emphasises that inpatient environments should promote safety, choice, therapeutic relationships and recovery.
Relational factors also warrant examination. Patient A reportedly asked several times about his leave date without receiving a clear answer. Although staff may not have known the decision, an explanation of the uncertainty could have prevented him from feeling ignored. Consistent communication matters because patients may interpret unanswered questions as rejection, particularly when they already feel powerless. The possibility that staff approached him from behind despite his apparent hypervigilance also raises concerns about whether his individual care needs informed practice. Trauma-informed care encourages professionals to consider how previous experiences may influence a person’s responses to perceived threats (Sweeney et al., 2018).
Organisational factors may have compounded these difficulties. Staff shortages, high patient acuity, interruptions to therapeutic activities and inconsistent implementation of prevention strategies can reduce opportunities for early intervention. However, the illustrative account does not establish whether staffing levels were inadequate or whether staff deliberately ignored the patient’s care plan. Such conclusions require evidence from placement records, staff accounts or ward documentation. The analysis should therefore distinguish observed events from possible explanations. Safewards encourages services to examine the ward’s contribution to conflict rather than assigning responsibility exclusively to the patient or individual nurses.
Trauma-Informed Care and Safewards Alternatives
Trauma-informed care provides a framework for understanding distress through safety, trust, collaboration, choice and empowerment. It recognises that restrictive interventions may reproduce experiences of helplessness, fear or loss of control. Sweeney et al. (2018) argue that relationships form a central component of trauma-informed mental health services, making the quality of staff communication particularly important. Patient A’s apparent sensitivity to staff approaching from behind suggests that nurses should have considered how their positioning affected his sense of safety. A trauma-informed response would involve approaching from the front, maintaining an appropriate distance, explaining intentions and allowing time for communication. These measures would not guarantee de-escalation, but they could reduce perceived threat.
A negotiated calm-down plan represents a practical alternative. Staff could have developed the plan with Patient A during admission or a period of relative stability. The plan might identify early signs of distress, preferred communication approaches, calming activities and people he trusted. Staff could then respond consistently when he began asking repeatedly about leave or became increasingly agitated. Sensory modulation, including access to a quieter space, headphones or familiar calming objects, could also help if these options matched his preferences. Trauma-informed care requires individual assessment rather than assuming that a particular intervention benefits every patient.
Safewards offers additional ward-level interventions. The model includes approaches such as soft words, mutual help meetings, reassurance and calm-down methods. Soft words encourage staff to communicate respectfully and avoid language that could increase shame or confrontation. Applied to Patient A, staff could have acknowledged his frustration and explained that the leave decision remained unresolved. Mutual help meetings might have supported a stronger sense of belonging and participation in ward life. Reassurance following distressing incidents could also help restore trust between patients and staff.
Evidence supports cautious optimism about Safewards. The integrative review by Mullen et al. (2022) identified evidence that the model can contribute to reductions in conflict and containment in inpatient settings, although implementation and contextual differences complicate comparisons. A 2024 scoping review also identified leadership, staff collaboration, feedback and co-design as important facilitators of implementation (Ward-Stockham et al., 2024). Safewards should not be treated as a guaranteed method of preventing seclusion. Its effectiveness depends on staff engagement, fidelity and the ward’s organisational culture.
A further alternative would involve early review of observation and engagement needs. Staff could have assigned a named nurse to communicate with Patient A, reassess his distress and explain decisions concerning leave. Increased observation may sometimes be necessary, but it should remain therapeutic rather than punitive. Reducing observation would only be appropriate following a documented risk assessment. Patient safety and autonomy must inform the decision together. If Patient A had continued to present an immediate danger despite these interventions, restrictive practice might still have been necessary. The relevant standard would be whether staff selected the least restrictive response capable of preventing serious harm.
Legal, Ethical and Professional Responsibilities
The Mental Health Act 1983 Code of Practice provides guidance on the lawful and appropriate use of seclusion in England. Staff must consider whether the intervention is necessary, proportionate and the least restrictive available response. Seclusion should not become a substitute for staffing, therapeutic engagement or effective ward management. The Code also requires appropriate monitoring, clinical review and documentation throughout the intervention (Department of Health, 2015). In Patient A’s case, the legal justification would depend on the actual level of risk, the alternatives attempted and the evidence that seclusion was necessary at that moment.
NICE guideline NG10 recommends de-escalation and preventive strategies before restrictive interventions wherever circumstances permit. It also emphasises safe practice, appropriate monitoring and review following incidents involving violence or aggression (National Institute for Health and Care Excellence, 2015). The assessment should establish whether staff recorded the rationale for seclusion, the patient’s presentation, duration, monitoring and clinical reviews. The precise timing and frequency of required reviews should be checked against the applicable Code, local policy and intervention type. A written account should not claim that the team complied with these requirements unless the documentation confirms it.
The Human Rights Act 1998 raises important considerations, particularly Articles 3, 5 and 8. Article 3 protects individuals from inhuman or degrading treatment, Article 5 concerns liberty and security, and Article 8 protects private and family life. Restrictive intervention may engage these rights because it limits movement, autonomy and personal dignity. However, the legal assessment depends on the circumstances, safeguards and proportionality of the intervention. Staff must not use seclusion to punish, humiliate or control a patient for convenience.
The Mental Capacity Act 2005 may also become relevant when a patient lacks capacity to make a particular decision. Capacity must be assessed in relation to the specific decision and time, rather than inferred from psychiatric diagnosis or distress. The Act does not automatically authorise seclusion or override the requirements of mental health legislation. Nurses should consider the applicable legal authority, document their reasoning and seek senior clinical advice when uncertainty arises.
The Mental Health Units (Use of Force) Act 2018 strengthens accountability by requiring mental health units to maintain policies, provide information about patients’ rights, train staff and record the use of force (Department of Health and Social Care, 2021). Professional standards also require nurses to protect dignity, maintain accurate records and raise concerns about unsafe practice. The Nursing and Midwifery Council’s Code requires nurses to prioritise people, preserve safety and promote professionalism and trust (NMC, 2018). A student nurse who witnesses potentially unsafe practice should report concerns through appropriate supervisory and governance channels.
Ethical reasoning involves balancing beneficence, non-maleficence, autonomy and justice. Seclusion may prevent immediate injury, supporting beneficence, but it can also cause psychological harm and restrict autonomy. The decision should therefore reflect the actual risk rather than staff convenience or assumptions about the patient’s diagnosis. A post-incident debrief should give Patient A an opportunity to describe his experience, identify triggers and contribute to changes in his care plan. Staff debriefing also matters because fear, fatigue and distress may influence future responses.
Recommendations for Ward Practice
The following recommendations could be implemented within three months:
- Introduce individualised calm-down plans: Nurses should discuss triggers, communication preferences and coping strategies with patients during admission. The ward manager could monitor the percentage of eligible patients with documented, reviewed plans.
- Strengthen Safewards implementation: A ward champion should coordinate staff training and monitor selected interventions, such as soft words and reassurance. Monthly audits should measure implementation fidelity and staff participation.
- Improve post-seclusion reviews: The multidisciplinary team should offer patient and staff debriefs after each incident. An audit should record completion rates and whether identified actions appear in care plans.
- Review restrictive-practice data: The ward manager should examine seclusion frequency, duration, repeat incidents and patient feedback each month. Findings should inform supervision and ward improvement meetings.
These recommendations focus on achievable changes rather than service-wide restructuring. Their effectiveness should be assessed through both incident data and patient experience because reductions in recorded seclusion alone may not demonstrate improved therapeutic care.
Conclusion
The illustrative episode suggests that seclusion may have followed a combination of patient distress, environmental disruption and relational difficulties rather than an isolated behavioural event. Safewards and trauma-informed care provide complementary approaches to understanding escalation and identifying earlier opportunities for intervention. The evidence supports their use while also requiring caution about claims of effectiveness, particularly where implementation remains inconsistent. Legal and professional responsibilities demand that staff justify restrictive practice through necessity, proportionality, documentation and appropriate review. The strongest clinical response would combine immediate safety measures with meaningful therapeutic engagement and learning after the incident. Ultimately, reducing seclusion requires wards to examine not only patient behaviour but also the conditions and relationships that shape it.
References
Bowers, L. (2014) ‘Safewards: a new model of conflict and containment on psychiatric wards’, Journal of Psychiatric and Mental Health Nursing, 21(6), pp. 499–508. Available at: https://doi.org/10.1111/jpm.12129.
Department of Health (2015) Mental Health Act 1983: Code of Practice. London: Department of Health. Available at: https://www.gov.uk/government/publications/code-of-practice-mental-health-act-1983 (Accessed: 7 November 2026).
Department of Health and Social Care (2021) Mental Health Units (Use of Force) Act 2018: statutory guidance for NHS organisations in England, and police forces in England and Wales. Available at: https://www.gov.uk/government/publications/mental-health-units-use-of-force-act-2018 (Accessed: 7 November 2026).
Mullen, A., Browne, G., Hamilton, B., Skinner, S., Froggatt, T., Bampton, E. and Riahi, S. (2022) ‘Safewards: An integrative review of the literature within inpatient and forensic mental health units’, International Journal of Mental Health Nursing, 31(5), pp. 1090–1108. Available at: https://doi.org/10.1111/inm.13001.
National Institute for Health and Care Excellence (2015) Violence and aggression: short-term management in mental health, health and community settings. NICE guideline NG10. Available at: https://www.nice.org.uk/guidance/ng10 (Accessed: 7 November 2026).
Sweeney, A., Filson, B., Kennedy, A., Collinson, L. and Gillard, S. (2018) ‘A paradigm shift: relationships in trauma-informed mental health services’, BJPsych Advances, 24(5), pp. 319–333. Available at: https://doi.org/10.1192/bja.2018.29.
Ward-Stockham, K., Daniel, C., Bujalka, H., Jarden, R.J., Yap, C.Y.L., Cochrane, L. and Gerdtz, M. (2024) ‘Implementation and use of the Safewards model in healthcare services: a scoping review’, International Journal of Mental Health Nursing, 33(5), pp. 1242–1271. Available at: https://doi.org/10.1111/inm.13345.
Additional authoritative source: NHS England (2023) Acute inpatient mental health care for adults and older adults. Available at: https://www.england.nhs.uk/long-read/acute-inpatient-mental-health-care-for-adults-and-older-adults/.
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