Safewards in Forensic Mental Health Settings: A Review of the Current State of Evidence

The Safewards model was developed to identify reasons for conflict and containment and aims to reduce them in mental health units through a set of 10 interventions. This systematic literature review focuses on Safewards in forensic settings, as the model has so far been studied mainly in civil settings, and there have been no reviews that include only studies from forensic settings. The review aims to synthesize the effects of Safewards on conflict and containment rates, ward atmosphere, implementation processes, and possible adaptations for forensic settings. A systematic search of PubMed, CINAHL, APA PsycINFO, MEDLINE, Google Scholar, and forensic mental health journals was conducted, which led to eight articles that met the inclusion criteria. A constant comparative method was used for data analysis; results are presented in tabular and narrative formats and grouped into six categories: recorded conflicts and containment rates, ward climate, implementation, fidelity, staff attitude, and adaptation for forensic settings. The results indicated that Safewards can reduce conflict and improve the perceived ward atmosphere when implemented with high fidelity and high staff engagement. Furthermore, we identified that for forensic settings, the adaptation of some interventions may be necessary, and additional interventions are proposed.