michelle eason & roman katz

Safe and Secure Hospitals Conference

20 – 21 October 2014

Prevention of violence through Therapeutic Security

Michelle Eason, Director of Nursing Forensic HospitalRoman Katz, Manager Security and Fire Safety Forensic Hospital

Forensic Hospital

JH&FMHN is the principal service provider and

coordinating agency for forensic mental health

services in NSW.

Forensic Hospital provides specialist mental health care for

mentally ill patients who have been in contact with the criminal

justice system and high risk civil patients.

The patient demographic consists of those found not guilty by

reason of mental illness, those unfit to plead, mentally disordered

offenders or those at risk of offending.

Forensic Hospital

The 135 bed hospital commenced operation

in November 2008. The Forensic Hospital is a

stand-alone high secure mental health facility

and is the first of its kind in NSW.

- High Dependency Units

- Acute Units

- Extended Care

- Special needs

- Rehabilitation

Custodial Laissez-Faire

- Behaviors that can

lead to and include

neglect and assault

and be punitive and

oppressive.

- Refers to “security not

nurses role” attitude.

- Not limit setting.

- Refusal to interfere.

Procedural

Physical

Relational

Therapeutic Security

0

10

20

30

40

50

60

70

80

ForensicHospital

Metropolitaninpatient

services 1

Metropolitaninpatient

services 2

Assaults in 6 month period

Forensic Hospital

Metropolitan inpatientservices 1

Metropolitan inpatientservices 2

Controlled access

Timely maintenance

Perimeter wallPersonal alarms

Design of facilities

Security equipment

Physical / Environmental Security

Emergency responses

(ERT)Legislation Orientation

Safe work practices (SWPs)

Trainingand

education

Policy and procedure

Procedural Security

Prevention

and

Constant Surveillance

Unit Based Incident

Emergency Response Teams

Containment

Security & Emergency levels

Training and Education

Orientation

CRAM (Clinical Risk Assessment and Management)

PMVA (Prevention and Management of Violence and Aggression)

Fire Safety training and drills

Relational Security

Unit dynamics

Dynamic risk

assessment

Therapeutic alliance

Staff-to-patient ratio

MDT

Knowledge of policy

and procedure

Knowledge of the

patients

Clinical skills

Reflective practice

Quality of care

Patient

Environment

How to avoid pitfalls

“The distinction between relational, physical and

procedural security is artificial. Security should be

viewed as an indivisible whole; ignore or neglect one

feature and security overall is weakened.”

T.Exworthy and J.Gunn (“Taking another tilt at high secure hospitals”, 2003)

Maximised safety

High quality of care

Minimised aggression and violence

Integration of clinical and non-clinical activities into

one therapeutic model of care

Outcomes

Michelle Eason, Director of Nursing

Phone: 9700 3145

michelle.eason@justicehealth.nsw.gov.au

Roman Katz, Manager Security and Fire Safety

Phone: 9700 3164

roman.katz@justicehealth.nsw.gov.au