michelle eason & roman katz
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Safe and Secure HospitalsTRANSCRIPT
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
Roman Katz, Manager Security and Fire Safety
Phone: 9700 3164