Development of Custodial Staff Modifiers for Safewards Secure-Custodial Mental Health.

Safewards is a nursing model of care designed for acute mental health inpatient units. Since inception, the model has gained popularity in many countries and has been implemented in settings other than mental health. A version for bed-based mental health units within prisons has also been developed to assist nurses working in this complex setting called Safewards Secure-Custodial Mental Health. A previous study identified that modifiers (things staff can do to prevent conflict and containment) were needed for custodial staff to finalise the prison model. The aim of this study was to develop custodial staff modifiers for the adapted model known as Safewards Secure-Custodial Mental Health. To inform the modifiers a literature review was first conducted. A Nominal Group Technique was then used to seek feedback and reach consensus on the proposed custodial staff modifiers. Participants (n = 15) included custodial officers, forensic mental health nurses, allied health and lived experience workers. Consensus was reached on the custodial staff modifiers after suggestions from the NGT were incorporated. Data were thematically analysed and three themes were interpreted: (1) Complexity with clashes in paradigms (custodial versus clinical); (2) You are a 'Care Bear': Ostracised for demonstrating care and concern; (3) Meeting in the middle (to work collaboratively). There was support for the implementation of Safewards Secure-Custodial Mental Health. Future research should consider the interventions for the custodial model with reference to contextual factors in a prison setting.