ArticleBMJ open quality2025
Reducing incidents of violence and aggression and self-harm on a secure mental health inpatient ward for women with learning disabilities.
Article in BMJ open quality, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Healthcare professionals working in inpatient settings are often challenged by behaviours associated with learning disability, autism and other mental health needs, including high levels of violence and aggression. This was the case on Oakley Ward, an integrated medium and low secure mental health service for women with a learning disability diagnosis. To affect change, a quality improvement project was initiated to reduce incidents of violence and aggression and incidents of self-harm by 25% over a 12-month period.We introduced two interventions. The first change idea was to introduce safety huddles to improve communication among staff and to enhance relationships with patients. Patients were invited to the beginning of the meeting to give their feedback and ask any questions they may have, thereby supporting coproduction and strengthening therapeutic relationships. The second change idea was a co-designed programme of activities; patients were actively involved in the selection and organisation of activities that were meaningful to them.Our baseline data demonstrated high levels of incidents. By June 2024, there was a 29% reduction in the number of incidents of violence and aggression per 1000 bed days and a 25% reduction in the number of incidents of self-harm per 1000 bed days. As a balancing measure, we observed a reduction of 55% in the number of seclusion hours. Improvements were also experienced anecdotally through staff feedback.The interventions led to substantial reductions in incidents. We have demonstrated the benefits of improved communication practices and meaningful engagement opportunities on quality of life and ward functionality. Both interventions could be easily replicated on other mental health and learning disability inpatient wards. The success of this initiative can be attributed to the collaborative efforts of multidisciplinary teams, strong leadership and proactive staff.
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