Keynote speakers

Professor
Emeritus Len Bowers

Bio

Len Bowers is Emeritus Professor of Psychiatric Nursing at King’s College London’s Institute of Psychiatry, Psychology & Neuroscience. A qualified psychiatric nurse, he is best known for leading the team that developed and tested the Safewards model, an evidence-based approach designed to reduce conflict and containment and to support safer, more therapeutic ward environments. He has extensive experience in psychiatric nursing, research and service development, with a particular focus on acute inpatient mental health care.

Abstract

There is no doubt that Safewards has been a huge success. It has been widely used in many countries all around the world. The research I led and published showed that using Safewards would lead to significant falls in conflict behaviours and containment use. There is every reason to hope that this has been achieved in the places where Safewards has been implemented in practice.  Perhaps now is a good moment to take stock and think about the future.  Can we do things any better, and are there any common mistakes being made by people using Safewards? Is it too popular, implemented too widely or too superficially? Did our use of social media in order to support Safewards actually have drawbacks as well as benefits, and how should that continue? The Safewards team made the decision to make it freely available to everyone, without any costs, constraints or accreditation. While that has certainly helped to get more people to use it, did that have costs we did not foresee? How do people who choose not to use Safewards see it, and are any of their criticisms right? During this presentation I will try to answer some of these questions, and will look forward to discussing them with you individually during the conference.

Assoc. Prof.
Anna Björkdahl

Bio

Anna is an Associate Professor and researcher at Karolinska Institutet, Sweden, with a background as a psychiatric mental health nurse. She currently works as Clinical Development Manager at Psychiatry South Stockholm, where she bridges research and clinical practice. Her work centres on preventing and managing violence and coercion in inpatient psychiatric care, approached from a nursing perspective. In recent years, she has published several papers on Safewards, drawing on both quantitative and qualitative methods and naturalistic research designs grounded in real-world clinical settings.

Abstract

What Really Makes Safewards Work? Identifying the Active Ingredients for Fidelity, Learning, and Impact

Safewards has become one of the most widely adopted interventions to prevent conflict and containment in psychiatric care, yet we still cannot confidently answer two fundamental questions: what exactly needs to happen for Safewards to work as intended, and how is Safewards actually implemented in practice?

This gap exists partly because we have lacked a robust tool to assess implementation fidelity, making it challenging to understand outcome variation, facilitate cross-site learning, or ensure Safewards is delivered as intended. At the core of this challenge has been an insufficiently articulated understanding of the active ingredients necessary for the ten Safewards interventions to achieve their intended effects. Without this knowledge, replication, refinement, and effective implementation are compromised, jeopardising both clinical quality assurance and scientific rigour.

This keynote presents the on-going development process of the Safewards Implementation Fidelity Tool (SIFT), and the identified active ingredients of Safewards. Through an international Delphi process, expert consensus identified the active ingredients for each intervention as well as measurement levels, informed by contemporary fidelity theory. As a next step, the SIFT was pilot-tested with frontline psychiatric staff and refined to ensure clinical relevance and feasibility.

The tool comprises 48 active ingredients with established measurements across all ten interventions. The number of ingredients, ranging from three to seven per intervention, captures the sophistication of Safewards and of high-quality mental health nursing practice. The SIFT is currently undergoing international psychometric validation.

Beyond measurement, the active ingredients may serve as a practical compass for implementation, helping clinicians, managers, and researchers understand, communicate, and sustain the core purpose of Safewards, particularly relevant at a time when growing popularity brings both opportunities and risks of drift. This work establishes a foundation for the next generation of Safewards implementation, one grounded in clarity, shared understanding, and the capacity to learn from what truly works.