Therapeutic and relational security is a best-in-class clinical approach to safety and security in high-risk health-care facilities. It recognizes that the best solution for patient aggression is prevention.
This approach to patient and staff safety aligns with current research and best practices in patient-centred, trauma-informed care. Putting the patient at the centre of care is integral to the approach at BC Mental Health and Substance Use Services.
Preventing aggressive incidents among patients who live with severe, complex mental illnesses and substance use challenges requires a thorough understanding of what causes aggression. When a patient lashes out, there may be many factors at play:
Psychosis and schizophrenia are common among our patients. Often, they live with a combination of more than one severe mental illness. This makes them more likely than most people to behave aggressively.
Another factor is a substance use disorder, which often accompanies severe mental illness. The links between alcohol use, drug use, and aggression are well-documented.
Many forensic patients are victims of abuse, neglect and other traumas, and any number of things in a forensic hospital setting might trigger or re-traumatize a patient—particularly when he or she has had poor experiences with the health-care system, as is often the case with patients who are severely mentally ill.
Therapeutic and relational security is about the connection and interplay between patient care and safety. Staff and physicians who have a thorough understanding of a patient, their triggers, and how they relate to others will often be able to stop violent incidents before they happen.
The approach focuses on four dimensions of a patient's environment:
- The care team
- Other patients
- The patient's inner world
- The patient's outer world
Therapeutic and relational security is designed to be used alongside other safety and security measures. There are three distinct but inter-related aspects of security for which different team members are responsible:
- Therapeutic and relational security
- Procedural security, or the policies, procedures, and staff training designed to maintain safety and security
- Physical security, including fences, locks, personal alarms, secure rooms and other infrastructure that keeps people safe
It is essential that all three approaches be in place at all times. One should never substantially compensate for the absence or ineffectiveness of another.