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Action plan generating encouraging results

​An 18-month public action plan designed to improve safety, patient care and operations at the 190-bed Forensic Psychiatric Hospital in Coquitlam is already making a difference.
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The Forensic Psychiatric Hospital, the only facility of its kind in B.C., treats patients who are found not criminally responsible for crimes due to a mental disorder, and assesses people's fitness to stand trial. The action plan followed an external review by a panel of international experts in psychiatry and forensic care.

"We treat the most challenging patients in the province," said Lynn Pelletier, the VP of BC Mental Health and Substance Use Services, who commissioned the review last year. "They have incredibly complex mental-health and substance-use challenges, and we are fortunate to have staff who are dedicated to working with this community. This action plan is the next step in ensuring that we are providing the very best in respectful, high-quality, trauma-informed care."

The five actions announced in September 2018 designed to improve staff safety are part of this action plan, and have already led to encouraging results. The actions included enhanced staff training, increased security and supervision, and the hiring of additional staff, including clinical-security liaisons, who specialize in safety at secure hospitals.

Other recently completed action plan items have included a new senior leadership team and facility upgrades. A comprehensive patient-needs assessment is underway.

Following these changes, there has been a drop in WorkSafeBC claims over the last several months. Pelletier credits dedicated leadership and staff, as well as meaningful engagement and consultation with key partners including the BC Nurses' Union, the BC Government Employees' Union, WorkSafeBC, the Ministry of Health and the B.C. Review Board for the positive outcomes. 

One of the most unique changes at the hospital is a significant investment in therapeutic and relational security, a specialized approach that has proven to be effective at keeping both patients and staff at secure hospitals safe. 

"Given the serious challenges our patients have faced, including trauma, addiction and severe and complex mental illness, they can be prone to disruption," said Dr. Connie Coniglio, who oversees the hospital. 

"In light of their background and our mandate as health-care professionals, the best way to keep everyone safe is to learn what makes patients tick and get a thorough understanding of their triggers. This is the basis of therapeutic and relational security. It teaches staff to be acutely aware of their environment, and focuses on building rapport and trust between staff and patients in a way that puts patients at ease and allows staff to anticipate and de-escalate potentially aggressive incidents."

The evidence-based model has been used to great success in the United Kingdom, which has over 55 forensic hospitals. Forensic Psychiatric Hospital leaders have been working with a curriculum designed by U.K.-based expert Elizabeth Allen, called See, Think, Act, and endorsed by the Royal College of Psychiatrists. 

More than 140 staff and physicians participated in the See, Think, Act training in November 2018, including Mandi Higenbottam, a patient care coordinator who has worked at the Forensic Psychiatric Hospital for the last several years.

"I think that we are at the beginning stages of a paradigm shift in this hospital," she said. "And I think it's really positive. I see people talking about relational security. I see people acknowledging the concepts related to relational security and trauma-informed practice…And I think that people are beginning to feel hopeful that change is happening, and it's possible here."

For updates on action plan progress, visit our website

BC Mental Health & Substance Use Services
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