A systematic review of the effectiveness of safewards: Has enthusiasm exceeded evidence?

 Safewards  is  intended  to  be  an  evidence-based  approach  to  reduce  levels  of  conflict  and  containment  in  mental  health  inpatient  settings.  A  systematic  review  was  carried  out  to  examine  whether  Safewards  is  effective  in  reducing  conflict  and  containment  events;  and  improving  ward  climate.  Searches  for  articles  evaluating  the  implementation  of  Safewards  was  conducted  using  PsycINFO,  PubMed,  Web  of  Science,  Cochrane  Library  and  CINAHL.  Thirteen  studies  were  included  for  review  after  applying  inclusion  and  exclusion  criteria.  The  Quality  Assessment  Tool  for  Studies  with  Diverse  Designs  (QATSDD)  was  used  to  assess  study  quality  and  the  majority  of  studies  (N  =    7)  were  rated  as  “moderate”  quality.  Whilst  there  is  evidence  to  suggest  that  Safewards  is  effective  for  reducing  conflict  and  containment  in  general  mental  health  services,  there  is  insufficient  high-quality  empirical  evidence  to  support  its  effectiveness  in  settings  beyond  this.  Further  research  using  robust  methodological  designs  with  larger,  more  representative  samples  is  required  in  order  for  the  effectiveness  of  Safewards  to  be  established  across  the  range  of  contexts  in  which  it  is  currently  being  applied.