The level of violence in psychiatric hospital settings presents ongoing challenges for both patients and staff. Hospitals and institutions continue in their efforts to both meet JACHO standards and make their institutions safe for patients and staff. This paper illustrates how one forensic nursing unit has experienced a substantial reduction in violence. Subsequently, the need for seclusion and restraints was also reduced by greater than 90% over three years.

There has been extensive research, examining the risks and benefits of seclusion and restraint (S/R) use for patients and staff. Although complete elimination of S/R use in a forensic hospital may not be feasible, the need for more restrictive interventions can be greatly reduced. Focusing on reducing the use of S/R should not distract from the focus of meeting the basic, holistic needs of patients: promotion of safety and reduction of trauma risk.

The American Psychiatric Nursing Association Seclusion and Restraint Standards of Practice (APNA) clarify that the key to S/R reduction is prevention of aggression by thorough assessment with early intervention using less restrictive measures. This goal can be accomplished by making unit changes that add structure and calmness, and by utilizing a treatment team approach that facilitates partnership with the patient, rather than control over the patient.(Seclusion and Restraint Position Statement and Standards of Practice, 2000). Utilizing these approaches has resulted in a substantial reduction in violence and the need for S/R in a forensic nursing unit. This paper illustrates how one forensic nursing unit reduced the need for S/R by focusing on core strategies that include teaching patients how to meet their needs using therapeutic, nonviolent communication skills.

The Intensive Treatment Unit (ITU) at Mendota Mental Health Institute (MMHI) in Madison, Wisconsin is a medium security 21-bed forensic unit designed to provide a safe therapeutic milieu for long-term intensive treatment of acute psychiatric, somatic, medical or behavioral symptoms. The male patients have diagnoses of psychotic, personality, mood, anxiety, and cognitive disorders and many have dual diagnoses.

The core strategies introduced into the ITU at MMHI are presented.