From Control to Connection: Reflections on Implementing Safe Steps in Acute Mental Health Units

Vollständiger Abstract

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ABSTRACT This paper presents a reflective account of the implementation of the Safe Steps for De‐escalation practice model over a 12‐month period across three acute mental health units. It describes the implementation process of the model, designed to reduce restrictive practices in acute mental health settings. The Safe Steps model is a mental health nurse‐designed and led approach for person‐centred, structured and relational de‐escalation. It positions therapeutic engagement, emotional attunement, and psychological safety as central components of effective responding, particularly during high‐stress situations. The model offers a practical and adaptable resource for diverse acute care environments. This paper examines the implementation process and lessons learned from a multi‐site evaluation of the Safe Steps model in a number of acute mental health units. The evaluation was guided by the complexity model of Skivington et al. (2021), which emphasises multifaceted real‐world approaches to evaluation. Drawing on reflective accounts from the research and implementation leads, using practice‐informed insights, the paper explores the opportunities, challenges and lessons learned in embedding a relational de‐escalation model into everyday clinical practice. Particular attention is given to capability building, scenario‐based learning, and team‐based support strategies that facilitated implementation. The findings highlight the importance of leadership, emotional safety, and inclusion of the consumer voice in sustaining reductions in coercive practices. The paper offers practical insights for clinicians and researchers seeking to implement relational and trauma‐informed approaches in acute mental health services.