De Bascule

Written by: Dr Nick Goddard - Consultant Child and Adolescent Psychiatrist

5 years ago De Bascule (child and adolescent psychiatry hospital in Amsterdam) had the idea to start using NVR on an acute psychiatric ward. A ward environment is not the typical setting to implement NVR. Parents are usually not always present and the population of the ward is young people with acute and severe psychiatric illness. The thinking behind the idea was to use NVR to: reduce the use of coercive treatment measures, e.g. seclusion and restraint; decrease violent incidents and to promote working together between young people, parents and staff.

5 years later much has been learnt about using NVR on a ward and many mistakes have been made! Some aspects of NVR need to be adapted for use in the clinic setting and some NVR principles clash with the legal framework, e.g. openness and transparency vs. the rights of a patient to confidentiality. Each of these apparent problems has helped further develop NVR for use in a ward environment. The acute ward has won national prizes for innovation in promoting safety and also for developing a more humane clinical setting. Many of the wards in De Bascule are also trained in using NVR with the result that aggression has decreased and with it the use of coercive practices. We have moved from the illusion that we can control the behaviour of others to the idea that we have control over, and responsibility for, our own actions. One ward has created a room where parents can sleep if need be. We are finalising a work book setting out some of the NVR concepts for use on a ward and have also made a DVD with scenes of NVR in practice to help with training. We hope to begin shortly with a research project looking at the effectiveness of NVR in the setting of a ward.

Was it such a strange idea to try and use NVR in a ward environment? – definitely! But, this new way of thinking and looking at the problem of providing a safe environment has helped change and develop the treatment ethos.

This is a work in progress. We welcome the opportunity to exchange ideas and learn from other developments in NVR and the New Authority. Please feel free to contact us via: NVR@debascule.com or read more in our NVR folder.