NVCWiki - User contributions [en]

Severe Mental Illness and NVC

2011-11-22T11:49:49Z

Johnm: Fixing broken link to Applicstion of Core Strategies

=Intention=
The intention of this page is to look at the use of [http://en.wikipedia.org/wiki/Nonviolent_Communication NonViolent Communication (NVC)] for treatment of [http://en.wikipedia.org/wiki/Mental_disorder Severe Mental Illness]

=[http://en.wikipedia.org/wiki/Nonviolent_Communication NVC] in an [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] =

[[Image:ITU_SR_hrs_pa_app_core_strat.JPG|frame|Table 1: Reduction in Seclusion and Restraint Hours]] Since revision of [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] programming in March 2004 [http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. and Corwith, C. (2007)] report the introduction of NVC into the [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] (ITU) ,at [http://dhs.wisconsin.gov/mh_mendota/INDEX.HTM Mendota Mental Health Institute] in Madison, Wisconsin , a 21 bed medium security forensic unit. [http://speakempathy.com/ Riemer] introduced a number of changes on the unit that added structure and calmness and utilizing a treatment team approach that facilitates partnership with the patient rather than control. They reduced the need for Seclusion and Restraints by using core strategies which included teaching patients how to meet their needs using therapeutic Nonviolent Communication (NVC) skills. Role playing, a NVC technique, was a major part of the staff education and training.

The use of these strategies, which included teaching NVC to patients and staff reduced the number of ITU seclusion and restraint hrs from 92 to 4 over a four year period. (see fig on right). It also reduced the [http://en.nvcwiki.com/images/ITU_SR_Inc_pa_app_core_strat_.JPG number of seclusion and restraint incidents] from 33 per yr to 2.0 per yr over the same four year period.

=[http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/Maximum.HTM#mtu Management and Treatment Unit] at Mendota Mental Health Institute=
[[Image:MTU_Violence_Indicators_Creating_Sanctuary.JPG |frame|Table 2: Decrease in violence indicators after introduction of Sanctuary Concept and NVC from [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] ]]
The [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/Maximum.HTM#mtu Management and Treatment Unit (MTU)] is a 14 bed unit that provides treatment to the most acutely civil and forensic male patients in need of maximum security at the [http://dhs.wisconsin.gov/mh_mendota/INDEX.HTM Mendota Mental Health Institute]in Madison Wisconsin. It provides treatment for '''patients with a history of aggression'''. In Aug 2007 the MTU team
decided to revise its ways of treatment to reduce violence. The first step was to achieve a common agreement as to the meaning of the word “violence”. The meaning was extended to include passive and non verbal violence in addition to the usual verbal and physical violence . It was finally defined to mean “behavior that increased the acuity of the unit’s environment and threatens sanctuary”. NVC training was given initially to staff and eventually used in treatment groups.Several weeks of training in NVC skills were given to patients. De-escalation plans were developed and the concept of a Sanctuary introduced based on Sandra Bloom's [http://www.amazon.com/Creating-Sanctuary-Toward-Evolution-Societies/dp/0415915686/ref=sr_1_1?ie=UTF8&s=books&qid=1246135934&sr=8-1 Sanctuary Model]. After these trainings were given the unit calmed down. After the patients and staff mutually developed their concept of sanctuary, it was implemented basically basically using the methodology of NVC. [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer (2009)] reports that the violence indicators dropped dramatically over a two year period as seen in the accompanying figure. The top bar shows that the number of injuries to staff from agression went down from 13 to 7.The next bar shows that the number of seclusion episodes were reduced from 40 to 20. The number of seclusion hours dropped from 320 to 174.Patients have Individual Emergency Response Plans (ERP) for use in emergency situations. The next bar on the graph (ERP) shows that their use dropped from 7.5 to 6.7. The use of Emergency Codes dropped from 14 to 5. The use of specially trained Emergency Intervention Teams (EIT) dropped from 62 to 32. It is important to note that the usage of Emergency Codes and EIT's declined despite the fact that patients were being managed with less reliance on restrictive measures.
Patient grievances against staff also dropped by 54% from 133 to 61.
Not only was there a reduction of forcible restraints for the patients, the staff also experienced an increase in safety. The number of [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG lost staff days] due to patient violence went down from 135 to 18 and [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG light staff days] went down from 41 to 17.

=Comparison with CA State Hospitals & Prisons=

[[Image:SplusR comparisons.jpg|center|frame|'''Table 3: Seclusion plus Restraint and Staff Injury data ordered by increasing Seclusion plus Restraint incidents]]''' is taken from a [[VPI | comparison study]] of the rates of violence in Psychiatric Institutions. Table 3 shows that the rate of violence in an institution using NVC. the Intensive Treatment Unit in 2007, is 11% of the average rate of violence for all CA State Hospitals and Prisons.

=[http://www.vchca.org/bh/ Ventura County,CA Behavioral Health Dept] Intensive Psychiatric Unit=
Liz Otterbein, R.N. is a certified NVC trainer who has been working in the Intensive Pyschiatric Unit (IPU) for about twelve years on weekends.
The IPU is part of [http://www.vchca.org/bh/ Ventura County,CA Behavioral Health Dept] and is located at Hillmont,Ventura and has forty-five beds. 
She uses the principles of NVC as an anger management technique.
As the IPU is a crisis unit for acute care, a number of patients are admitted under a legal hold as they are deemed to be a danger to self or others. They are typically feeling very angry, not only at the situation that initially aroused their anger but also because they have been forcibly restrained by the police and bought into the unit under duress. She incorporates the principles of NVC in her discussions with the patients and, as a result, they calm down very rapidly. [[Tim |Tim's story]] illustrates such a discussion in which a very angry young man becomes peaceful and starts taking constructive action for himself in about thirty minutes without any use of violence, threats or medications because he is treated with respect, understanding and offered compassion and empathy.
Liz labels describes the process she uses as anger management. It is primarily based on the principles and techniques of NVC.

=Atascadero State Hospital=

Kathi Aichner has written a [[NVC_at_Atascadero_Sate_Hospital| report]] on the use of NVC at Atascadero State Hospital which showed that the patients were very enthusiastic about its use.

=Books=

Melanie Sears has published two books about the use of NVC in Mental Health settings. One is
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Choose your words], a book describing how NVC is used in a mental health system. The other is
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Humanizing Health Care with NVC], a book describing how the use of NVC can improve the delivery of mental health services.

=References=

[[NVC_at_Atascadero_Sate_Hospital| Aichner,K. NVC at Atascadero State Hospital, personal communication, 2008]] 
[http://www.amazon.com/Creating-Sanctuary-Toward-Evolution-Societies/dp/0415915686/ref=sr_1_1?ie=UTF8&s=books&qid=1246135934&sr=8-1 Bloom, Sandra Creating Sanctuary: Toward the Evolution of Sane Societies (1997) Routledge] 
[http://www.iafn.org/associations/8556/files/OTEFall2007.pdf Riemer,D. Corwith, C. Application of Core Strategies: Reducing Seclusion & Restraint Use, On The Edge, 13(3) (2007)] 
[http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] 
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Sears, M. Choose your words, CareInAction (2007)] 
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Sears M.,Humanizing Health Care with NVC, iUniverse, Lincoln Ne, (2006)] 

''Please add any other citations to the use of NVC in Mental Health Settings to this page. If you experience difficulty in adding to this page directly , please [mailto:support@dreamsharing.info e-mail] the submission to [[User:JohnM | John Mudie]] directly.''

[[Category:SMI]]

Talk:Severe Mental Illness and NVC

2009-08-27T21:15:04Z

Johnm: Removing all content from page

Severe Mental Illness and NVC

2009-08-27T21:14:09Z

Johnm: adding in liz's secton

=Intention=
The intention of this page is to look at the use of [http://en.wikipedia.org/wiki/Nonviolent_Communication NonViolent Communication (NVC)] for treatment of [http://en.wikipedia.org/wiki/Mental_disorder Severe Mental Illness]

=[http://en.wikipedia.org/wiki/Nonviolent_Communication NVC] in an [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] =

[[Image:ITU_SR_hrs_pa_app_core_strat.JPG|frame|Table 1: Reduction in Seclusion and Restraint Hours]] Since revision of [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] programming in March 2004 [http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. and Corwith, C. (2007)] report the introduction of NVC into the [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] (ITU) ,at [http://dhs.wisconsin.gov/mh_mendota/INDEX.HTM Mendota Mental Health Institute] in Madison, Wisconsin , a 21 bed medium security forensic unit. [http://speakempathy.com/ Riemer] introduced a number of changes on the unit that added structure and calmness and utilizing a treatment team approach that facilitates partnership with the patient rather than control. They reduced the need for Seclusion and Restraints by using core strategies which included teaching patients how to meet their needs using therapeutic Nonviolent Communication (NVC) skills. Role playing, a NVC technique, was a major part of the staff education and training.

The use of these strategies, which included teaching NVC to patients and staff reduced the number of ITU seclusion and restraint hrs from 92 to 4 over a four year period. (see fig on right). It also reduced the [http://en.nvcwiki.com/images/ITU_SR_Inc_pa_app_core_strat_.JPG number of seclusion and restraint incidents] from 33 per yr to 2.0 per yr over the same four year period.

=[http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/Maximum.HTM#mtu Management and Treatment Unit] at Mendota Mental Health Institute=
[[Image:MTU_Violence_Indicators_Creating_Sanctuary.JPG |frame|Table 2: Decrease in violence indicators after introduction of Sanctuary Concept and NVC from [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] ]]
The [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/Maximum.HTM#mtu Management and Treatment Unit (MTU)] is a 14 bed unit that provides treatment to the most acutely civil and forensic male patients in need of maximum security at the [http://dhs.wisconsin.gov/mh_mendota/INDEX.HTM Mendota Mental Health Institute]in Madison Wisconsin. It provides treatment for '''patients with a history of aggression'''. In Aug 2007 the MTU team
decided to revise its ways of treatment to reduce violence. The first step was to achieve a common agreement as to the meaning of the word “violence”. The meaning was extended to include passive and non verbal violence in addition to the usual verbal and physical violence . It was finally defined to mean “behavior that increased the acuity of the unit’s environment and threatens sanctuary”. NVC training was given initially to staff and eventually used in treatment groups.Several weeks of training in NVC skills were given to patients. De-escalation plans were developed and the concept of a Sanctuary introduced based on Sandra Bloom's [http://www.amazon.com/Creating-Sanctuary-Toward-Evolution-Societies/dp/0415915686/ref=sr_1_1?ie=UTF8&s=books&qid=1246135934&sr=8-1 Sanctuary Model]. After these trainings were given the unit calmed down. After the patients and staff mutually developed their concept of sanctuary, it was implemented basically basically using the methodology of NVC. [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer (2009)] reports that the violence indicators dropped dramatically over a two year period as seen in the accompanying figure. The top bar shows that the number of injuries to staff from agression went down from 13 to 7.The next bar shows that the number of seclusion episodes were reduced from 40 to 20. The number of seclusion hours dropped from 320 to 174.Patients have Individual Emergency Response Plans (ERP) for use in emergency situations. The next bar on the graph (ERP) shows that their use dropped from 7.5 to 6.7. The use of Emergency Codes dropped from 14 to 5. The use of specially trained Emergency Intervention Teams (EIT) dropped from 62 to 32. It is important to note that the usage of Emergency Codes and EIT's declined despite the fact that patients were being managed with less reliance on restrictive measures.
Patient grievances against staff also dropped by 54% from 133 to 61.
Not only was there a reduction of forcible restraints for the patients, the staff also experienced an increase in safety. The number of [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG lost staff days] due to patient violence went down from 135 to 18 and [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG light staff days] went down from 41 to 17.

=Comparison with CA State Hospitals & Prisons=

[[Image:SplusR comparisons.jpg|center|frame|'''Table 3: Seclusion plus Restraint and Staff Injury data ordered by increasing Seclusion plus Restraint incidents]]''' is taken from a [[VPI | comparison study]] of the rates of violence in Psychiatric Institutions. Table 3 shows that the rate of violence in an institution using NVC. the Intensive Treatment Unit in 2007, is 11% of the average rate of violence for all CA State Hospitals and Prisons.

=[http://www.vchca.org/bh/ Ventura County,CA Behavioral Health Dept] Intensive Psychiatric Unit=
Liz Otterbein, R.N. is a certified NVC trainer who has been working in the Intensive Pyschiatric Unit (IPU) for about twelve years on weekends.
The IPU is part of [http://www.vchca.org/bh/ Ventura County,CA Behavioral Health Dept] and is located at Hillmont,Ventura and has forty-five beds. 
She uses the principles of NVC as an anger management technique.
As the IPU is a crisis unit for acute care, a number of patients are admitted under a legal hold as they are deemed to be a danger to self or others. They are typically feeling very angry, not only at the situation that initially aroused their anger but also because they have been forcibly restrained by the police and bought into the unit under duress. She incorporates the principles of NVC in her discussions with the patients and, as a result, they calm down very rapidly. [[Tim |Tim's story]] illustrates such a discussion in which a very angry young man becomes peaceful and starts taking constructive action for himself in about thirty minutes without any use of violence, threats or medications because he is treated with respect, understanding and offered compassion and empathy.
Liz labels describes the process she uses as anger management. It is primarily based on the principles and techniques of NVC.

=Atascadero State Hospital=

Kathi Aichner has written a [[NVC_at_Atascadero_Sate_Hospital| report]] on the use of NVC at Atascadero State Hospital which showed that the patients were very enthusiastic about its use.

=Books=

Melanie Sears has published two books about the use of NVC in Mental Health settings. One is
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Choose your words], a book describing how NVC is used in a mental health system. The other is
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Humanizing Health Care with NVC], a book describing how the use of NVC can improve the delivery of mental health services.

=References=

[[NVC_at_Atascadero_Sate_Hospital| Aichner,K. NVC at Atascadero State Hospital, personal communication, 2008]] 
[http://www.amazon.com/Creating-Sanctuary-Toward-Evolution-Societies/dp/0415915686/ref=sr_1_1?ie=UTF8&s=books&qid=1246135934&sr=8-1 Bloom, Sandra Creating Sanctuary: Toward the Evolution of Sane Societies (1997) Routledge] 
[http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. Corwith, C. Application of Core Strategies: Reducing Seclusion & Restraint Use, On The Edge, 13(3) (2007)] 
[http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] 
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Sears, M. Choose your words, CareInAction (2007)] 
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Sears M.,Humanizing Health Care with NVC, iUniverse, Lincoln Ne, (2006)] 

''Please add any other citations to the use of NVC in Mental Health Settings to this page. If you experience difficulty in adding to this page directly , please [mailto:support@dreamsharing.info e-mail] the submission to [[User:JohnM | John Mudie]] directly.''

[[Category:SMI]]

Talk:Severe Mental Illness and NVC

2009-08-27T19:38:15Z

Johnm:

=[http://www.vchca.org/bh/ Ventura County,CA Behavioral Health Dept] Intensive Psychiatric Unit=
Liz Otterbein, R.N. is a certified NVC trainer who has been working in the Intensive Pyschiatric Unit (IPU) for about twelve years on weekends.
The IPU is part of [http://www.vchca.org/bh/ Ventura County,CA Behavioral Health Dept] and is located at Hillmont,Ventura and has forty-five beds. 
She uses the principles of NVC as an anger management technique.
As the IPU is a crisis unit for acute care, a number of patients are admitted under a legal hold as they are deemed to be a danger to self or others. They are typically feeling very angry, not only at the situation that initially aroused their anger but also because they have been forcibly restrained by the police and bought into the unit under duress. She incorporates the principles of NVC in her discussions with the patients and, as a result, they calm down very rapidly. [[Tim |Tim's story]] illustrates such a discussion in which a very angry young man becomes peaceful and starts taking constructive action for himself in about thirty minutes without any use of violence, threats or medications because he is treated with respect, understanding and offered compassion and empathy.
Liz labels describes the process she uses as anger management. It is primarily based on the principles and techniques of NVC.

'''''This section is under construction and will eventually be included in the main page'''''.

Treating an angry involuntary hold with compassion; Tim's story

2009-08-27T19:24:03Z

Johnm: Correcting length of time

Could Violence be a disconnection with our human nature, a disconnection with our human needs ?

I am probably not the first one to see that, but what amazes me is how fast people can reconnect with their human nature, use the power of anger to serve life, and move forward toward happiness when they are given the chance to reconnect.

Let me tell you the story of one of my patients.

I am a nurse in a short-term, locked facility for people that are on a 72 hour legal hold as a danger to self or to others due to psychological disorder. In other words my patients arrive often on the unit yelling with hands cuffs on.

This is how Tim ( for the story) arrived on my unit. He was a young man on a hold for being a danger to others. Before he arrived, I learned by phone report that he had broken everything at his ex-girlfriend’s apartment, had thrown the TV out the window and they had needed three policemen to contain his fury. His yelling preceded his physical arrival onto the unit and because he refused to “cooperate” with the doctor, he was escorted directly into one of our seclusion rooms.

The policeman asked Tim to sit on the bed and Tim complied. The officer gave us a look as if to say,” what is your plan?”

Our concern at this point was safety, so I told Tim that I wanted to listen to him but I needed to be safe. He gave me a quick look of surprise and raised his shoulder and said “of course”. I said “thank you”. I gave a sign to the officer that it was Ok to remover the handcuffs, still locked on Tim’s wrists behind his back.

With a quick chin gesture I told the staff that they could leave; only my assigned health tech stayed at the door.

Tim’s voice was getting lower as he was continuing with his list of grievances against us first and then against his ex. “What right do you have to lock me up; I am not the problem; that ‘f—b’ is the problem. Why don’t you get her instead of me? You are on her side, right? So she can rat on me that I am using, and that’s OK. The ‘b’ wants me out of her life and my son’s life. Who do you think you are anyway, some kind of God that knows what is right or wrong?”

At that point I am listening, I am also very in touch with my need for safety. Now that he has agreed to sit, I feel safe and I can really listen.

I am always really curious to understand how a young man can “end up” on my unit. I know deep inside me that he is on the same search for happiness, like all the rest of us. But what happen, what choices did he make to get so far away from his happiness?

So I listen, listen in the best way that I can. I mean I listen with all my body, without letting my head get in the way. I listen without analyzing, without judging, with just a genuine listening to what is really alive in him at this time. (It helps me to know I have only heard one side of the story. So how can I pretend to an opinion when half the information is missing?)

At times, I do some echoing of what I hear. For Tim, I heard frustration first; we were taking his freedom away and that was frustrating. When I let him go deeper he said, “She wants me out of my son’s life”; so I hear sadness, a deep sadness under all that anger.

I told him that is what I heard. “I hear so much Sadness, when you are talking about your son”. He became suddenly silent as if he were searching whether it was sadness inside him. Like he needed a few seconds to feel what was in him. He took a sigh and remained quiet for the first time; and then he said, “I am not going to be an absent father like mine was”.

I stay quiet with him for some time and offered, “So I hear that it is important for you to be a father for your kid”. He said, “yes”, and gives me a first real eye-to-eye contact.

I felt that he was re-connected to his feelings and his needs. What I had heard, even though it was only a guess on my part, allowed him to go inside and search. He was then very quick to jump into the strategies to meet those needs, like in a hurry to not waste any more time. He asked to use the phone to call the social worker.

About thirty minutes elapsed between the time the policeman brought him into the room and Tim asked to see a social worker.

It was so sweet to see it happen, to see the power of the connection to the deep self, the one looking for happiness.

This was the Happiness of the father loving his son.

This is what I mean, when I talk about reconnecting with our human nature, our human needs.

I have seen over and over that amazing power that comes out when this reconnection happens. The power of the clear action coming from our common human needs just once step behind the loud confusing noise of anger.

I am not sure what happened to Tim after his discharge. During his 3 days stay in the hospital he never expressed in a destructive way his anger for us or for his life.

I ran into him, once as I was waiting at a traffic light; he drove by in a truck and yelled with a big smile “ I got a job!” and disappeared.

Liz Otterbein,R.N.Certified NVC Trainer 
<c> Otterbein {2009)
[[Category:SMI]]

File:Sec annual comparisons .jpg

2009-08-26T21:03:42Z

Johnm: uploaded a new version of "Image:Sec annual comparisons .jpg": Revised

Used in SMI category

File:SplusR comparisons.jpg

2009-08-26T21:02:31Z

Johnm: uploaded a new version of "Image:SplusR comparisons.jpg": Revised

Used by files in SMI Category

Talk:Severe Mental Illness and NVC

2009-08-26T16:35:57Z

Johnm:

=[http://www.vchca.org/bh/ Ventura County,CA Behavioural Health Dept] Pysch Unit=
Liz Otterbein, R.N. is a certified NVC trainer who has been working in the Intensive Pysch Unit for about twelve years on weekends.
The Intensive Psych Unit is part of [http://www.vchca.org/bh/ Ventura County,CA Behavioural Health Dept] and is located at Hillmont,Ventura,
She uses the principles of NVC as an anger managemement techique.
As the Psych Unit is a crisis unit, a number of patients are admitted under a legal hold as they are deemed to be a danger to self or others. They are typically feeling very angry, not only at the situation that initially aroused their anger but also becausse they have been forcibly restrained by the police and bought into the unit under duress as the result of a legal hold. She incorporates the principles of NVC in her discussions with the patients and as a result, they calm down very rapidly. [[Tim |Tim's story]] illustrates such a discussion in which a very angry young man becomes peaceful and starts taking constructive action for himself without any use of violence or threats becuase he is treated with respect, understanding and offered compassion and empathy.

'''''This section is under construction and will evenutally be included in the main page'''''.

Treating an angry involuntary hold with compassion; Tim's story

2009-08-26T16:31:29Z

Johnm:

Could Violence be a disconnection with our human nature, a disconnection with our human needs ?

I am probably not the first one to see that, but what amazes me is how fast people can reconnect with their human nature, use the power of anger to serve life, and move forward toward happiness when they are given the chance to reconnect.

Let me tell you the story of one of my patients.

I am a nurse in a short-term, locked facility for people that are on a 72 hour legal hold as a danger to self or to others due to psychological disorder. In other words my patients arrive often on the unit yelling with hands cuffs on.

This is how Tim ( for the story) arrived on my unit. He was a young man on a hold for being a danger to others. Before he arrived, I learned by phone report that he had broken everything at his ex-girlfriend’s apartment, had thrown the TV out the window and they had needed three policemen to contain his fury. His yelling preceded his physical arrival onto the unit and because he refused to “cooperate” with the doctor, he was escorted directly into one of our seclusion rooms.

The policeman asked Tim to sit on the bed and Tim complied. The officer gave us a look as if to say,” what is your plan?”

Our concern at this point was safety, so I told Tim that I wanted to listen to him but I needed to be safe. He gave me a quick look of surprise and raised his shoulder and said “of course”. I said “thank you”. I gave a sign to the officer that it was Ok to remover the handcuffs, still locked on Tim’s wrists behind his back.

With a quick chin gesture I told the staff that they could leave; only my assigned health tech stayed at the door.

Tim’s voice was getting lower as he was continuing with his list of grievances against us first and then against his ex. “What right do you have to lock me up; I am not the problem; that ‘f—b’ is the problem. Why don’t you get her instead of me? You are on her side, right? So she can rat on me that I am using, and that’s OK. The ‘b’ wants me out of her life and my son’s life. Who do you think you are anyway, some kind of God that knows what is right or wrong?”

At that point I am listening, I am also very in touch with my need for safety. Now that he has agreed to sit, I feel safe and I can really listen.

I am always really curious to understand how a young man can “end up” on my unit. I know deep inside me that he is on the same search for happiness, like all the rest of us. But what happen, what choices did he make to get so far away from his happiness?

So I listen, listen in the best way that I can. I mean I listen with all my body, without letting my head get in the way. I listen without analyzing, without judging, with just a genuine listening to what is really alive in him at this time. (It helps me to know I have only heard one side of the story. So how can I pretend to an opinion when half the information is missing?)

At times, I do some echoing of what I hear. For Tim, I heard frustration first; we were taking his freedom away and that was frustrating. When I let him go deeper he said, “She wants me out of my son’s life”; so I hear sadness, a deep sadness under all that anger.

I told him that is what I heard. “I hear so much Sadness, when you are talking about your son”. He became suddenly silent as if he were searching whether it was sadness inside him. Like he needed a few seconds to feel what was in him. He took a sigh and remained quiet for the first time; and then he said, “I am not going to be an absent father like mine was”.

I stay quiet with him for some time and offered, “So I hear that it is important for you to be a father for your kid”. He said, “yes”, and gives me a first real eye-to-eye contact.

I felt that he was re-connected to his feelings and his needs. What I had heard, even though it was only a guess on my part, allowed him to go inside and search. He was then very quick to jump into the strategies to meet those needs, like in a hurry to not waste any more time. He asked to use the phone to call the social worker.

About 45 minutes elapsed between the time the policeman brought him into the room and asked to see a social worker.

It was so sweet to see it happen, to see the power of the connection to the deep self, the one looking for happiness.

This was the Happiness of the father loving his son.

This is what I mean, when I talk about reconnecting with our human nature, our human needs.

I have seen over and over that amazing power that comes out when this reconnection happens. The power of the clear action coming from our common human needs just once step behind the loud confusing noise of anger.

I am not sure what happened to Tim after his discharge. During his 3 days stay in the hospital he never expressed in a destructive way his anger for us or for his life.

I ran into him, once as I was waiting at a traffic light; he drove by in a truck and yelled with a big smile “ I got a job!” and disappeared.

Liz Otterbein,R.N.Certified NVC Trainer 
<c> Otterbein {2009)
[[Category:SMI]]

Violence in Psychiatric Institutions

2009-08-07T21:01:02Z

Johnm: /* Results */

=Intention=
The intention of this page is to review measures of the use of violence in psychiatric institutions particularly those using [http://en.wikipedia.org/wiki/Nonviolent_Communication Nonviolent Communication] developed by [http://en.wikipedia.org/wiki/Nonviolent_Communication Marshall Rosenberg].

=Methodology=

Published and unpublished data were collected from a variety of sources (see tables). The data collected consisted of:
#number of seclusion incidents,
#number of hours patients were secluded,
#number of restraint incidents,
#number of hours patients were restrained
#number of staff injuries over a period of time.
. The data was then "normalized" by expressing the data per 1000 patient days. When the number of patient days during the observation period was not available, the unit capacity times length of data collection period was used as an estimate of patient days.

In some cases only combined seclusion plus restraint data were available so these were compared with the calculated seclusion plus restraint data for other institutions.

A "blank" entry in a results table indicates that the data were unavailable

=Results=

[[Image:SplusR comparisons.jpg|center|frame|'''Table 1: Seclusion plus Restraint and Staff Injury data ordered by increasing Seclusion plus Restraint incidents]]'''
 
The total seclusion plus restraint data show that only three institutions had Seclusion plus Restraint incident rate of less than 1.0 incident per 1000 patient days. These were Coalinga State Hospital and the Intensive Treatment Unit (ITU) during years that Nonviolent Communication was being used. During a previous year (2003) when the ITU was not using NVC, the violence rate was comparable (4.31) to that of other Ca State Hospitals.
 
The high rate (36.13) associated with the Santa Barbara Psychiatric Health Facility is most probably in large measure due to the fact that it only accepts people when they are in crisis in contrast to the CA State Hospitals which have relatively stable populations.

[[Image:Sec annual comparisons .jpg|center|frame|Table 2: '''Seclusion and Staff Injury data ordered by increasing Seclusion incidents''' ]]
 
In Table 2,the institution using NVC , the Management and Treatment unit (MTU), does not appear to show a significant improvement over the CA State Hospitals. Its rate (3.91 incidents / 1000 patient days) is relatively high. The MTU caters for a very special population. It treats the most violent from jails, hospitals , prisons, and community and and gets the hardest cases in the state.
According to Riemer(2009) it is the most secure of four maximum security units and provides treatment "to the most acutely aggressive civil and forensic patients in need of maximum security".
 

=References=

Garrity, M. (2009) Pychiatric Health Facility Seclusion and Restraints Statistics (personal communication) 2009 
[http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. Corwith, C. Application of Core Strategies: Reducing Seclusion & Restraint Use, On The Edge, 13(3) (2007)] 
[http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] 
Stringer,K a Using Quality Imporvement (QI) as a tool to reduce seclsion and restraints (S/R) and data sharing on the internet, presentation (2009) 
Stringer K,b Excel spreadsheet incorporating [http://www.dmh.ca.gov/Services_and_Programs/State_Hospitals/S_and_R/default.asp CA Dept of Mental Health Data on seclusions and restraints] (personal communication) 2009.

''Please add any other reports of violence in psychiatric settings to this page. If you experience difficulty in adding to this page directly , please [mailto:support@dreamsharing.info e-mail] the submission to [[User:JohnM | John Mudie]] directly.''

[[Category:SMI]]

Severe Mental Illness and NVC

2009-08-01T17:34:19Z

Johnm: /* Comparison with CA State Hospitas & Prisons */

=Intention=
The intention of this page is to look at the use of [http://en.wikipedia.org/wiki/Nonviolent_Communication NonViolent Communication (NVC)] for treatment of [http://en.wikipedia.org/wiki/Mental_disorder Severe Mental Illness]

=[http://en.wikipedia.org/wiki/Nonviolent_Communication NVC] in an [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] =

[[Image:ITU_SR_hrs_pa_app_core_strat.JPG|frame|Table 1: Reduction in Seclusion and Restraint Hours]] Since revision of [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] programming in March 2004 [http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. and Corwith, C. (2007)] report the introduction of NVC into the [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] (ITU) ,at [http://dhs.wisconsin.gov/mh_mendota/INDEX.HTM Mendota Mental Health Institute] in Madison, Wisconsin , a 21 bed medium security forensic unit. [http://speakempathy.com/ Riemer] introduced a number of changes on the unit that added structure and calmness and utilizing a treatment team approach that facilitates partnership with the patient rather than control. They reduced the need for Seclusion and Restraints by using core strategies which included teaching patients how to meet their needs using therapeutic Nonviolent Communication (NVC) skills. Role playing, a NVC technique, was a major part of the staff education and training.

The use of these strategies, which included teaching NVC to patients and staff reduced the number of ITU seclusion and restraint hrs from 92 to 4 over a four year period. (see fig on right). It also reduced the [http://en.nvcwiki.com/images/ITU_SR_Inc_pa_app_core_strat_.JPG number of seclusion and restraint incidents] from 33 per yr to 2.0 per yr over the same four year period.

=[http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/Maximum.HTM#mtu Management and Treatment Unit] at Mendota Mental Health Institute=
[[Image:MTU_Violence_Indicators_Creating_Sanctuary.JPG |frame|Table 2: Decrease in violence indicators after introduction of Sanctuary Concept and NVC from [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] ]]
The [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/Maximum.HTM#mtu Management and Treatment Unit (MTU)] is a 14 bed unit that provides treatment to the most acutely civil and forensic male patients in need of maximum security at the [http://dhs.wisconsin.gov/mh_mendota/INDEX.HTM Mendota Mental Health Institute]in Madison Wisconsin. It provides treatment for '''patients with a history of aggression'''. In Aug 2007 the MTU team
decided to revise its ways of treatment to reduce violence. The first step was to achieve a common agreement as to the meaning of the word “violence”. The meaning was extended to include passive and non verbal violence in addition to the usual verbal and physical violence . It was finally defined to mean “behavior that increased the acuity of the unit’s environment and threatens sanctuary”. NVC training was given initially to staff and eventually used in treatment groups.Several weeks of training in NVC skills were given to patients. De-escalation plans were developed and the concept of a Sanctuary introduced based on Sandra Bloom's [http://www.amazon.com/Creating-Sanctuary-Toward-Evolution-Societies/dp/0415915686/ref=sr_1_1?ie=UTF8&s=books&qid=1246135934&sr=8-1 Sanctuary Model]. After these trainings were given the unit calmed down. After the patients and staff mutually developed their concept of sanctuary, it was implemented basically basically using the methodology of NVC. [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer (2009)] reports that the violence indicators dropped dramatically over a two year period as seen in the accompanying figure. The top bar shows that the number of injuries to staff from agression went down from 13 to 7.The next bar shows that the number of seclusion episodes were reduced from 40 to 20. The number of seclusion hours dropped from 320 to 174.Patients have Individual Emergency Response Plans (ERP) for use in emergency situations. The next bar on the graph (ERP) shows that their use dropped from 7.5 to 6.7. The use of Emergency Codes dropped from 14 to 5. The use of specially trained Emergency Intervention Teams (EIT) dropped from 62 to 32. It is important to note that the usage of Emergency Codes and EIT's declined despite the fact that patients were being managed with less reliance on restrictive measures.
Patient grievances against staff also dropped by 54% from 133 to 61.
Not only was there a reduction of forcible restraints for the patients, the staff also experienced an increase in safety. The number of [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG lost staff days] due to patient violence went down from 135 to 18 and [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG light staff days] went down from 41 to 17.

=Comparison with CA State Hospitals & Prisons=

[[Image:SplusR comparisons.jpg|center|frame|'''Table 3: Seclusion plus Restraint and Staff Injury data ordered by increasing Seclusion plus Restraint incidents]]''' is taken from a [[VPI | comparison study]] of the rates of violence in Psychiatric Institutions. Table 3 shows that the rate of violence in an institution using NVC. the Intensive Treatment Unit in 2007, is 11% of the average rate of violence for all CA State Hospitals and Prisons.

=Atascadero State Hospital=

Kathi Aichner has written a [[NVC_at_Atascadero_Sate_Hospital| report]] on the use of NVC at Atascadero State Hospital which showed that the patients were very enthusiastic about its use.

=Books=

Melanie Sears has published two books about the use of NVC in Mental Health settings. One is
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Choose your words], a book describing how NVC is used in a mental health system. The other is
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Humanizing Health Care with NVC], a book describing how the use of NVC can improve the delivery of mental health services.

=References=

[[NVC_at_Atascadero_Sate_Hospital| Aichner,K. NVC at Atascadero State Hospital, personal communication, 2008]] 
[http://www.amazon.com/Creating-Sanctuary-Toward-Evolution-Societies/dp/0415915686/ref=sr_1_1?ie=UTF8&s=books&qid=1246135934&sr=8-1 Bloom, Sandra Creating Sanctuary: Toward the Evolution of Sane Societies (1997) Routledge] 
[http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. Corwith, C. Application of Core Strategies: Reducing Seclusion & Restraint Use, On The Edge, 13(3) (2007)] 
[http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] 
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Sears, M. Choose your words, CareInAction (2007)] 
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Sears M.,Humanizing Health Care with NVC, iUniverse, Lincoln Ne, (2006)] 

''Please add any other citations to the use of NVC in Mental Health Settings to this page. If you experience difficulty in adding to this page directly , please [mailto:support@dreamsharing.info e-mail] the submission to [[User:JohnM | John Mudie]] directly.''

[[Category:SMI]]

Severe Mental Illness and NVC

2009-08-01T17:34:04Z

Johnm: /* Comparison with CA State Hospitals */

=Intention=
The intention of this page is to look at the use of [http://en.wikipedia.org/wiki/Nonviolent_Communication NonViolent Communication (NVC)] for treatment of [http://en.wikipedia.org/wiki/Mental_disorder Severe Mental Illness]

=[http://en.wikipedia.org/wiki/Nonviolent_Communication NVC] in an [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] =

[[Image:ITU_SR_hrs_pa_app_core_strat.JPG|frame|Table 1: Reduction in Seclusion and Restraint Hours]] Since revision of [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] programming in March 2004 [http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. and Corwith, C. (2007)] report the introduction of NVC into the [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] (ITU) ,at [http://dhs.wisconsin.gov/mh_mendota/INDEX.HTM Mendota Mental Health Institute] in Madison, Wisconsin , a 21 bed medium security forensic unit. [http://speakempathy.com/ Riemer] introduced a number of changes on the unit that added structure and calmness and utilizing a treatment team approach that facilitates partnership with the patient rather than control. They reduced the need for Seclusion and Restraints by using core strategies which included teaching patients how to meet their needs using therapeutic Nonviolent Communication (NVC) skills. Role playing, a NVC technique, was a major part of the staff education and training.

The use of these strategies, which included teaching NVC to patients and staff reduced the number of ITU seclusion and restraint hrs from 92 to 4 over a four year period. (see fig on right). It also reduced the [http://en.nvcwiki.com/images/ITU_SR_Inc_pa_app_core_strat_.JPG number of seclusion and restraint incidents] from 33 per yr to 2.0 per yr over the same four year period.

=[http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/Maximum.HTM#mtu Management and Treatment Unit] at Mendota Mental Health Institute=
[[Image:MTU_Violence_Indicators_Creating_Sanctuary.JPG |frame|Table 2: Decrease in violence indicators after introduction of Sanctuary Concept and NVC from [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] ]]
The [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/Maximum.HTM#mtu Management and Treatment Unit (MTU)] is a 14 bed unit that provides treatment to the most acutely civil and forensic male patients in need of maximum security at the [http://dhs.wisconsin.gov/mh_mendota/INDEX.HTM Mendota Mental Health Institute]in Madison Wisconsin. It provides treatment for '''patients with a history of aggression'''. In Aug 2007 the MTU team
decided to revise its ways of treatment to reduce violence. The first step was to achieve a common agreement as to the meaning of the word “violence”. The meaning was extended to include passive and non verbal violence in addition to the usual verbal and physical violence . It was finally defined to mean “behavior that increased the acuity of the unit’s environment and threatens sanctuary”. NVC training was given initially to staff and eventually used in treatment groups.Several weeks of training in NVC skills were given to patients. De-escalation plans were developed and the concept of a Sanctuary introduced based on Sandra Bloom's [http://www.amazon.com/Creating-Sanctuary-Toward-Evolution-Societies/dp/0415915686/ref=sr_1_1?ie=UTF8&s=books&qid=1246135934&sr=8-1 Sanctuary Model]. After these trainings were given the unit calmed down. After the patients and staff mutually developed their concept of sanctuary, it was implemented basically basically using the methodology of NVC. [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer (2009)] reports that the violence indicators dropped dramatically over a two year period as seen in the accompanying figure. The top bar shows that the number of injuries to staff from agression went down from 13 to 7.The next bar shows that the number of seclusion episodes were reduced from 40 to 20. The number of seclusion hours dropped from 320 to 174.Patients have Individual Emergency Response Plans (ERP) for use in emergency situations. The next bar on the graph (ERP) shows that their use dropped from 7.5 to 6.7. The use of Emergency Codes dropped from 14 to 5. The use of specially trained Emergency Intervention Teams (EIT) dropped from 62 to 32. It is important to note that the usage of Emergency Codes and EIT's declined despite the fact that patients were being managed with less reliance on restrictive measures.
Patient grievances against staff also dropped by 54% from 133 to 61.
Not only was there a reduction of forcible restraints for the patients, the staff also experienced an increase in safety. The number of [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG lost staff days] due to patient violence went down from 135 to 18 and [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG light staff days] went down from 41 to 17.

=Comparison with CA State Hospitas & Prisons=

[[Image:SplusR comparisons.jpg|center|frame|'''Table 3: Seclusion plus Restraint and Staff Injury data ordered by increasing Seclusion plus Restraint incidents]]''' is taken from a [[VPI | comparison study]] of the rates of violence in Psychiatric Institutions. Table 3 shows that the rate of violence in an institution using NVC. the Intensive Treatment Unit in 2007, is 11% of the average rate of violence for all CA State Hospitals and Prisons.

=Atascadero State Hospital=

Kathi Aichner has written a [[NVC_at_Atascadero_Sate_Hospital| report]] on the use of NVC at Atascadero State Hospital which showed that the patients were very enthusiastic about its use.

=Books=

Melanie Sears has published two books about the use of NVC in Mental Health settings. One is
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Choose your words], a book describing how NVC is used in a mental health system. The other is
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Humanizing Health Care with NVC], a book describing how the use of NVC can improve the delivery of mental health services.

=References=

[[NVC_at_Atascadero_Sate_Hospital| Aichner,K. NVC at Atascadero State Hospital, personal communication, 2008]] 
[http://www.amazon.com/Creating-Sanctuary-Toward-Evolution-Societies/dp/0415915686/ref=sr_1_1?ie=UTF8&s=books&qid=1246135934&sr=8-1 Bloom, Sandra Creating Sanctuary: Toward the Evolution of Sane Societies (1997) Routledge] 
[http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. Corwith, C. Application of Core Strategies: Reducing Seclusion & Restraint Use, On The Edge, 13(3) (2007)] 
[http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] 
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Sears, M. Choose your words, CareInAction (2007)] 
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Sears M.,Humanizing Health Care with NVC, iUniverse, Lincoln Ne, (2006)] 

''Please add any other citations to the use of NVC in Mental Health Settings to this page. If you experience difficulty in adding to this page directly , please [mailto:support@dreamsharing.info e-mail] the submission to [[User:JohnM | John Mudie]] directly.''

[[Category:SMI]]

Severe Mental Illness and NVC

2009-08-01T17:32:52Z

Johnm: /* Comparison with CA State Hospitals */

=Intention=
The intention of this page is to look at the use of [http://en.wikipedia.org/wiki/Nonviolent_Communication NonViolent Communication (NVC)] for treatment of [http://en.wikipedia.org/wiki/Mental_disorder Severe Mental Illness]

=[http://en.wikipedia.org/wiki/Nonviolent_Communication NVC] in an [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] =

[[Image:ITU_SR_hrs_pa_app_core_strat.JPG|frame|Table 1: Reduction in Seclusion and Restraint Hours]] Since revision of [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] programming in March 2004 [http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. and Corwith, C. (2007)] report the introduction of NVC into the [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] (ITU) ,at [http://dhs.wisconsin.gov/mh_mendota/INDEX.HTM Mendota Mental Health Institute] in Madison, Wisconsin , a 21 bed medium security forensic unit. [http://speakempathy.com/ Riemer] introduced a number of changes on the unit that added structure and calmness and utilizing a treatment team approach that facilitates partnership with the patient rather than control. They reduced the need for Seclusion and Restraints by using core strategies which included teaching patients how to meet their needs using therapeutic Nonviolent Communication (NVC) skills. Role playing, a NVC technique, was a major part of the staff education and training.

The use of these strategies, which included teaching NVC to patients and staff reduced the number of ITU seclusion and restraint hrs from 92 to 4 over a four year period. (see fig on right). It also reduced the [http://en.nvcwiki.com/images/ITU_SR_Inc_pa_app_core_strat_.JPG number of seclusion and restraint incidents] from 33 per yr to 2.0 per yr over the same four year period.

=[http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/Maximum.HTM#mtu Management and Treatment Unit] at Mendota Mental Health Institute=
[[Image:MTU_Violence_Indicators_Creating_Sanctuary.JPG |frame|Table 2: Decrease in violence indicators after introduction of Sanctuary Concept and NVC from [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] ]]
The [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/Maximum.HTM#mtu Management and Treatment Unit (MTU)] is a 14 bed unit that provides treatment to the most acutely civil and forensic male patients in need of maximum security at the [http://dhs.wisconsin.gov/mh_mendota/INDEX.HTM Mendota Mental Health Institute]in Madison Wisconsin. It provides treatment for '''patients with a history of aggression'''. In Aug 2007 the MTU team
decided to revise its ways of treatment to reduce violence. The first step was to achieve a common agreement as to the meaning of the word “violence”. The meaning was extended to include passive and non verbal violence in addition to the usual verbal and physical violence . It was finally defined to mean “behavior that increased the acuity of the unit’s environment and threatens sanctuary”. NVC training was given initially to staff and eventually used in treatment groups.Several weeks of training in NVC skills were given to patients. De-escalation plans were developed and the concept of a Sanctuary introduced based on Sandra Bloom's [http://www.amazon.com/Creating-Sanctuary-Toward-Evolution-Societies/dp/0415915686/ref=sr_1_1?ie=UTF8&s=books&qid=1246135934&sr=8-1 Sanctuary Model]. After these trainings were given the unit calmed down. After the patients and staff mutually developed their concept of sanctuary, it was implemented basically basically using the methodology of NVC. [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer (2009)] reports that the violence indicators dropped dramatically over a two year period as seen in the accompanying figure. The top bar shows that the number of injuries to staff from agression went down from 13 to 7.The next bar shows that the number of seclusion episodes were reduced from 40 to 20. The number of seclusion hours dropped from 320 to 174.Patients have Individual Emergency Response Plans (ERP) for use in emergency situations. The next bar on the graph (ERP) shows that their use dropped from 7.5 to 6.7. The use of Emergency Codes dropped from 14 to 5. The use of specially trained Emergency Intervention Teams (EIT) dropped from 62 to 32. It is important to note that the usage of Emergency Codes and EIT's declined despite the fact that patients were being managed with less reliance on restrictive measures.
Patient grievances against staff also dropped by 54% from 133 to 61.
Not only was there a reduction of forcible restraints for the patients, the staff also experienced an increase in safety. The number of [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG lost staff days] due to patient violence went down from 135 to 18 and [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG light staff days] went down from 41 to 17.

=Comparison with CA State Hospitals=

[[Image:SplusR comparisons.jpg|center|frame|'''Table 3: Seclusion plus Restraint and Staff Injury data ordered by increasing Seclusion plus Restraint incidents]]''' is taken from a [[VPI | comparison study]] of the rates of violence in Psychiatric Institutions. Table 3 shows that the rate of violence in an institution using NVC. the Intensive Treatment Unit in 2007, is 11% of the average rate of violence for all CA State Hospitals and Prisons.

=Atascadero State Hospital=

Kathi Aichner has written a [[NVC_at_Atascadero_Sate_Hospital| report]] on the use of NVC at Atascadero State Hospital which showed that the patients were very enthusiastic about its use.

=Books=

Melanie Sears has published two books about the use of NVC in Mental Health settings. One is
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Choose your words], a book describing how NVC is used in a mental health system. The other is
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Humanizing Health Care with NVC], a book describing how the use of NVC can improve the delivery of mental health services.

=References=

[[NVC_at_Atascadero_Sate_Hospital| Aichner,K. NVC at Atascadero State Hospital, personal communication, 2008]] 
[http://www.amazon.com/Creating-Sanctuary-Toward-Evolution-Societies/dp/0415915686/ref=sr_1_1?ie=UTF8&s=books&qid=1246135934&sr=8-1 Bloom, Sandra Creating Sanctuary: Toward the Evolution of Sane Societies (1997) Routledge] 
[http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. Corwith, C. Application of Core Strategies: Reducing Seclusion & Restraint Use, On The Edge, 13(3) (2007)] 
[http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] 
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Sears, M. Choose your words, CareInAction (2007)] 
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Sears M.,Humanizing Health Care with NVC, iUniverse, Lincoln Ne, (2006)] 

''Please add any other citations to the use of NVC in Mental Health Settings to this page. If you experience difficulty in adding to this page directly , please [mailto:support@dreamsharing.info e-mail] the submission to [[User:JohnM | John Mudie]] directly.''

[[Category:SMI]]

Severe Mental Illness and NVC

2009-08-01T17:31:45Z

Johnm: /* Comparison with CA State Hospitals */

=Intention=
The intention of this page is to look at the use of [http://en.wikipedia.org/wiki/Nonviolent_Communication NonViolent Communication (NVC)] for treatment of [http://en.wikipedia.org/wiki/Mental_disorder Severe Mental Illness]

=[http://en.wikipedia.org/wiki/Nonviolent_Communication NVC] in an [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] =

[[Image:ITU_SR_hrs_pa_app_core_strat.JPG|frame|Table 1: Reduction in Seclusion and Restraint Hours]] Since revision of [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] programming in March 2004 [http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. and Corwith, C. (2007)] report the introduction of NVC into the [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] (ITU) ,at [http://dhs.wisconsin.gov/mh_mendota/INDEX.HTM Mendota Mental Health Institute] in Madison, Wisconsin , a 21 bed medium security forensic unit. [http://speakempathy.com/ Riemer] introduced a number of changes on the unit that added structure and calmness and utilizing a treatment team approach that facilitates partnership with the patient rather than control. They reduced the need for Seclusion and Restraints by using core strategies which included teaching patients how to meet their needs using therapeutic Nonviolent Communication (NVC) skills. Role playing, a NVC technique, was a major part of the staff education and training.

The use of these strategies, which included teaching NVC to patients and staff reduced the number of ITU seclusion and restraint hrs from 92 to 4 over a four year period. (see fig on right). It also reduced the [http://en.nvcwiki.com/images/ITU_SR_Inc_pa_app_core_strat_.JPG number of seclusion and restraint incidents] from 33 per yr to 2.0 per yr over the same four year period.

=[http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/Maximum.HTM#mtu Management and Treatment Unit] at Mendota Mental Health Institute=
[[Image:MTU_Violence_Indicators_Creating_Sanctuary.JPG |frame|Table 2: Decrease in violence indicators after introduction of Sanctuary Concept and NVC from [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] ]]
The [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/Maximum.HTM#mtu Management and Treatment Unit (MTU)] is a 14 bed unit that provides treatment to the most acutely civil and forensic male patients in need of maximum security at the [http://dhs.wisconsin.gov/mh_mendota/INDEX.HTM Mendota Mental Health Institute]in Madison Wisconsin. It provides treatment for '''patients with a history of aggression'''. In Aug 2007 the MTU team
decided to revise its ways of treatment to reduce violence. The first step was to achieve a common agreement as to the meaning of the word “violence”. The meaning was extended to include passive and non verbal violence in addition to the usual verbal and physical violence . It was finally defined to mean “behavior that increased the acuity of the unit’s environment and threatens sanctuary”. NVC training was given initially to staff and eventually used in treatment groups.Several weeks of training in NVC skills were given to patients. De-escalation plans were developed and the concept of a Sanctuary introduced based on Sandra Bloom's [http://www.amazon.com/Creating-Sanctuary-Toward-Evolution-Societies/dp/0415915686/ref=sr_1_1?ie=UTF8&s=books&qid=1246135934&sr=8-1 Sanctuary Model]. After these trainings were given the unit calmed down. After the patients and staff mutually developed their concept of sanctuary, it was implemented basically basically using the methodology of NVC. [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer (2009)] reports that the violence indicators dropped dramatically over a two year period as seen in the accompanying figure. The top bar shows that the number of injuries to staff from agression went down from 13 to 7.The next bar shows that the number of seclusion episodes were reduced from 40 to 20. The number of seclusion hours dropped from 320 to 174.Patients have Individual Emergency Response Plans (ERP) for use in emergency situations. The next bar on the graph (ERP) shows that their use dropped from 7.5 to 6.7. The use of Emergency Codes dropped from 14 to 5. The use of specially trained Emergency Intervention Teams (EIT) dropped from 62 to 32. It is important to note that the usage of Emergency Codes and EIT's declined despite the fact that patients were being managed with less reliance on restrictive measures.
Patient grievances against staff also dropped by 54% from 133 to 61.
Not only was there a reduction of forcible restraints for the patients, the staff also experienced an increase in safety. The number of [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG lost staff days] due to patient violence went down from 135 to 18 and [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG light staff days] went down from 41 to 17.

=Comparison with CA State Hospitals=

[[Image:SplusR comparisons.jpg|center|frame|'''Table 3: Seclusion plus Restraint and Staff Injury data ordered by increasing Seclusion plus Restraint incidents]]''' is taken from a [[VPI | comaprison study]] of the rates of violence in Psyhicatric Instituions. Table 3 shows that the rate of violence in an institution using NVC. the Intensive Treatment Unit in 2007, is 11% of the avergae rate of violence for all CA State Psychiatric Units.

=Atascadero State Hospital=

Kathi Aichner has written a [[NVC_at_Atascadero_Sate_Hospital| report]] on the use of NVC at Atascadero State Hospital which showed that the patients were very enthusiastic about its use.

=Books=

Melanie Sears has published two books about the use of NVC in Mental Health settings. One is
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Choose your words], a book describing how NVC is used in a mental health system. The other is
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Humanizing Health Care with NVC], a book describing how the use of NVC can improve the delivery of mental health services.

=References=

[[NVC_at_Atascadero_Sate_Hospital| Aichner,K. NVC at Atascadero State Hospital, personal communication, 2008]] 
[http://www.amazon.com/Creating-Sanctuary-Toward-Evolution-Societies/dp/0415915686/ref=sr_1_1?ie=UTF8&s=books&qid=1246135934&sr=8-1 Bloom, Sandra Creating Sanctuary: Toward the Evolution of Sane Societies (1997) Routledge] 
[http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. Corwith, C. Application of Core Strategies: Reducing Seclusion & Restraint Use, On The Edge, 13(3) (2007)] 
[http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] 
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Sears, M. Choose your words, CareInAction (2007)] 
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Sears M.,Humanizing Health Care with NVC, iUniverse, Lincoln Ne, (2006)] 

''Please add any other citations to the use of NVC in Mental Health Settings to this page. If you experience difficulty in adding to this page directly , please [mailto:support@dreamsharing.info e-mail] the submission to [[User:JohnM | John Mudie]] directly.''

[[Category:SMI]]

Severe Mental Illness and NVC

2009-08-01T17:26:49Z

Johnm: /* Comparison with CA State Hospitals */

=Intention=
The intention of this page is to look at the use of [http://en.wikipedia.org/wiki/Nonviolent_Communication NonViolent Communication (NVC)] for treatment of [http://en.wikipedia.org/wiki/Mental_disorder Severe Mental Illness]

=[http://en.wikipedia.org/wiki/Nonviolent_Communication NVC] in an [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] =

[[Image:ITU_SR_hrs_pa_app_core_strat.JPG|frame|Table 1: Reduction in Seclusion and Restraint Hours]] Since revision of [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] programming in March 2004 [http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. and Corwith, C. (2007)] report the introduction of NVC into the [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] (ITU) ,at [http://dhs.wisconsin.gov/mh_mendota/INDEX.HTM Mendota Mental Health Institute] in Madison, Wisconsin , a 21 bed medium security forensic unit. [http://speakempathy.com/ Riemer] introduced a number of changes on the unit that added structure and calmness and utilizing a treatment team approach that facilitates partnership with the patient rather than control. They reduced the need for Seclusion and Restraints by using core strategies which included teaching patients how to meet their needs using therapeutic Nonviolent Communication (NVC) skills. Role playing, a NVC technique, was a major part of the staff education and training.

The use of these strategies, which included teaching NVC to patients and staff reduced the number of ITU seclusion and restraint hrs from 92 to 4 over a four year period. (see fig on right). It also reduced the [http://en.nvcwiki.com/images/ITU_SR_Inc_pa_app_core_strat_.JPG number of seclusion and restraint incidents] from 33 per yr to 2.0 per yr over the same four year period.

=[http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/Maximum.HTM#mtu Management and Treatment Unit] at Mendota Mental Health Institute=
[[Image:MTU_Violence_Indicators_Creating_Sanctuary.JPG |frame|Table 2: Decrease in violence indicators after introduction of Sanctuary Concept and NVC from [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] ]]
The [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/Maximum.HTM#mtu Management and Treatment Unit (MTU)] is a 14 bed unit that provides treatment to the most acutely civil and forensic male patients in need of maximum security at the [http://dhs.wisconsin.gov/mh_mendota/INDEX.HTM Mendota Mental Health Institute]in Madison Wisconsin. It provides treatment for '''patients with a history of aggression'''. In Aug 2007 the MTU team
decided to revise its ways of treatment to reduce violence. The first step was to achieve a common agreement as to the meaning of the word “violence”. The meaning was extended to include passive and non verbal violence in addition to the usual verbal and physical violence . It was finally defined to mean “behavior that increased the acuity of the unit’s environment and threatens sanctuary”. NVC training was given initially to staff and eventually used in treatment groups.Several weeks of training in NVC skills were given to patients. De-escalation plans were developed and the concept of a Sanctuary introduced based on Sandra Bloom's [http://www.amazon.com/Creating-Sanctuary-Toward-Evolution-Societies/dp/0415915686/ref=sr_1_1?ie=UTF8&s=books&qid=1246135934&sr=8-1 Sanctuary Model]. After these trainings were given the unit calmed down. After the patients and staff mutually developed their concept of sanctuary, it was implemented basically basically using the methodology of NVC. [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer (2009)] reports that the violence indicators dropped dramatically over a two year period as seen in the accompanying figure. The top bar shows that the number of injuries to staff from agression went down from 13 to 7.The next bar shows that the number of seclusion episodes were reduced from 40 to 20. The number of seclusion hours dropped from 320 to 174.Patients have Individual Emergency Response Plans (ERP) for use in emergency situations. The next bar on the graph (ERP) shows that their use dropped from 7.5 to 6.7. The use of Emergency Codes dropped from 14 to 5. The use of specially trained Emergency Intervention Teams (EIT) dropped from 62 to 32. It is important to note that the usage of Emergency Codes and EIT's declined despite the fact that patients were being managed with less reliance on restrictive measures.
Patient grievances against staff also dropped by 54% from 133 to 61.
Not only was there a reduction of forcible restraints for the patients, the staff also experienced an increase in safety. The number of [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG lost staff days] due to patient violence went down from 135 to 18 and [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG light staff days] went down from 41 to 17.

=Comparison with CA State Hospitals=

[[Image:SplusR comparisons.jpg|center|frame|'''Table 3: Seclusion plus Restraint and Staff Injury data ordered by increasing Seclusion plus Restraint incidents]]''' is taken from a [[VPI | comaprison study]] of the rates of violence in Psyhicatric Instituions. Table 3 shows that the rate of violence in an institution using NVC is one tenth of the rate of violence in instituions using NVC.

=Atascadero State Hospital=

Kathi Aichner has written a [[NVC_at_Atascadero_Sate_Hospital| report]] on the use of NVC at Atascadero State Hospital which showed that the patients were very enthusiastic about its use.

=Books=

Melanie Sears has published two books about the use of NVC in Mental Health settings. One is
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Choose your words], a book describing how NVC is used in a mental health system. The other is
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Humanizing Health Care with NVC], a book describing how the use of NVC can improve the delivery of mental health services.

=References=

[[NVC_at_Atascadero_Sate_Hospital| Aichner,K. NVC at Atascadero State Hospital, personal communication, 2008]] 
[http://www.amazon.com/Creating-Sanctuary-Toward-Evolution-Societies/dp/0415915686/ref=sr_1_1?ie=UTF8&s=books&qid=1246135934&sr=8-1 Bloom, Sandra Creating Sanctuary: Toward the Evolution of Sane Societies (1997) Routledge] 
[http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. Corwith, C. Application of Core Strategies: Reducing Seclusion & Restraint Use, On The Edge, 13(3) (2007)] 
[http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] 
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Sears, M. Choose your words, CareInAction (2007)] 
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Sears M.,Humanizing Health Care with NVC, iUniverse, Lincoln Ne, (2006)] 

''Please add any other citations to the use of NVC in Mental Health Settings to this page. If you experience difficulty in adding to this page directly , please [mailto:support@dreamsharing.info e-mail] the submission to [[User:JohnM | John Mudie]] directly.''

[[Category:SMI]]

Severe Mental Illness and NVC

2009-08-01T17:26:06Z

Johnm: /* [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/Maximum.HTM#mtu Management and Treatment Unit] at Mendota Mental Health Institute */

=Intention=
The intention of this page is to look at the use of [http://en.wikipedia.org/wiki/Nonviolent_Communication NonViolent Communication (NVC)] for treatment of [http://en.wikipedia.org/wiki/Mental_disorder Severe Mental Illness]

=[http://en.wikipedia.org/wiki/Nonviolent_Communication NVC] in an [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] =

[[Image:ITU_SR_hrs_pa_app_core_strat.JPG|frame|Table 1: Reduction in Seclusion and Restraint Hours]] Since revision of [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] programming in March 2004 [http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. and Corwith, C. (2007)] report the introduction of NVC into the [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] (ITU) ,at [http://dhs.wisconsin.gov/mh_mendota/INDEX.HTM Mendota Mental Health Institute] in Madison, Wisconsin , a 21 bed medium security forensic unit. [http://speakempathy.com/ Riemer] introduced a number of changes on the unit that added structure and calmness and utilizing a treatment team approach that facilitates partnership with the patient rather than control. They reduced the need for Seclusion and Restraints by using core strategies which included teaching patients how to meet their needs using therapeutic Nonviolent Communication (NVC) skills. Role playing, a NVC technique, was a major part of the staff education and training.

The use of these strategies, which included teaching NVC to patients and staff reduced the number of ITU seclusion and restraint hrs from 92 to 4 over a four year period. (see fig on right). It also reduced the [http://en.nvcwiki.com/images/ITU_SR_Inc_pa_app_core_strat_.JPG number of seclusion and restraint incidents] from 33 per yr to 2.0 per yr over the same four year period.

=[http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/Maximum.HTM#mtu Management and Treatment Unit] at Mendota Mental Health Institute=
[[Image:MTU_Violence_Indicators_Creating_Sanctuary.JPG |frame|Table 2: Decrease in violence indicators after introduction of Sanctuary Concept and NVC from [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] ]]
The [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/Maximum.HTM#mtu Management and Treatment Unit (MTU)] is a 14 bed unit that provides treatment to the most acutely civil and forensic male patients in need of maximum security at the [http://dhs.wisconsin.gov/mh_mendota/INDEX.HTM Mendota Mental Health Institute]in Madison Wisconsin. It provides treatment for '''patients with a history of aggression'''. In Aug 2007 the MTU team
decided to revise its ways of treatment to reduce violence. The first step was to achieve a common agreement as to the meaning of the word “violence”. The meaning was extended to include passive and non verbal violence in addition to the usual verbal and physical violence . It was finally defined to mean “behavior that increased the acuity of the unit’s environment and threatens sanctuary”. NVC training was given initially to staff and eventually used in treatment groups.Several weeks of training in NVC skills were given to patients. De-escalation plans were developed and the concept of a Sanctuary introduced based on Sandra Bloom's [http://www.amazon.com/Creating-Sanctuary-Toward-Evolution-Societies/dp/0415915686/ref=sr_1_1?ie=UTF8&s=books&qid=1246135934&sr=8-1 Sanctuary Model]. After these trainings were given the unit calmed down. After the patients and staff mutually developed their concept of sanctuary, it was implemented basically basically using the methodology of NVC. [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer (2009)] reports that the violence indicators dropped dramatically over a two year period as seen in the accompanying figure. The top bar shows that the number of injuries to staff from agression went down from 13 to 7.The next bar shows that the number of seclusion episodes were reduced from 40 to 20. The number of seclusion hours dropped from 320 to 174.Patients have Individual Emergency Response Plans (ERP) for use in emergency situations. The next bar on the graph (ERP) shows that their use dropped from 7.5 to 6.7. The use of Emergency Codes dropped from 14 to 5. The use of specially trained Emergency Intervention Teams (EIT) dropped from 62 to 32. It is important to note that the usage of Emergency Codes and EIT's declined despite the fact that patients were being managed with less reliance on restrictive measures.
Patient grievances against staff also dropped by 54% from 133 to 61.
Not only was there a reduction of forcible restraints for the patients, the staff also experienced an increase in safety. The number of [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG lost staff days] due to patient violence went down from 135 to 18 and [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG light staff days] went down from 41 to 17.

=Comparison with CA State Hospitals=

[[Image:SplusR comparisons.jpg|center|frame|'''Table 1: Seclusion plus Restraint and Staff Injury data ordered by increasing Seclusion plus Restraint incidents]]''' is taken from a [[VPI | comaprison study]] of the rates of violence in Psyhicatric Instituions. It shows that the rate of violence in an institution using NVC is one tenth of the rate of violence in instituions using NVC.

=Atascadero State Hospital=

Kathi Aichner has written a [[NVC_at_Atascadero_Sate_Hospital| report]] on the use of NVC at Atascadero State Hospital which showed that the patients were very enthusiastic about its use.

=Books=

Melanie Sears has published two books about the use of NVC in Mental Health settings. One is
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Choose your words], a book describing how NVC is used in a mental health system. The other is
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Humanizing Health Care with NVC], a book describing how the use of NVC can improve the delivery of mental health services.

=References=

[[NVC_at_Atascadero_Sate_Hospital| Aichner,K. NVC at Atascadero State Hospital, personal communication, 2008]] 
[http://www.amazon.com/Creating-Sanctuary-Toward-Evolution-Societies/dp/0415915686/ref=sr_1_1?ie=UTF8&s=books&qid=1246135934&sr=8-1 Bloom, Sandra Creating Sanctuary: Toward the Evolution of Sane Societies (1997) Routledge] 
[http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. Corwith, C. Application of Core Strategies: Reducing Seclusion & Restraint Use, On The Edge, 13(3) (2007)] 
[http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] 
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Sears, M. Choose your words, CareInAction (2007)] 
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Sears M.,Humanizing Health Care with NVC, iUniverse, Lincoln Ne, (2006)] 

''Please add any other citations to the use of NVC in Mental Health Settings to this page. If you experience difficulty in adding to this page directly , please [mailto:support@dreamsharing.info e-mail] the submission to [[User:JohnM | John Mudie]] directly.''

[[Category:SMI]]

Severe Mental Illness and NVC

2009-08-01T17:25:18Z

Johnm: /* [http://en.wikipedia.org/wiki/Nonviolent_Communication NVC] in an [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] */

=Intention=
The intention of this page is to look at the use of [http://en.wikipedia.org/wiki/Nonviolent_Communication NonViolent Communication (NVC)] for treatment of [http://en.wikipedia.org/wiki/Mental_disorder Severe Mental Illness]

=[http://en.wikipedia.org/wiki/Nonviolent_Communication NVC] in an [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] =

[[Image:ITU_SR_hrs_pa_app_core_strat.JPG|frame|Table 1: Reduction in Seclusion and Restraint Hours]] Since revision of [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] programming in March 2004 [http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. and Corwith, C. (2007)] report the introduction of NVC into the [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] (ITU) ,at [http://dhs.wisconsin.gov/mh_mendota/INDEX.HTM Mendota Mental Health Institute] in Madison, Wisconsin , a 21 bed medium security forensic unit. [http://speakempathy.com/ Riemer] introduced a number of changes on the unit that added structure and calmness and utilizing a treatment team approach that facilitates partnership with the patient rather than control. They reduced the need for Seclusion and Restraints by using core strategies which included teaching patients how to meet their needs using therapeutic Nonviolent Communication (NVC) skills. Role playing, a NVC technique, was a major part of the staff education and training.

The use of these strategies, which included teaching NVC to patients and staff reduced the number of ITU seclusion and restraint hrs from 92 to 4 over a four year period. (see fig on right). It also reduced the [http://en.nvcwiki.com/images/ITU_SR_Inc_pa_app_core_strat_.JPG number of seclusion and restraint incidents] from 33 per yr to 2.0 per yr over the same four year period.

=[http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/Maximum.HTM#mtu Management and Treatment Unit] at Mendota Mental Health Institute=
[[Image:MTU_Violence_Indicators_Creating_Sanctuary.JPG |frame|Decrease in violence indicators after introduction of Sanctuary Concept and NVC from [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] ]]
The [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/Maximum.HTM#mtu Management and Treatment Unit (MTU)] is a 14 bed unit that provides treatment to the most acutely civil and forensic male patients in need of maximum security at the [http://dhs.wisconsin.gov/mh_mendota/INDEX.HTM Mendota Mental Health Institute]in Madison Wisconsin. It provides treatment for '''patients with a history of aggression'''. In Aug 2007 the MTU team
decided to revise its ways of treatment to reduce violence. The first step was to achieve a common agreement as to the meaning of the word “violence”. The meaning was extended to include passive and non verbal violence in addition to the usual verbal and physical violence . It was finally defined to mean “behavior that increased the acuity of the unit’s environment and threatens sanctuary”. NVC training was given initially to staff and eventually used in treatment groups.Several weeks of training in NVC skills were given to patients. De-escalation plans were developed and the concept of a Sanctuary introduced based on Sandra Bloom's [http://www.amazon.com/Creating-Sanctuary-Toward-Evolution-Societies/dp/0415915686/ref=sr_1_1?ie=UTF8&s=books&qid=1246135934&sr=8-1 Sanctuary Model]. After these trainings were given the unit calmed down. After the patients and staff mutually developed their concept of sanctuary, it was implemented basically basically using the methodology of NVC. [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer (2009)] reports that the violence indicators dropped dramatically over a two year period as seen in the accompanying figure. The top bar shows that the number of injuries to staff from agression went down from 13 to 7.The next bar shows that the number of seclusion episodes were reduced from 40 to 20. The number of seclusion hours dropped from 320 to 174.Patients have Individual Emergency Response Plans (ERP) for use in emergency situations. The next bar on the graph (ERP) shows that their use dropped from 7.5 to 6.7. The use of Emergency Codes dropped from 14 to 5. The use of specially trained Emergency Intervention Teams (EIT) dropped from 62 to 32. It is important to note that the usage of Emergency Codes and EIT's declined despite the fact that patients were being managed with less reliance on restrictive measures.
Patient grievances against staff also dropped by 54% from 133 to 61.
Not only was there a reduction of forcible restraints for the patients, the staff also experienced an increase in safety. The number of [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG lost staff days] due to patient violence went down from 135 to 18 and [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG light staff days] went down from 41 to 17.

=Comparison with CA State Hospitals=

[[Image:SplusR comparisons.jpg|center|frame|'''Table 1: Seclusion plus Restraint and Staff Injury data ordered by increasing Seclusion plus Restraint incidents]]''' is taken from a [[VPI | comaprison study]] of the rates of violence in Psyhicatric Instituions. It shows that the rate of violence in an institution using NVC is one tenth of the rate of violence in instituions using NVC.

=Atascadero State Hospital=

Kathi Aichner has written a [[NVC_at_Atascadero_Sate_Hospital| report]] on the use of NVC at Atascadero State Hospital which showed that the patients were very enthusiastic about its use.

=Books=

Melanie Sears has published two books about the use of NVC in Mental Health settings. One is
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Choose your words], a book describing how NVC is used in a mental health system. The other is
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Humanizing Health Care with NVC], a book describing how the use of NVC can improve the delivery of mental health services.

=References=

[[NVC_at_Atascadero_Sate_Hospital| Aichner,K. NVC at Atascadero State Hospital, personal communication, 2008]] 
[http://www.amazon.com/Creating-Sanctuary-Toward-Evolution-Societies/dp/0415915686/ref=sr_1_1?ie=UTF8&s=books&qid=1246135934&sr=8-1 Bloom, Sandra Creating Sanctuary: Toward the Evolution of Sane Societies (1997) Routledge] 
[http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. Corwith, C. Application of Core Strategies: Reducing Seclusion & Restraint Use, On The Edge, 13(3) (2007)] 
[http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] 
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Sears, M. Choose your words, CareInAction (2007)] 
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Sears M.,Humanizing Health Care with NVC, iUniverse, Lincoln Ne, (2006)] 

''Please add any other citations to the use of NVC in Mental Health Settings to this page. If you experience difficulty in adding to this page directly , please [mailto:support@dreamsharing.info e-mail] the submission to [[User:JohnM | John Mudie]] directly.''

[[Category:SMI]]

Severe Mental Illness and NVC

2009-08-01T17:21:47Z

Johnm: /* [http://en.wikipedia.org/wiki/Nonviolent_Communication NVC] in an [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] */

=Intention=
The intention of this page is to look at the use of [http://en.wikipedia.org/wiki/Nonviolent_Communication NonViolent Communication (NVC)] for treatment of [http://en.wikipedia.org/wiki/Mental_disorder Severe Mental Illness]

=[http://en.wikipedia.org/wiki/Nonviolent_Communication NVC] in an [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] =

[[Image:ITU_SR_hrs_pa_app_core_strat.JPG|frame|Reduction in Seclusion and Restraint Hours]] Since revision of [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] programming in March 2004 [http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. and Corwith, C. (2007)] report the introduction of NVC into the [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] (ITU) ,at [http://dhs.wisconsin.gov/mh_mendota/INDEX.HTM Mendota Mental Health Institute] in Madison, Wisconsin , a 21 bed medium security forensic unit. [http://speakempathy.com/ Riemer] introduced a number of changes on the unit that added structure and calmness and utilizing a treatment team approach that facilitates partnership with the patient rather than control. They reduced the need for Seclusion and Restraints by using core strategies which included teaching patients how to meet their needs using therapeutic Nonviolent Communication (NVC) skills. Role playing, a NVC technique, was a major part of the staff education and training.

The use of these strategies, which included teaching NVC to patients and staff reduced the number of ITU seclusion and restraint hrs from 92 to 4 over a four year period. (see fig on right). It also reduced the [http://en.nvcwiki.com/images/ITU_SR_Inc_pa_app_core_strat_.JPG Table 1: Number of seclusion and restraint incidents] from 33 per yr to 2.0 per yr over the same four year period.

=[http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/Maximum.HTM#mtu Management and Treatment Unit] at Mendota Mental Health Institute=
[[Image:MTU_Violence_Indicators_Creating_Sanctuary.JPG |frame|Decrease in violence indicators after introduction of Sanctuary Concept and NVC from [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] ]]
The [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/Maximum.HTM#mtu Management and Treatment Unit (MTU)] is a 14 bed unit that provides treatment to the most acutely civil and forensic male patients in need of maximum security at the [http://dhs.wisconsin.gov/mh_mendota/INDEX.HTM Mendota Mental Health Institute]in Madison Wisconsin. It provides treatment for '''patients with a history of aggression'''. In Aug 2007 the MTU team
decided to revise its ways of treatment to reduce violence. The first step was to achieve a common agreement as to the meaning of the word “violence”. The meaning was extended to include passive and non verbal violence in addition to the usual verbal and physical violence . It was finally defined to mean “behavior that increased the acuity of the unit’s environment and threatens sanctuary”. NVC training was given initially to staff and eventually used in treatment groups.Several weeks of training in NVC skills were given to patients. De-escalation plans were developed and the concept of a Sanctuary introduced based on Sandra Bloom's [http://www.amazon.com/Creating-Sanctuary-Toward-Evolution-Societies/dp/0415915686/ref=sr_1_1?ie=UTF8&s=books&qid=1246135934&sr=8-1 Sanctuary Model]. After these trainings were given the unit calmed down. After the patients and staff mutually developed their concept of sanctuary, it was implemented basically basically using the methodology of NVC. [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer (2009)] reports that the violence indicators dropped dramatically over a two year period as seen in the accompanying figure. The top bar shows that the number of injuries to staff from agression went down from 13 to 7.The next bar shows that the number of seclusion episodes were reduced from 40 to 20. The number of seclusion hours dropped from 320 to 174.Patients have Individual Emergency Response Plans (ERP) for use in emergency situations. The next bar on the graph (ERP) shows that their use dropped from 7.5 to 6.7. The use of Emergency Codes dropped from 14 to 5. The use of specially trained Emergency Intervention Teams (EIT) dropped from 62 to 32. It is important to note that the usage of Emergency Codes and EIT's declined despite the fact that patients were being managed with less reliance on restrictive measures.
Patient grievances against staff also dropped by 54% from 133 to 61.
Not only was there a reduction of forcible restraints for the patients, the staff also experienced an increase in safety. The number of [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG lost staff days] due to patient violence went down from 135 to 18 and [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG light staff days] went down from 41 to 17.

=Comparison with CA State Hospitals=

[[Image:SplusR comparisons.jpg|center|frame|'''Table 1: Seclusion plus Restraint and Staff Injury data ordered by increasing Seclusion plus Restraint incidents]]''' is taken from a [[VPI | comaprison study]] of the rates of violence in Psyhicatric Instituions. It shows that the rate of violence in an institution using NVC is one tenth of the rate of violence in instituions using NVC.

=Atascadero State Hospital=

Kathi Aichner has written a [[NVC_at_Atascadero_Sate_Hospital| report]] on the use of NVC at Atascadero State Hospital which showed that the patients were very enthusiastic about its use.

=Books=

Melanie Sears has published two books about the use of NVC in Mental Health settings. One is
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Choose your words], a book describing how NVC is used in a mental health system. The other is
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Humanizing Health Care with NVC], a book describing how the use of NVC can improve the delivery of mental health services.

=References=

[[NVC_at_Atascadero_Sate_Hospital| Aichner,K. NVC at Atascadero State Hospital, personal communication, 2008]] 
[http://www.amazon.com/Creating-Sanctuary-Toward-Evolution-Societies/dp/0415915686/ref=sr_1_1?ie=UTF8&s=books&qid=1246135934&sr=8-1 Bloom, Sandra Creating Sanctuary: Toward the Evolution of Sane Societies (1997) Routledge] 
[http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. Corwith, C. Application of Core Strategies: Reducing Seclusion & Restraint Use, On The Edge, 13(3) (2007)] 
[http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] 
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Sears, M. Choose your words, CareInAction (2007)] 
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Sears M.,Humanizing Health Care with NVC, iUniverse, Lincoln Ne, (2006)] 

''Please add any other citations to the use of NVC in Mental Health Settings to this page. If you experience difficulty in adding to this page directly , please [mailto:support@dreamsharing.info e-mail] the submission to [[User:JohnM | John Mudie]] directly.''

[[Category:SMI]]

Severe Mental Illness and NVC

2009-08-01T17:20:48Z

Johnm: /* Comparison with CA State Hospitals */ incorporating results from CA state hospitals

=Intention=
The intention of this page is to look at the use of [http://en.wikipedia.org/wiki/Nonviolent_Communication NonViolent Communication (NVC)] for treatment of [http://en.wikipedia.org/wiki/Mental_disorder Severe Mental Illness]

=[http://en.wikipedia.org/wiki/Nonviolent_Communication NVC] in an [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] =

[[Image:ITU_SR_hrs_pa_app_core_strat.JPG|frame|Reduction in Seclusion and Restraint Hours]] Since revision of [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] programming in March 2004 [http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. and Corwith, C. (2007)] report the introduction of NVC into the [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] (ITU) ,at [http://dhs.wisconsin.gov/mh_mendota/INDEX.HTM Mendota Mental Health Institute] in Madison, Wisconsin , a 21 bed medium security forensic unit. [http://speakempathy.com/ Riemer] introduced a number of changes on the unit that added structure and calmness and utilizing a treatment team approach that facilitates partnership with the patient rather than control. They reduced the need for Seclusion and Restraints by using core strategies which included teaching patients how to meet their needs using therapeutic Nonviolent Communication (NVC) skills. Role playing, a NVC technique, was a major part of the staff education and training.

The use of these strategies, which included teaching NVC to patients and staff reduced the number of ITU seclusion and restraint hrs from 92 to 4 over a four year period. (see fig on right). It also reduced the [http://en.nvcwiki.com/images/ITU_SR_Inc_pa_app_core_strat_.JPG number of seclusion and restraint incidents] from 33 per yr to 2.0 per yr over the same four year period.

=[http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/Maximum.HTM#mtu Management and Treatment Unit] at Mendota Mental Health Institute=
[[Image:MTU_Violence_Indicators_Creating_Sanctuary.JPG |frame|Decrease in violence indicators after introduction of Sanctuary Concept and NVC from [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] ]]
The [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/Maximum.HTM#mtu Management and Treatment Unit (MTU)] is a 14 bed unit that provides treatment to the most acutely civil and forensic male patients in need of maximum security at the [http://dhs.wisconsin.gov/mh_mendota/INDEX.HTM Mendota Mental Health Institute]in Madison Wisconsin. It provides treatment for '''patients with a history of aggression'''. In Aug 2007 the MTU team
decided to revise its ways of treatment to reduce violence. The first step was to achieve a common agreement as to the meaning of the word “violence”. The meaning was extended to include passive and non verbal violence in addition to the usual verbal and physical violence . It was finally defined to mean “behavior that increased the acuity of the unit’s environment and threatens sanctuary”. NVC training was given initially to staff and eventually used in treatment groups.Several weeks of training in NVC skills were given to patients. De-escalation plans were developed and the concept of a Sanctuary introduced based on Sandra Bloom's [http://www.amazon.com/Creating-Sanctuary-Toward-Evolution-Societies/dp/0415915686/ref=sr_1_1?ie=UTF8&s=books&qid=1246135934&sr=8-1 Sanctuary Model]. After these trainings were given the unit calmed down. After the patients and staff mutually developed their concept of sanctuary, it was implemented basically basically using the methodology of NVC. [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer (2009)] reports that the violence indicators dropped dramatically over a two year period as seen in the accompanying figure. The top bar shows that the number of injuries to staff from agression went down from 13 to 7.The next bar shows that the number of seclusion episodes were reduced from 40 to 20. The number of seclusion hours dropped from 320 to 174.Patients have Individual Emergency Response Plans (ERP) for use in emergency situations. The next bar on the graph (ERP) shows that their use dropped from 7.5 to 6.7. The use of Emergency Codes dropped from 14 to 5. The use of specially trained Emergency Intervention Teams (EIT) dropped from 62 to 32. It is important to note that the usage of Emergency Codes and EIT's declined despite the fact that patients were being managed with less reliance on restrictive measures.
Patient grievances against staff also dropped by 54% from 133 to 61.
Not only was there a reduction of forcible restraints for the patients, the staff also experienced an increase in safety. The number of [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG lost staff days] due to patient violence went down from 135 to 18 and [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG light staff days] went down from 41 to 17.

=Comparison with CA State Hospitals=

[[Image:SplusR comparisons.jpg|center|frame|'''Table 1: Seclusion plus Restraint and Staff Injury data ordered by increasing Seclusion plus Restraint incidents]]''' is taken from a [[VPI | comaprison study]] of the rates of violence in Psyhicatric Instituions. It shows that the rate of violence in an institution using NVC is one tenth of the rate of violence in instituions using NVC.

=Atascadero State Hospital=

Kathi Aichner has written a [[NVC_at_Atascadero_Sate_Hospital| report]] on the use of NVC at Atascadero State Hospital which showed that the patients were very enthusiastic about its use.

=Books=

Melanie Sears has published two books about the use of NVC in Mental Health settings. One is
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Choose your words], a book describing how NVC is used in a mental health system. The other is
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Humanizing Health Care with NVC], a book describing how the use of NVC can improve the delivery of mental health services.

=References=

[[NVC_at_Atascadero_Sate_Hospital| Aichner,K. NVC at Atascadero State Hospital, personal communication, 2008]] 
[http://www.amazon.com/Creating-Sanctuary-Toward-Evolution-Societies/dp/0415915686/ref=sr_1_1?ie=UTF8&s=books&qid=1246135934&sr=8-1 Bloom, Sandra Creating Sanctuary: Toward the Evolution of Sane Societies (1997) Routledge] 
[http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. Corwith, C. Application of Core Strategies: Reducing Seclusion & Restraint Use, On The Edge, 13(3) (2007)] 
[http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] 
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Sears, M. Choose your words, CareInAction (2007)] 
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Sears M.,Humanizing Health Care with NVC, iUniverse, Lincoln Ne, (2006)] 

''Please add any other citations to the use of NVC in Mental Health Settings to this page. If you experience difficulty in adding to this page directly , please [mailto:support@dreamsharing.info e-mail] the submission to [[User:JohnM | John Mudie]] directly.''

[[Category:SMI]]

Violence in Psychiatric Institutions

2009-08-01T17:14:34Z

Johnm: /* Results */

=Intention=
The intention of this page is to review measures of the use of violence in psychiatric institutions particularly those using [http://en.wikipedia.org/wiki/Nonviolent_Communication Nonviolent Communication] developed by [http://en.wikipedia.org/wiki/Nonviolent_Communication Marshall Rosenberg].

=Methodology=

Published and unpublished data were collected from a variety of sources (see tables). The data collected consisted of:
#number of seclusion incidents,
#number of hours patients were secluded,
#number of restraint incidents,
#number of hours patients were restrained
#number of staff injuries over a period of time.
. The data was then "normalized" by expressing the data per 1000 patient days. When the number of patient days during the observation period was not available, the unit capacity times length of data collection period was used as an estimate of patient days.

In some cases only combined seclusion plus restraint data were available so these were compared with the calculated seclusion plus restraint data for other institutions.

A "blank" entry in a results table indicates that the data were unavailable

=Results=

[[Image:SplusR comparisons.jpg|center|frame|'''Table 1: Seclusion plus Restraint and Staff Injury data ordered by increasing Seclusion plus Restraint incidents]]'''
 
The total seclusion plus restraint data show that only three institutions had Seclusion plus Comparison incident rate of less than 1.0 incident rate per 1000 patient days. These were Coalinga State Hospital and the Intensive Treatment Unit (ITU) during years that Nonviolent Communication was being used. During a previous year (2003) when the ITU was not using NVC, the violence rate was comparable (4.31) to that of other Ca State Hospitals.
 
The high rate (36.13) associated with the Santa Barbara Psychiatric Health Facility is most probably in large measure due to the fact that it only accepts people when they are in crisis in contrast to the CA State Hospitals which have relatively stable populations.

[[Image:Sec annual comparisons .jpg|center|frame|Table 2: '''Seclusion and Staff Injury data ordered by increasing Seclusion incidents''' ]]
 
In Table 2,the institution using NVC , the Management and Treatment unit (MTU), does not appear to show a significant improvement over the CA State Hospitals. Its rate (3.91 incidents / 1000 patient days) is relatively high. The MTU caters for a very special population. It treats the most violent from jails, hospitals , prisons, and community and and gets the hardest cases in the state.
According to Riemer(2009) it is the most secure of four maximum security units and provides treatment "to the most acutely aggressive civil and forensic patients in need of maximum security".
 

=References=

Garrity, M. (2009) Pychiatric Health Facility Seclusion and Restraints Statistics (personal communication) 2009 
[http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. Corwith, C. Application of Core Strategies: Reducing Seclusion & Restraint Use, On The Edge, 13(3) (2007)] 
[http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] 
Stringer,K a Using Quality Imporvement (QI) as a tool to reduce seclsion and restraints (S/R) and data sharing on the internet, presentation (2009) 
Stringer K,b Excel spreadsheet incorporating [http://www.dmh.ca.gov/Services_and_Programs/State_Hospitals/S_and_R/default.asp CA Dept of Mental Health Data on seclusions and restraints] (personal communication) 2009.

''Please add any other reports of violence in psychiatric settings to this page. If you experience difficulty in adding to this page directly , please [mailto:support@dreamsharing.info e-mail] the submission to [[User:JohnM | John Mudie]] directly.''

[[Category:SMI]]

Violence in Psychiatric Institutions

2009-07-27T22:21:24Z

Johnm: /* Intention */

=Intention=
The intention of this page is to review measures of the use of violence in psychiatric institutions particularly those using [http://en.wikipedia.org/wiki/Nonviolent_Communication Nonviolent Communication] developed by [http://en.wikipedia.org/wiki/Nonviolent_Communication Marshall Rosenberg].

=Methodology=

Published and unpublished data were collected from a variety of sources (see tables). The data collected consisted of:
#number of seclusion incidents,
#number of hours patients were secluded,
#number of restraint incidents,
#number of hours patients were restrained
#number of staff injuries over a period of time.
. The data was then "normalized" by expressing the data per 1000 patient days. When the number of patient days during the observation period was not available, the unit capacity times length of data collection period was used as an estimate of patient days.

In some cases only combined seclusion plus restraint data were available so these were compared with the calculated seclusion plus restraint data for other institutions.

A "blank" entry in a results table indicates that the data were unavailable

=Results=

[[Image:SplusR comparisons.jpg|center|frame|'''Table 1: Seclusion plus Restraint and Staff Injury data ordered by increasing Seclusion plus Restraint incidents]]'''
 
The total seclusion plus restraint data show that only three institutions had Seclusion plus Comparison incident rate of less than 1.0 incident rate per 1000 patient days. These were Coalinga State Hospital and the Intensive Treatment Unit (ITU) during years that Nonviolent Communication was being used. During a previous year (2003) when the ITU was not using NVC, the violence rate was comparable (4.31) to that of other Ca State Hospitals.
 
The high rate (36.13) associated with the Santa Barbara Psychiatric Health Facility is most probably in large measure due to the fact that it only accepts people when they are in crisis in contrast to the CA State Hospitals which have relatively stable populations.

[[Image:Sec annual comparisons .jpg|center|frame|Table 2: '''Seclusion and Staff Injury data ordered by increasing Seclusion incidents''' ]]
 
In Table 2,the institution using NVC , the Management and Treatment unit, does not appear to show a significant improvement over the CA State Hospitals. Its rate (3.91 incidents / 1000 patient days) is relatively high. This may be due to the fact that the MTU caters for a very special population. According to Reimer(2009) it is the most secure of four maximum security units and provides treatment "to the most acutely aggressive civil and forensic patients in need of maximum security".
 

=References=

Garrity, M. (2009) Pychiatric Health Facility Seclusion and Restraints Statistics (personal communication) 2009 
[http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. Corwith, C. Application of Core Strategies: Reducing Seclusion & Restraint Use, On The Edge, 13(3) (2007)] 
[http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] 
Stringer,K a Using Quality Imporvement (QI) as a tool to reduce seclsion and restraints (S/R) and data sharing on the internet, presentation (2009) 
Stringer K,b Excel spreadsheet incorporating [http://www.dmh.ca.gov/Services_and_Programs/State_Hospitals/S_and_R/default.asp CA Dept of Mental Health Data on seclusions and restraints] (personal communication) 2009.

''Please add any other reports of violence in psychiatric settings to this page. If you experience difficulty in adding to this page directly , please [mailto:support@dreamsharing.info e-mail] the submission to [[User:JohnM | John Mudie]] directly.''

[[Category:SMI]]

Violence in Psychiatric Institutions

2009-07-27T22:20:38Z

Johnm: /* References */

=Intention=
The intention of this page is to review measures of violence in psychiatric institutions particularly those using [http://en.wikipedia.org/wiki/Nonviolent_Communication Nonviolent Communication] developed by [http://en.wikipedia.org/wiki/Nonviolent_Communication Marshall Rosenberg].

=Methodology=

Published and unpublished data were collected from a variety of sources (see tables). The data collected consisted of:
#number of seclusion incidents,
#number of hours patients were secluded,
#number of restraint incidents,
#number of hours patients were restrained
#number of staff injuries over a period of time.
. The data was then "normalized" by expressing the data per 1000 patient days. When the number of patient days during the observation period was not available, the unit capacity times length of data collection period was used as an estimate of patient days.

In some cases only combined seclusion plus restraint data were available so these were compared with the calculated seclusion plus restraint data for other institutions.

A "blank" entry in a results table indicates that the data were unavailable

=Results=

[[Image:SplusR comparisons.jpg|center|frame|'''Table 1: Seclusion plus Restraint and Staff Injury data ordered by increasing Seclusion plus Restraint incidents]]'''
 
The total seclusion plus restraint data show that only three institutions had Seclusion plus Comparison incident rate of less than 1.0 incident rate per 1000 patient days. These were Coalinga State Hospital and the Intensive Treatment Unit (ITU) during years that Nonviolent Communication was being used. During a previous year (2003) when the ITU was not using NVC, the violence rate was comparable (4.31) to that of other Ca State Hospitals.
 
The high rate (36.13) associated with the Santa Barbara Psychiatric Health Facility is most probably in large measure due to the fact that it only accepts people when they are in crisis in contrast to the CA State Hospitals which have relatively stable populations.

[[Image:Sec annual comparisons .jpg|center|frame|Table 2: '''Seclusion and Staff Injury data ordered by increasing Seclusion incidents''' ]]
 
In Table 2,the institution using NVC , the Management and Treatment unit, does not appear to show a significant improvement over the CA State Hospitals. Its rate (3.91 incidents / 1000 patient days) is relatively high. This may be due to the fact that the MTU caters for a very special population. According to Reimer(2009) it is the most secure of four maximum security units and provides treatment "to the most acutely aggressive civil and forensic patients in need of maximum security".
 

=References=

Garrity, M. (2009) Pychiatric Health Facility Seclusion and Restraints Statistics (personal communication) 2009 
[http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. Corwith, C. Application of Core Strategies: Reducing Seclusion & Restraint Use, On The Edge, 13(3) (2007)] 
[http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] 
Stringer,K a Using Quality Imporvement (QI) as a tool to reduce seclsion and restraints (S/R) and data sharing on the internet, presentation (2009) 
Stringer K,b Excel spreadsheet incorporating [http://www.dmh.ca.gov/Services_and_Programs/State_Hospitals/S_and_R/default.asp CA Dept of Mental Health Data on seclusions and restraints] (personal communication) 2009.

''Please add any other reports of violence in psychiatric settings to this page. If you experience difficulty in adding to this page directly , please [mailto:support@dreamsharing.info e-mail] the submission to [[User:JohnM | John Mudie]] directly.''

[[Category:SMI]]

Violence in Psychiatric Institutions

2009-07-27T22:20:12Z

Johnm: /* References */

=Intention=
The intention of this page is to review measures of violence in psychiatric institutions particularly those using [http://en.wikipedia.org/wiki/Nonviolent_Communication Nonviolent Communication] developed by [http://en.wikipedia.org/wiki/Nonviolent_Communication Marshall Rosenberg].

=Methodology=

Published and unpublished data were collected from a variety of sources (see tables). The data collected consisted of:
#number of seclusion incidents,
#number of hours patients were secluded,
#number of restraint incidents,
#number of hours patients were restrained
#number of staff injuries over a period of time.
. The data was then "normalized" by expressing the data per 1000 patient days. When the number of patient days during the observation period was not available, the unit capacity times length of data collection period was used as an estimate of patient days.

In some cases only combined seclusion plus restraint data were available so these were compared with the calculated seclusion plus restraint data for other institutions.

A "blank" entry in a results table indicates that the data were unavailable

=Results=

[[Image:SplusR comparisons.jpg|center|frame|'''Table 1: Seclusion plus Restraint and Staff Injury data ordered by increasing Seclusion plus Restraint incidents]]'''
 
The total seclusion plus restraint data show that only three institutions had Seclusion plus Comparison incident rate of less than 1.0 incident rate per 1000 patient days. These were Coalinga State Hospital and the Intensive Treatment Unit (ITU) during years that Nonviolent Communication was being used. During a previous year (2003) when the ITU was not using NVC, the violence rate was comparable (4.31) to that of other Ca State Hospitals.
 
The high rate (36.13) associated with the Santa Barbara Psychiatric Health Facility is most probably in large measure due to the fact that it only accepts people when they are in crisis in contrast to the CA State Hospitals which have relatively stable populations.

[[Image:Sec annual comparisons .jpg|center|frame|Table 2: '''Seclusion and Staff Injury data ordered by increasing Seclusion incidents''' ]]
 
In Table 2,the institution using NVC , the Management and Treatment unit, does not appear to show a significant improvement over the CA State Hospitals. Its rate (3.91 incidents / 1000 patient days) is relatively high. This may be due to the fact that the MTU caters for a very special population. According to Reimer(2009) it is the most secure of four maximum security units and provides treatment "to the most acutely aggressive civil and forensic patients in need of maximum security".
 

=References=

Garrity, M. (2009) Pychiatric Health Facility Seclusion and Restraints Statistics (personal communication) 2009 
[http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. Corwith, C. Application of Core Strategies: Reducing Seclusion & Restraint Use, On The Edge, 13(3) (2007)] 
[http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] 
Stringer,K a Using Quality Imporvement (QI) as a tool to reduce seclsion and restraints (S/R) and data sharing on the internet, presentation (2009) 
Stringer K,b Excel spreadsheet incorporating [http://www.dmh.ca.gov/Services_and_Programs/State_Hospitals/S_and_R/default.asp CA Dept of Mental Health Data on seclusions and restraints] (personal communication) 2009.

''Please add any other reports of violence in psychiatric setting s to this page. If you experience difficulty in adding to this page directly , please [mailto:support@dreamsharing.info e-mail] the submission to [[User:JohnM | John Mudie]] directly.''

[[Category:SMI]]

Violence in Psychiatric Institutions

2009-07-27T22:18:42Z

Johnm: /* References */

=Intention=
The intention of this page is to review measures of violence in psychiatric institutions particularly those using [http://en.wikipedia.org/wiki/Nonviolent_Communication Nonviolent Communication] developed by [http://en.wikipedia.org/wiki/Nonviolent_Communication Marshall Rosenberg].

=Methodology=

Published and unpublished data were collected from a variety of sources (see tables). The data collected consisted of:
#number of seclusion incidents,
#number of hours patients were secluded,
#number of restraint incidents,
#number of hours patients were restrained
#number of staff injuries over a period of time.
. The data was then "normalized" by expressing the data per 1000 patient days. When the number of patient days during the observation period was not available, the unit capacity times length of data collection period was used as an estimate of patient days.

In some cases only combined seclusion plus restraint data were available so these were compared with the calculated seclusion plus restraint data for other institutions.

A "blank" entry in a results table indicates that the data were unavailable

=Results=

[[Image:SplusR comparisons.jpg|center|frame|'''Table 1: Seclusion plus Restraint and Staff Injury data ordered by increasing Seclusion plus Restraint incidents]]'''
 
The total seclusion plus restraint data show that only three institutions had Seclusion plus Comparison incident rate of less than 1.0 incident rate per 1000 patient days. These were Coalinga State Hospital and the Intensive Treatment Unit (ITU) during years that Nonviolent Communication was being used. During a previous year (2003) when the ITU was not using NVC, the violence rate was comparable (4.31) to that of other Ca State Hospitals.
 
The high rate (36.13) associated with the Santa Barbara Psychiatric Health Facility is most probably in large measure due to the fact that it only accepts people when they are in crisis in contrast to the CA State Hospitals which have relatively stable populations.

[[Image:Sec annual comparisons .jpg|center|frame|Table 2: '''Seclusion and Staff Injury data ordered by increasing Seclusion incidents''' ]]
 
In Table 2,the institution using NVC , the Management and Treatment unit, does not appear to show a significant improvement over the CA State Hospitals. Its rate (3.91 incidents / 1000 patient days) is relatively high. This may be due to the fact that the MTU caters for a very special population. According to Reimer(2009) it is the most secure of four maximum security units and provides treatment "to the most acutely aggressive civil and forensic patients in need of maximum security".
 

=References=

Garrity, M. (2009) Pychiatric Health Facility Seclusion and Restraints Statistics (personal communication) 2009 
[http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. Corwith, C. Application of Core Strategies: Reducing Seclusion & Restraint Use, On The Edge, 13(3) (2007)] 
[http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] 
Stringer,K a Using Quality Imporvement (QI) as a tool to reduce seclsion and restraints (S/R) and data sharing on the internet, presentation (2009) 
Stringer K,b Excel spreadsheet incorporating [http://www.dmh.ca.gov/Services_and_Programs/State_Hospitals/S_and_R/default.asp CA Dept of Mental Health Data on seclusions and restraints] (personal communication) 2009.

''Please add any other citations to the use of NVC in Mental Health Settings to this page. If you experience difficulty in adding to this page directly , please [mailto:support@dreamsharing.info e-mail] the submission to [[User:JohnM | John Mudie]] directly.''

[[Category:SMI]]

Violence in Psychiatric Institutions

2009-07-27T22:17:50Z

Johnm: /* Methodology */

=Intention=
The intention of this page is to review measures of violence in psychiatric institutions particularly those using [http://en.wikipedia.org/wiki/Nonviolent_Communication Nonviolent Communication] developed by [http://en.wikipedia.org/wiki/Nonviolent_Communication Marshall Rosenberg].

=Methodology=

Published and unpublished data were collected from a variety of sources (see tables). The data collected consisted of:
#number of seclusion incidents,
#number of hours patients were secluded,
#number of restraint incidents,
#number of hours patients were restrained
#number of staff injuries over a period of time.
. The data was then "normalized" by expressing the data per 1000 patient days. When the number of patient days during the observation period was not available, the unit capacity times length of data collection period was used as an estimate of patient days.

In some cases only combined seclusion plus restraint data were available so these were compared with the calculated seclusion plus restraint data for other institutions.

A "blank" entry in a results table indicates that the data were unavailable

=Results=

[[Image:SplusR comparisons.jpg|center|frame|'''Table 1: Seclusion plus Restraint and Staff Injury data ordered by increasing Seclusion plus Restraint incidents]]'''
 
The total seclusion plus restraint data show that only three institutions had Seclusion plus Comparison incident rate of less than 1.0 incident rate per 1000 patient days. These were Coalinga State Hospital and the Intensive Treatment Unit (ITU) during years that Nonviolent Communication was being used. During a previous year (2003) when the ITU was not using NVC, the violence rate was comparable (4.31) to that of other Ca State Hospitals.
 
The high rate (36.13) associated with the Santa Barbara Psychiatric Health Facility is most probably in large measure due to the fact that it only accepts people when they are in crisis in contrast to the CA State Hospitals which have relatively stable populations.

[[Image:Sec annual comparisons .jpg|center|frame|Table 2: '''Seclusion and Staff Injury data ordered by increasing Seclusion incidents''' ]]
 
In Table 2,the institution using NVC , the Management and Treatment unit, does not appear to show a significant improvement over the CA State Hospitals. Its rate (3.91 incidents / 1000 patient days) is relatively high. This may be due to the fact that the MTU caters for a very special population. According to Reimer(2009) it is the most secure of four maximum security units and provides treatment "to the most acutely aggressive civil and forensic patients in need of maximum security".
 

=References=

McGarrity, M. (2009) Pychiatric Health Facility Seclusion and Restraints Statistics (personal communication) 2009 
[http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. Corwith, C. Application of Core Strategies: Reducing Seclusion & Restraint Use, On The Edge, 13(3) (2007)] 
[http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] 
Stringer,K a Using Quality Imporvement (QI) as a tool to reduce seclsion and restraints (S/R) and data sharing on the internet, presentation (2009) 
Stringer K,b Excel spreadsheet incorporating [http://www.dmh.ca.gov/Services_and_Programs/State_Hospitals/S_and_R/default.asp CA Dept of Mental Health Data on seclusions and restraints] (personal communication) 2009.

''Please add any other citations to the use of NVC in Mental Health Settings to this page. If you experience difficulty in adding to this page directly , please [mailto:support@dreamsharing.info e-mail] the submission to [[User:JohnM | John Mudie]] directly.''

[[Category:SMI]]

Violence in Psychiatric Institutions

2009-07-27T22:17:20Z

Johnm: /* Methodology */

=Intention=
The intention of this page is to review measures of violence in psychiatric institutions particularly those using [http://en.wikipedia.org/wiki/Nonviolent_Communication Nonviolent Communication] developed by [http://en.wikipedia.org/wiki/Nonviolent_Communication Marshall Rosenberg].

=Methodology=

Published and unpublished data were collected from a variety of sources (see tables). The data collected consisted of:
#number of seclusion incidents,
#number of hours patients were secluded,
#number of restraint incidents,
#number of hours patients were restrained #number of staff injuries over a period of time.
. The data was then "normalized" by expressing the data per 1000 patient days. When the number of patient days during the observation period was not available, the unit capacity times length of data collection period was used as an estimate of patient days.

In some cases only combined seclusion plus restraint data were available so these were compared with the calculated seclusion plus restraint data for other institutions.

A "blank" entry in a results table indicates that the data were unavailable

=Results=

[[Image:SplusR comparisons.jpg|center|frame|'''Table 1: Seclusion plus Restraint and Staff Injury data ordered by increasing Seclusion plus Restraint incidents]]'''
 
The total seclusion plus restraint data show that only three institutions had Seclusion plus Comparison incident rate of less than 1.0 incident rate per 1000 patient days. These were Coalinga State Hospital and the Intensive Treatment Unit (ITU) during years that Nonviolent Communication was being used. During a previous year (2003) when the ITU was not using NVC, the violence rate was comparable (4.31) to that of other Ca State Hospitals.
 
The high rate (36.13) associated with the Santa Barbara Psychiatric Health Facility is most probably in large measure due to the fact that it only accepts people when they are in crisis in contrast to the CA State Hospitals which have relatively stable populations.

[[Image:Sec annual comparisons .jpg|center|frame|Table 2: '''Seclusion and Staff Injury data ordered by increasing Seclusion incidents''' ]]
 
In Table 2,the institution using NVC , the Management and Treatment unit, does not appear to show a significant improvement over the CA State Hospitals. Its rate (3.91 incidents / 1000 patient days) is relatively high. This may be due to the fact that the MTU caters for a very special population. According to Reimer(2009) it is the most secure of four maximum security units and provides treatment "to the most acutely aggressive civil and forensic patients in need of maximum security".
 

=References=

McGarrity, M. (2009) Pychiatric Health Facility Seclusion and Restraints Statistics (personal communication) 2009 
[http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. Corwith, C. Application of Core Strategies: Reducing Seclusion & Restraint Use, On The Edge, 13(3) (2007)] 
[http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] 
Stringer,K a Using Quality Imporvement (QI) as a tool to reduce seclsion and restraints (S/R) and data sharing on the internet, presentation (2009) 
Stringer K,b Excel spreadsheet incorporating [http://www.dmh.ca.gov/Services_and_Programs/State_Hospitals/S_and_R/default.asp CA Dept of Mental Health Data on seclusions and restraints] (personal communication) 2009.

''Please add any other citations to the use of NVC in Mental Health Settings to this page. If you experience difficulty in adding to this page directly , please [mailto:support@dreamsharing.info e-mail] the submission to [[User:JohnM | John Mudie]] directly.''

[[Category:SMI]]

Severe Mental Illness and NVC

2009-07-02T08:04:04Z

Johnm: /* Intention */

=Intention=
The intention of this page is to look at the use of [http://en.wikipedia.org/wiki/Nonviolent_Communication NonViolent Communication (NVC)] for treatment of [http://en.wikipedia.org/wiki/Mental_disorder Severe Mental Illness]

=[http://en.wikipedia.org/wiki/Nonviolent_Communication NVC] in an [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] =

[[Image:ITU_SR_hrs_pa_app_core_strat.JPG|frame|Reduction in Seclusion and Restraint Hours]] Since revision of [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] programming in March 2004 [http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. and Corwith, C. (2007)] report the introduction of NVC into the [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] (ITU) ,at [http://dhs.wisconsin.gov/mh_mendota/INDEX.HTM Mendota Mental Health Institute] in Madison, Wisconsin , a 21 bed medium security forensic unit. [http://speakempathy.com/ Riemer] introduced a number of changes on the unit that added structure and calmness and utilizing a treatment team approach that facilitates partnership with the patient rather than control. They reduced the need for Seclusion and Restraints by using core strategies which included teaching patients how to meet their needs using therapeutic Nonviolent Communication (NVC) skills. Role playing, a NVC technique, was a major part of the staff education and training.

The use of these strategies, which included teaching NVC to patients and staff reduced the number of ITU seclusion and restraint hrs from 92 to 4 over a four year period. (see fig on right). It also reduced the [http://en.nvcwiki.com/images/ITU_SR_Inc_pa_app_core_strat_.JPG number of seclusion and restraint incidents] from 33 per yr to 2.0 per yr over the same four year period.

=[http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/Maximum.HTM#mtu Management and Treatment Unit] at Mendota Mental Health Institute=
[[Image:MTU_Violence_Indicators_Creating_Sanctuary.JPG |frame|Decrease in violence indicators after introduction of Sanctuary Concept and NVC from [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] ]]
The [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/Maximum.HTM#mtu Management and Treatment Unit (MTU)] is a 14 bed unit that provides treatment to the most acutely civil and forensic male patients in need of maximum security at the [http://dhs.wisconsin.gov/mh_mendota/INDEX.HTM Mendota Mental Health Institute]in Madison Wisconsin. It provides treatment for '''patients with a history of aggression'''. In Aug 2007 the MTU team
decided to revise its ways of treatment to reduce violence. The first step was to achieve a common agreement as to the meaning of the word “violence”. The meaning was extended to include passive and non verbal violence in addition to the usual verbal and physical violence . It was finally defined to mean “behavior that increased the acuity of the unit’s environment and threatens sanctuary”. NVC training was given initially to staff and eventually used in treatment groups.Several weeks of training in NVC skills were given to patients. De-escalation plans were developed and the concept of a Sanctuary introduced based on Sandra Bloom's [http://www.amazon.com/Creating-Sanctuary-Toward-Evolution-Societies/dp/0415915686/ref=sr_1_1?ie=UTF8&s=books&qid=1246135934&sr=8-1 Sanctuary Model]. After these trainings were given the unit calmed down. After the patients and staff mutually developed their concept of sanctuary, it was implemented basically basically using the methodology of NVC. [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer (2009)] reports that the violence indicators dropped dramatically over a two year period as seen in the accompanying figure. The top bar shows that the number of injuries to staff from agression went down from 13 to 7.The next bar shows that the number of seclusion episodes were reduced from 40 to 20. The number of seclusion hours dropped from 320 to 174.Patients have Individual Emergency Response Plans (ERP) for use in emergency situations. The next bar on the graph (ERP) shows that their use dropped from 7.5 to 6.7. The use of Emergency Codes dropped from 14 to 5. The use of specially trained Emergency Intervention Teams (EIT) dropped from 62 to 32. It is important to note that the usage of Emergency Codes and EIT's declined despite the fact that patients were being managed with less reliance on restrictive measures.
Patient grievances against staff also dropped by 54% from 133 to 61.
Not only was there a reduction of forcible restraints for the patients, the staff also experienced an increase in safety. The number of [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG lost staff days] due to patient violence went down from 135 to 18 and [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG light staff days] went down from 41 to 17.

=Atascadero State Hospital=

Kathi Aichner has written a [[NVC_at_Atascadero_Sate_Hospital| report]] on the use of NVC at Atascadero State Hospital which showed that the patients were very enthusiastic about its use.

=Books=

Melanie Sears has published two books about the use of NVC in Mental Health settings. One is
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Choose your words], a book describing how NVC is used in a mental health system. The other is
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Humanizing Health Care with NVC], a book describing how the use of NVC can improve the delivery of mental health services.

=References=

[[NVC_at_Atascadero_Sate_Hospital| Aichner,K. NVC at Atascadero State Hospital, personal communication, 2008]] 
[http://www.amazon.com/Creating-Sanctuary-Toward-Evolution-Societies/dp/0415915686/ref=sr_1_1?ie=UTF8&s=books&qid=1246135934&sr=8-1 Bloom, Sandra Creating Sanctuary: Toward the Evolution of Sane Societies (1997) Routledge] 
[http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. Corwith, C. Application of Core Strategies: Reducing Seclusion & Restraint Use, On The Edge, 13(3) (2007)] 
[http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] 
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Sears, M. Choose your words, CareInAction (2007)] 
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Sears M.,Humanizing Health Care with NVC, iUniverse, Lincoln Ne, (2006)] 

''Please add any other citations to the use of NVC in Mental Health Settings to this page. If you experience difficulty in adding to this page directly , please [mailto:support@dreamsharing.info e-mail] the submission to [[User:JohnM | John Mudie]] directly.''

[[Category:SMI]]

Severe Mental Illness and NVC

2009-07-02T08:03:14Z

Johnm:

=Intention=
The intention of this page is to look at the use of [http://en.wikipedia.org/wiki/Nonviolent_Communication NonViolent Communication (NVC) ]for treatment of [http://en.wikipedia.org/wiki/Mental_disorder Severe Mental Illness]

=[http://en.wikipedia.org/wiki/Nonviolent_Communication NVC] in an [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] =

[[Image:ITU_SR_hrs_pa_app_core_strat.JPG|frame|Reduction in Seclusion and Restraint Hours]] Since revision of [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] programming in March 2004 [http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. and Corwith, C. (2007)] report the introduction of NVC into the [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] (ITU) ,at [http://dhs.wisconsin.gov/mh_mendota/INDEX.HTM Mendota Mental Health Institute] in Madison, Wisconsin , a 21 bed medium security forensic unit. [http://speakempathy.com/ Riemer] introduced a number of changes on the unit that added structure and calmness and utilizing a treatment team approach that facilitates partnership with the patient rather than control. They reduced the need for Seclusion and Restraints by using core strategies which included teaching patients how to meet their needs using therapeutic Nonviolent Communication (NVC) skills. Role playing, a NVC technique, was a major part of the staff education and training.

The use of these strategies, which included teaching NVC to patients and staff reduced the number of ITU seclusion and restraint hrs from 92 to 4 over a four year period. (see fig on right). It also reduced the [http://en.nvcwiki.com/images/ITU_SR_Inc_pa_app_core_strat_.JPG number of seclusion and restraint incidents] from 33 per yr to 2.0 per yr over the same four year period.

=[http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/Maximum.HTM#mtu Management and Treatment Unit] at Mendota Mental Health Institute=
[[Image:MTU_Violence_Indicators_Creating_Sanctuary.JPG |frame|Decrease in violence indicators after introduction of Sanctuary Concept and NVC from [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] ]]
The [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/Maximum.HTM#mtu Management and Treatment Unit (MTU)] is a 14 bed unit that provides treatment to the most acutely civil and forensic male patients in need of maximum security at the [http://dhs.wisconsin.gov/mh_mendota/INDEX.HTM Mendota Mental Health Institute]in Madison Wisconsin. It provides treatment for '''patients with a history of aggression'''. In Aug 2007 the MTU team
decided to revise its ways of treatment to reduce violence. The first step was to achieve a common agreement as to the meaning of the word “violence”. The meaning was extended to include passive and non verbal violence in addition to the usual verbal and physical violence . It was finally defined to mean “behavior that increased the acuity of the unit’s environment and threatens sanctuary”. NVC training was given initially to staff and eventually used in treatment groups.Several weeks of training in NVC skills were given to patients. De-escalation plans were developed and the concept of a Sanctuary introduced based on Sandra Bloom's [http://www.amazon.com/Creating-Sanctuary-Toward-Evolution-Societies/dp/0415915686/ref=sr_1_1?ie=UTF8&s=books&qid=1246135934&sr=8-1 Sanctuary Model]. After these trainings were given the unit calmed down. After the patients and staff mutually developed their concept of sanctuary, it was implemented basically basically using the methodology of NVC. [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer (2009)] reports that the violence indicators dropped dramatically over a two year period as seen in the accompanying figure. The top bar shows that the number of injuries to staff from agression went down from 13 to 7.The next bar shows that the number of seclusion episodes were reduced from 40 to 20. The number of seclusion hours dropped from 320 to 174.Patients have Individual Emergency Response Plans (ERP) for use in emergency situations. The next bar on the graph (ERP) shows that their use dropped from 7.5 to 6.7. The use of Emergency Codes dropped from 14 to 5. The use of specially trained Emergency Intervention Teams (EIT) dropped from 62 to 32. It is important to note that the usage of Emergency Codes and EIT's declined despite the fact that patients were being managed with less reliance on restrictive measures.
Patient grievances against staff also dropped by 54% from 133 to 61.
Not only was there a reduction of forcible restraints for the patients, the staff also experienced an increase in safety. The number of [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG lost staff days] due to patient violence went down from 135 to 18 and [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG light staff days] went down from 41 to 17.

=Atascadero State Hospital=

Kathi Aichner has written a [[NVC_at_Atascadero_Sate_Hospital| report]] on the use of NVC at Atascadero State Hospital which showed that the patients were very enthusiastic about its use.

=Books=

Melanie Sears has published two books about the use of NVC in Mental Health settings. One is
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Choose your words], a book describing how NVC is used in a mental health system. The other is
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Humanizing Health Care with NVC], a book describing how the use of NVC can improve the delivery of mental health services.

=References=

[[NVC_at_Atascadero_Sate_Hospital| Aichner,K. NVC at Atascadero State Hospital, personal communication, 2008]] 
[http://www.amazon.com/Creating-Sanctuary-Toward-Evolution-Societies/dp/0415915686/ref=sr_1_1?ie=UTF8&s=books&qid=1246135934&sr=8-1 Bloom, Sandra Creating Sanctuary: Toward the Evolution of Sane Societies (1997) Routledge] 
[http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. Corwith, C. Application of Core Strategies: Reducing Seclusion & Restraint Use, On The Edge, 13(3) (2007)] 
[http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] 
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Sears, M. Choose your words, CareInAction (2007)] 
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Sears M.,Humanizing Health Care with NVC, iUniverse, Lincoln Ne, (2006)] 

''Please add any other citations to the use of NVC in Mental Health Settings to this page. If you experience difficulty in adding to this page directly , please [mailto:support@dreamsharing.info e-mail] the submission to [[User:JohnM | John Mudie]] directly.''

[[Category:SMI]]

Severe Mental Illness and NVC

2009-07-02T08:00:06Z

Johnm:

=Intention=
The intention of this page is to look at the use of [http://en.wikipedia.org/wiki/Nonviolent_Communication NonViolent Communication (NVC) ]for treatment of Severe Mental Illness

==[http://en.wikipedia.org/wiki/Nonviolent_Communication NVC] in an [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] ==

[[Image:ITU_SR_hrs_pa_app_core_strat.JPG|frame|Reduction in Seclusion and Restraint Hours]] Since revision of [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] programming in March 2004 [http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. and Corwith, C. (2007)] report the introduction of NVC into the [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/medium.htm#itu Intensive Treatment Unit] (ITU) ,at [http://dhs.wisconsin.gov/mh_mendota/INDEX.HTM Mendota Mental Health Institute] in Madison, Wisconsin , a 21 bed medium security forensic unit. [http://speakempathy.com/ Riemer] introduced a number of changes on the unit that added structure and calmness and utilizing a treatment team approach that facilitates partnership with the patient rather than control. They reduced the need for Seclusion and Restraints by using core strategies which included teaching patients how to meet their needs using therapeutic Nonviolent Communication (NVC) skills. Role playing, a NVC technique, was a major part of the staff education and training.

The use of these strategies, which included teaching NVC to patients and staff reduced the number of ITU seclusion and restraint hrs from 92 to 4 over a four year period. (see fig on right). It also reduced the [http://en.nvcwiki.com/images/ITU_SR_Inc_pa_app_core_strat_.JPG number of seclusion and restraint incidents] from 33 per yr to 2.0 per yr over the same four year period.

=[http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/Maximum.HTM#mtu Management and Treatment Unit] at Mendota Mental Health Institute=
[[Image:MTU_Violence_Indicators_Creating_Sanctuary.JPG |frame|Decrease in violence indicators after introduction of Sanctuary Concept and NVC from [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] ]]
The [http://dhs.wisconsin.gov/mh_mendota/Programs/Forensic/Maximum.HTM#mtu Management and Treatment Unit (MTU)] is a 14 bed unit that provides treatment to the most acutely civil and forensic male patients in need of maximum security at the [http://dhs.wisconsin.gov/mh_mendota/INDEX.HTM Mendota Mental Health Institute]in Madison Wisconsin. It provides treatment for '''patients with a history of aggression'''. In Aug 2007 the MTU team
decided to revise its ways of treatment to reduce violence. The first step was to achieve a common agreement as to the meaning of the word “violence”. The meaning was extended to include passive and non verbal violence in addition to the usual verbal and physical violence . It was finally defined to mean “behavior that increased the acuity of the unit’s environment and threatens sanctuary”. NVC training was given initially to staff and eventually used in treatment groups.Several weeks of training in NVC skills were given to patients. De-escalation plans were developed and the concept of a Sanctuary introduced based on Sandra Bloom's [http://www.amazon.com/Creating-Sanctuary-Toward-Evolution-Societies/dp/0415915686/ref=sr_1_1?ie=UTF8&s=books&qid=1246135934&sr=8-1 Sanctuary Model]. After these trainings were given the unit calmed down. After the patients and staff mutually developed their concept of sanctuary, it was implemented basically basically using the methodology of NVC. [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer (2009)] reports that the violence indicators dropped dramatically over a two year period as seen in the accompanying figure. The top bar shows that the number of injuries to staff from agression went down from 13 to 7.The next bar shows that the number of seclusion episodes were reduced from 40 to 20. The number of seclusion hours dropped from 320 to 174.Patients have Individual Emergency Response Plans (ERP) for use in emergency situations. The next bar on the graph (ERP) shows that their use dropped from 7.5 to 6.7. The use of Emergency Codes dropped from 14 to 5. The use of specially trained Emergency Intervention Teams (EIT) dropped from 62 to 32. It is important to note that the usage of Emergency Codes and EIT's declined despite the fact that patients were being managed with less reliance on restrictive measures.
Patient grievances against staff also dropped by 54% from 133 to 61.
Not only was there a reduction of forcible restraints for the patients, the staff also experienced an increase in safety. The number of [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG lost staff days] due to patient violence went down from 135 to 18 and [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG light staff days] went down from 41 to 17.

=Atascadero State Hospital=

Kathi Aichner has written a [[NVC_at_Atascadero_Sate_Hospital| report]] on the use of NVC at Atascadero State Hospital which showed that the patients were very enthusiastic about its use.

=Books=

Melanie Sears has published two books about the use of NVC in Mental Health settings. One is
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Choose your words], a book describing how NVC is used in a mental health system. The other is
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Humanizing Health Care with NVC], a book describing how the use of NVC can improve the delivery of mental health services.

=References=

[[NVC_at_Atascadero_Sate_Hospital| Aichner,K. NVC at Atascadero State Hospital, personal communication, 2008]] 
[http://www.amazon.com/Creating-Sanctuary-Toward-Evolution-Societies/dp/0415915686/ref=sr_1_1?ie=UTF8&s=books&qid=1246135934&sr=8-1 Bloom, Sandra Creating Sanctuary: Toward the Evolution of Sane Societies (1997) Routledge] 
[http://insightcommunications.ca/documents/FORENSICS.pdf Riemer,D. Corwith, C. Application of Core Strategies: Reducing Seclusion & Restraint Use, On The Edge, 13(3) (2007)] 
[http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Riemer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] 
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Sears, M. Choose your words, CareInAction (2007)] 
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Sears M.,Humanizing Health Care with NVC, iUniverse, Lincoln Ne, (2006)] 

''Please add any other citations to the use of NVC in Mental Health Settings to this page. If you experience difficulty in adding to this page directly , please [mailto:support@dreamsharing.info e-mail] the submission to [[User:JohnM | John Mudie]] directly.''

[[Category:SMI]]

Severe Mental Illness and NVC

2009-06-20T03:19:53Z

Johnm:

==NVC in an Intensive Treatment Unit ==

[[Image:ITU_SR_hrs_pa_app_core_strat.JPG|frame|Reduction in Seclusion and Restraint Hours since revision of Intensive Treatment Unit programming in March 2004]][http://insightcommunications.ca/documents/FORENSICS.pdf Reimer,D. and Corwin C (2007)] discuss the introduction of NVC into the intensive Treatment Unit (ITU) ,at Mendota Mental Health Institute (MMHI) in Madison, Wisconsin , a 21 bed medium security forensic unit. [http://speakempathy.com/ Reimer] introduced a number of changes on the unit that added structure and calmness and utilizing a treatment team approach that facilitates partnership with the patient rather than control. They reduced the need for Seclusion and Restraints by using core strategies which included teaching patients how to meet their needs using therapeutic Nonviolent Communication (NVC) skills. Role playing, a NVC technique, was a major part of the staff education and training.

The use of these strategies, which included teaching NVC to patients and staff reduced the number of hours of seclusion and restraint from 92 hrs to 4 hrs over a four year period. It also reduced the [http://en.nvcwiki.com/images/ITU_SR_Inc_pa_app_core_strat_.JPG number of seclusion and restraint incidents] from 33 per yr to 2.0 per yr over the same four year period.

=Management and Treatment Unit at Mendota Mental Health Institute=
[[Image:MTU_Violence_Indicators_Creating_Sanctuary.JPG |frame|Decrease in violence indicators after introduction of Sanctuary Concept and NVC from [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Reimer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] ]]
The Management and Treatment Unit (MTU)is a 14 bed unit that provides treatment to the most acutely civil and forensic male patients in need of maximum security at the Mendota Mental Health Institute in Madison Wisconsin . In Aug 2007 the MTU team
Decided to revise its ways of treatment to reduce violence. The first step was to achieve a common agreement as to the meaning of the word “violence”. The meaning was extended to include passive and non verbal violence in addition to the usual verbal and physical violence . It was finally defined to mean “behavior that increased the acuity of the unit’s environment and threatens sanctuary”. Training was given initially to staff and eventually all in the use of NVC and de-esc alation plans developed and the concept of a Sanctuary introduced based on the ideas of an organization devoted to [http://www.pavingtheway.net/ “Promoting Awareness, Victim Empowerment” (PAVE)] After the patients and staff mutually developed their concept of sanctuary, it was implemented basically basically using the methodology of NVC. [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Reimier (2009 ] reports that the violence indicators dropped dramatically over a two year period.

Not only was their a reduction of forcible restraints for the patients, the staff also experienced an increase in safety too. The [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG number of lost staff days and light staff days as a result of patient violence] went down too.

''THIS SECTION IS UNDER CONSTRUCTION''

=Atascadero State Hospital=

Kathi Aichner has written a [[NVC_at_Atascadero_Sate_Hospital| report]] on the use of NVC at Atascadero State Hospital which showed that the patients were very enthusiastic about its use.

===Books===

Melanie Sears has published two books about the use of NVC in Mental Health settings. One is
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Choose your words], a book describing how NVC is used in a mental health system. The other is
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Humanizing Health Care with NVC], a book describing how the use of NVC can improve the delivery of mental health services.

=References=

[[NVC_at_Atascadero_Sate_Hospital| Aichner,K. NVC at Atascadero State Hospital, personal communication, 2008]] 
[http://insightcommunications.ca/documents/FORENSICS.pdf Reimer,D. Corwin C. Application of Core Strategies: Reducing Seclusion & Restraint Use, On The Edge, 13(3) (2007)] 
[http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Reimer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] 
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Sears, M. Choose your words, CareInAction (2007)] 
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Sears M.,Humanizing Health Care with NVC, iUniverse, Lincoln Ne, (2006)] 

''Please add any other citations to the use of NVC in Mental Health Settings to this page. If you experience difficulty in adding to this page directly , please [mailto:support@dreamsharing.info e-mail] the submission to [[User:JohnM | John Mudie]] directly.''

[[Category:SMI]]

Severe Mental Illness and NVC

2009-06-20T03:18:56Z

Johnm: /* Recommendations */

===Books===

Melanie Sears has published two books about the use of NVC in Mental Health settings. One is
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Choose your words], a book describing how NVC is used in a mental health system. The other is
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Humanizing Health Care with NVC], a book describing how the use of NVC can improve the delivery of mental health services.

==NVC in an Intensive Treatment Unit ==

[[Image:ITU_SR_hrs_pa_app_core_strat.JPG|frame|Reduction in Seclusion and Restraint Hours since revision of Intensive Treatment Unit programming in March 2004]][http://insightcommunications.ca/documents/FORENSICS.pdf Reimer,D. and Corwin C (2007)] discuss the introduction of NVC into the intensive Treatment Unit (ITU) ,at Mendota Mental Health Institute (MMHI) in Madison, Wisconsin , a 21 bed medium security forensic unit. [http://speakempathy.com/ Reimer] introduced a number of changes on the unit that added structure and calmness and utilizing a treatment team approach that facilitates partnership with the patient rather than control. They reduced the need for Seclusion and Restraints by using core strategies which included teaching patients how to meet their needs using therapeutic Nonviolent Communication (NVC) skills. Role playing, a NVC technique, was a major part of the staff education and training.

The use of these strategies, which included teaching NVC to patients and staff reduced the number of hours of seclusion and restraint from 92 hrs to 4 hrs over a four year period. It also reduced the [http://en.nvcwiki.com/images/ITU_SR_Inc_pa_app_core_strat_.JPG number of seclusion and restraint incidents] from 33 per yr to 2.0 per yr over the same four year period.

=Management and Treatment Unit at Mendota Mental Health Institute=
[[Image:MTU_Violence_Indicators_Creating_Sanctuary.JPG |frame|Decrease in violence indicators after introduction of Sanctuary Concept and NVC from [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Reimer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] ]]
The Management and Treatment Unit (MTU)is a 14 bed unit that provides treatment to the most acutely civil and forensic male patients in need of maximum security at the Mendota Mental Health Institute in Madison Wisconsin . In Aug 2007 the MTU team
Decided to revise its ways of treatment to reduce violence. The first step was to achieve a common agreement as to the meaning of the word “violence”. The meaning was extended to include passive and non verbal violence in addition to the usual verbal and physical violence . It was finally defined to mean “behavior that increased the acuity of the unit’s environment and threatens sanctuary”. Training was given initially to staff and eventually all in the use of NVC and de-esc alation plans developed and the concept of a Sanctuary introduced based on the ideas of an organization devoted to [http://www.pavingtheway.net/ “Promoting Awareness, Victim Empowerment” (PAVE)] After the patients and staff mutually developed their concept of sanctuary, it was implemented basically basically using the methodology of NVC. [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Reimier (2009 ] reports that the violence indicators dropped dramatically over a two year period.

Not only was their a reduction of forcible restraints for the patients, the staff also experienced an increase in safety too. The [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG number of lost staff days and light staff days as a result of patient violence] went down too.

''THIS SECTION IS UNDER CONSTRUCTION''

=Atascadero State Hospital=

Kathi Aichner has written a [[NVC_at_Atascadero_Sate_Hospital| report]] on the use of NVC at Atascadero State Hospital which showed that the patients were very enthusiastic about its use.

=References=

[[NVC_at_Atascadero_Sate_Hospital| Aichner,K. NVC at Atascadero State Hospital, personal communication, 2008]] 
[http://insightcommunications.ca/documents/FORENSICS.pdf Reimer,D. Corwin C. Application of Core Strategies: Reducing Seclusion & Restraint Use, On The Edge, 13(3) (2007)] 
[http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Reimer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] 
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Sears, M. Choose your words, CareInAction (2007)] 
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Sears M.,Humanizing Health Care with NVC, iUniverse, Lincoln Ne, (2006)] 

''Please add any other citations to the use of NVC in Mental Health Settings to this page. If you experience difficulty in adding to this page directly , please [mailto:support@dreamsharing.info e-mail] the submission to [[User:JohnM | John Mudie]] directly.''

[[Category:SMI]]

Severe Mental Illness and NVC

2009-06-20T03:18:12Z

Johnm:

===Books===

Melanie Sears has published two books about the use of NVC in Mental Health settings. One is
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Choose your words], a book describing how NVC is used in a mental health system. The other is
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Humanizing Health Care with NVC], a book describing how the use of NVC can improve the delivery of mental health services.

==NVC in an Intensive Treatment Unit ==

[[Image:ITU_SR_hrs_pa_app_core_strat.JPG|frame|Reduction in Seclusion and Restraint Hours since revision of Intensive Treatment Unit programming in March 2004]][http://insightcommunications.ca/documents/FORENSICS.pdf Reimer,D. and Corwin C (2007)] discuss the introduction of NVC into the intensive Treatment Unit (ITU) ,at Mendota Mental Health Institute (MMHI) in Madison, Wisconsin , a 21 bed medium security forensic unit. [http://speakempathy.com/ Reimer] introduced a number of changes on the unit that added structure and calmness and utilizing a treatment team approach that facilitates partnership with the patient rather than control. They reduced the need for Seclusion and Restraints by using core strategies which included teaching patients how to meet their needs using therapeutic Nonviolent Communication (NVC) skills. Role playing, a NVC technique, was a major part of the staff education and training.

The use of these strategies, which included teaching NVC to patients and staff reduced the number of hours of seclusion and restraint from 92 hrs to 4 hrs over a four year period. It also reduced the [http://en.nvcwiki.com/images/ITU_SR_Inc_pa_app_core_strat_.JPG number of seclusion and restraint incidents] from 33 per yr to 2.0 per yr over the same four year period.

=Management and Treatment Unit at Mendota Mental Health Institute=
[[Image:MTU_Violence_Indicators_Creating_Sanctuary.JPG |frame|Decrease in violence indicators after introduction of Sanctuary Concept and NVC from [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Reimer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] ]]
The Management and Treatment Unit (MTU)is a 14 bed unit that provides treatment to the most acutely civil and forensic male patients in need of maximum security at the Mendota Mental Health Institute in Madison Wisconsin . In Aug 2007 the MTU team
Decided to revise its ways of treatment to reduce violence. The first step was to achieve a common agreement as to the meaning of the word “violence”. The meaning was extended to include passive and non verbal violence in addition to the usual verbal and physical violence . It was finally defined to mean “behavior that increased the acuity of the unit’s environment and threatens sanctuary”. Training was given initially to staff and eventually all in the use of NVC and de-esc alation plans developed and the concept of a Sanctuary introduced based on the ideas of an organization devoted to [http://www.pavingtheway.net/ “Promoting Awareness, Victim Empowerment” (PAVE)] After the patients and staff mutually developed their concept of sanctuary, it was implemented basically basically using the methodology of NVC. [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Reimier (2009 ] reports that the violence indicators dropped dramatically over a two year period.

Not only was their a reduction of forcible restraints for the patients, the staff also experienced an increase in safety too. The [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG number of lost staff days and light staff days as a result of patient violence] went down too.

''THIS SECTION IS UNDER CONSTRUCTION''

=Atascadero State Hospital=

Kathi Aichner has written a [[NVC_at_Atascadero_Sate_Hospital| report]] on the use of NVC at Atascadero State Hospital which showed that the patients were very enthusiastic about its use.

=Recommendations=
Professionals interested in participating in the development of NVC programs under the aegis of Innovative programs under the Mental Health Services Act might contact the MHSA department of their County Mental Health Departments for more information on how to submit proposals for programs introducing NVC into their local Mental Health Delivery systems.

=References=

[[NVC_at_Atascadero_Sate_Hospital| Aichner,K. NVC at Atascadero State Hospital, personal communication, 2008]] 
[http://insightcommunications.ca/documents/FORENSICS.pdf Reimer,D. Corwin C. Application of Core Strategies: Reducing Seclusion & Restraint Use, On The Edge, 13(3) (2007)] 
[http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Reimer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] 
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Sears, M. Choose your words, CareInAction (2007)] 
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Sears M.,Humanizing Health Care with NVC, iUniverse, Lincoln Ne, (2006)] 

''Please add any other citations to the use of NVC in Mental Health Settings to this page. If you experience difficulty in adding to this page directly , please [mailto:support@dreamsharing.info e-mail] the submission to [[User:JohnM | John Mudie]] directly.''

[[Category:SMI]]

Severe Mental Ilness and NVC

2009-06-20T03:14:56Z

Johnm: PLease delete this page

Mis-spelt title, please delete this page [[User:Johnm|Johnm]] 05:14, 20 June 2009 (CEST)

Category:SMI

2009-06-20T03:13:30Z

Johnm: Declaration of Severe Mental Illness (SMI) category

Pages concerned with Severe Mental Illness (SMI) appear in the category.

NVC at Atascadero Sate Hospital

2009-06-20T03:11:47Z

Johnm:

==Non Violent Communication (NVC) at Atascadero State Hospital==

Non Violent Communication (NVC) was first taken into Atascadero State Hospital (ASH) about three and a half years ago. It was tolerated yet not whole-heartedly accepted. There was fear expressed by staff, fear generated by a need for emotional safety (and deeper, trust - wanting to trust that by being open and honest themselves that they would be safe in the company of the inmates). During the fall of 2007, NVC was accepted as an acknowledged training modality! Alicia Nowicki is offering 5 different 1-hr. sessions to inmates (clients). Staff was offered a 1-hr. intro about 3 weeks ago. The ripple effect of that intro is still being discussed. Psychiatrists, psychologists, nursing staff and other administrative staff are showing interest as they see the value NVC offers. Staff members have been invited to sit in on sessions and are giving positive feedback.

One psychiatrist sat in on a session and reported to Alicia after the session that she had been working with one of the imamates in the session for about 8 months. She shared that she had never seen him be more authentic. She guessed it came from the level of trust developed between the participants and Alicia.

One inmate, upon completion of some work of his stated, "How come I want to reach out and hug the world?"

"Sex offenders" are connecting with the idea of the act which placed them at ASH was a strategy to meet a need(s). They have been coached to explore how they might satisfy that need(s) in a way that would be welcomed and accepted by society.

Some of the "sex offenders" have been transferred to another facility, Coalinga. Alicia has received several calls from staff at Coalinga asking about NVC because the newly transferred are asking for it.

Kathi Aichner

2/7/08

[[Category:SMI]]

Severe Mental Illness and NVC

2009-06-20T03:10:57Z

Johnm:

===Reference Books===

Melanie Sears has published two books about the use of NVC in Mental Health settings. One is
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Choose your words], a book describing how NVC is used in a mental health system. The other is
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Humanizing Health Care with NVC], a book describing how the use of NVC can improve the delivery of mental health services.

==NVC in an Intensive Treatment Unit ==

[[Image:ITU_SR_hrs_pa_app_core_strat.JPG|frame|Reduction in Seclusion and Restraint Hours since revision of Intensive Treatment Unit programming in March 2004]][http://insightcommunications.ca/documents/FORENSICS.pdf Reimer,D. and Corwin C (2007)] discuss the introduction of NVC into the intensive Treatment Unit (ITU) ,at Mendota Mental Health Institute (MMHI) in Madison, Wisconsin , a 21 bed medium security forensic unit. [http://speakempathy.com/ Reimer] introduced a number of changes on the unit that added structure and calmness and utilizing a treatment team approach that facilitates partnership with the patient rather than control. They reduced the need for Seclusion and Restraints by using core strategies which included teaching patients how to meet their needs using therapeutic Nonviolent Communication (NVC) skills. Role playing, a NVC technique, was a major part of the staff education and training.

The use of these strategies, which included teaching NVC to patients and staff reduced the number of hours of seclusion and restraint from 92 hrs to 4 hrs over a four year period. It also reduced the [http://en.nvcwiki.com/images/ITU_SR_Inc_pa_app_core_strat_.JPG number of seclusion and restraint incidents] from 33 per yr to 2.0 per yr over the same four year period.

=Management and Treatment Unit at Mendota Mental Health Institute=
[[Image:MTU_Violence_Indicators_Creating_Sanctuary.JPG |frame|Decrease in violence indicators after introduction of Sanctuary Concept and NVC from [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Reimer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] ]]
The Management and Treatment Unit (MTU)is a 14 bed unit that provides treatment to the most acutely civil and forensic male patients in need of maximum security at the Mendota Mental Health Institute in Madison Wisconsin . In Aug 2007 the MTU team
Decided to revise its ways of treatment to reduce violence. The first step was to achieve a common agreement as to the meaning of the word “violence”. The meaning was extended to include passive and non verbal violence in addition to the usual verbal and physical violence . It was finally defined to mean “behavior that increased the acuity of the unit’s environment and threatens sanctuary”. Training was given initially to staff and eventually all in the use of NVC and de-esc alation plans developed and the concept of a Sanctuary introduced based on the ideas of an organization devoted to [http://www.pavingtheway.net/ “Promoting Awareness, Victim Empowerment” (PAVE)] After the patients and staff mutually developed their concept of sanctuary, it was implemented basically basically using the methodology of NVC. [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Reimier (2009 ] reports that the violence indicators dropped dramatically over a two year period.

Not only was their a reduction of forcible restraints for the patients, the staff also experienced an increase in safety too. The [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG number of lost staff days and light staff days as a result of patient violence] went down too.

''THIS SECTION IS UNDER CONSTRUCTION''

=Atascadero State Hospital=

Kathi Aichner has written a [[NVC_at_Atascadero_Sate_Hospital| report]] on the use of NVC at Atascadero State Hospital which showed that the patients were very enthusiastic about its use.

=Recommendations=
Professionals interested in participating in the development of NVC programs under the aegis of Innovative programs under the Mental Health Services Act might contact the MHSA department of their County Mental Health Departments for more information on how to submit proposals for programs introducing NVC into their local Mental Health Delivery systems.

=References=

[[NVC_at_Atascadero_Sate_Hospital| Aichner,K. NVC at Atascadero State Hospital, personal communication, 2008]] 
[http://insightcommunications.ca/documents/FORENSICS.pdf Reimer,D. Corwin C. Application of Core Strategies: Reducing Seclusion & Restraint Use, On The Edge, 13(3) (2007)] 
[http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Reimer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] 
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Sears, M. Choose your words, CareInAction (2007)] 
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Sears M.,Humanizing Health Care with NVC, iUniverse, Lincoln Ne, (2006)] 

''Please add any other citations to the use of NVC in Mental Health Settings to this page. If you experience difficulty in adding to this page directly , please [mailto:support@dreamsharing.info e-mail] the submission to [[User:JohnM | John Mudie]] directly.''

[[Category:SMI]]

Mental Health Services Act

2009-06-20T03:09:44Z

Johnm:

Mental Health Services Act

2009-06-20T03:07:57Z

Johnm:

Mental Health Services Act

2009-06-20T03:06:41Z

Johnm: Remove section on use of NVC in Mental Health Settings

Mental Health Services Act

2009-06-20T03:04:05Z

Johnm: Remove section on use of NVC in Mental Health Settings

'''''NVC and the [http://en.wikipedia.org/wiki/California_Mental_Health_Services_Act Mental Health Services Act] [http://www.dmh.ca.gov/Prop_63/MHSA/default.asp (MHSA)] of California'''''

=Intention=
The intention of this page is to discuss and explore the possible relevance of the Mental Health Services Act aka Prop 63 of California to the support of Nonviolent Communication=

=MHSA Background=

The MHSA was passed by the voters of California in 2004 as Proposition 63 to encourage the support and development of services to people with severe mental illness. The money's (approximately 750M$ in fiscal year 2005-2006 ) is distributed to the County Mental Health systems by the http://www.dmh.ca.gov/ California Department of Mental Health] (DMH) under the supervision of the Oversight and Accountability Commission

Planning and distribution of the funds is being accomplished in five phases

Community Services and supports program (CSSP) 
Capital (buildings) and information technology (IT) 
Education and training (human resources) (WET) 
Prevention and early intervention (PEI) 
Innovation
=Innovation=
Innovation is concerned with the introduction of innovative programs which have significant likelihood of improving Mental Health Services. As NVC has been shown to have a significant effect on the delivery of Mental Health Services, it would appear that programs based on NVC have a significant likelihood of receiving support from MHSA Funds.

In Jan 09 , DMH published a set of [http://www.dmh.ca.gov/Prop_63/MHSA/Publications/Notices.asp Notice 09-02] concerning innovative programs.

=Benefits of incorporating NVC in a mental health setting=

Click [[Severe_Mental_Illness_and_NVC | here]] for research results on the benefits of using NVC for treatment of Severe Mental Illness.
===Reference Books===

Melanie Sears has published two books about the use of NVC in Mental Health settings. One is
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Choose your words], a book describing how NVC is used in a mental health system. The other is
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Humanizing Health Care with NVC], a book describing how the use of NVC can improve the delivery of mental health services.

==NVC in an Intensive Treatment Unit ==

[[Image:ITU_SR_hrs_pa_app_core_strat.JPG|frame|Reduction in Seclusion and Restraint Hours since revision of Intensive Treatment Unit programming in March 2004]][http://insightcommunications.ca/documents/FORENSICS.pdf Reimer,D. and Corwin C (2007)] discuss the introduction of NVC into the intensive Treatment Unit (ITU) ,at Mendota Mental Health Institute (MMHI) in Madison, Wisconsin , a 21 bed medium security forensic unit. [http://speakempathy.com/ Reimer] introduced a number of changes on the unit that added structure and calmness and utilizing a treatment team approach that facilitates partnership with the patient rather than control. They reduced the need for Seclusion and Restraints by using core strategies which included teaching patients how to meet their needs using therapeutic Nonviolent Communication (NVC) skills. Role playing, a NVC technique, was a major part of the staff education and training.

The use of these strategies, which included teaching NVC to patients and staff reduced the number of hours of seclusion and restraint from 92 hrs to 4 hrs over a four year period. It also reduced the [http://en.nvcwiki.com/images/ITU_SR_Inc_pa_app_core_strat_.JPG number of seclusion and restraint incidents] from 33 per yr to 2.0 per yr over the same four year period.

=Management and Treatment Unit at Mendota Mental Health Institute=
[[Image:MTU_Violence_Indicators_Creating_Sanctuary.JPG |frame|Decrease in violence indicators after introduction of Sanctuary Concept and NVC from [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Reimer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] ]]
The Management and Treatment Unit (MTU)is a 14 bed unit that provides treatment to the most acutely civil and forensic male patients in need of maximum security at the Mendota Mental Health Institute in Madison Wisconsin . In Aug 2007 the MTU team
Decided to revise its ways of treatment to reduce violence. The first step was to achieve a common agreement as to the meaning of the word “violence”. The meaning was extended to include passive and non verbal violence in addition to the usual verbal and physical violence . It was finally defined to mean “behavior that increased the acuity of the unit’s environment and threatens sanctuary”. Training was given initially to staff and eventually all in the use of NVC and de-esc alation plans developed and the concept of a Sanctuary introduced based on the ideas of an organization devoted to [http://www.pavingtheway.net/ “Promoting Awareness, Victim Empowerment” (PAVE)] After the patients and staff mutually developed their concept of sanctuary, it was implemented basically basically using the methodology of NVC. [http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Reimier (2009 ] reports that the violence indicators dropped dramatically over a two year period.

Not only was their a reduction of forcible restraints for the patients, the staff also experienced an increase in safety too. The [http://en.nvcwiki.com/images/No_of_lost_days_creating_sanctuary.JPG number of lost staff days and light staff days as a result of patient violence] went down too.

''THIS SECTION IS UNDER CONSTRUCTION''

=Atascadero State Hospital=

Kathi Aichner has written a [[NVC_at_Atascadero_Sate_Hospital| report]] on the use of NVC at Atascadero State Hospital which showed that the patients were very enthusiastic about its use.

=Recommendations=
Professionals interested in participating in the development of NVC programs under the aegis of Innovative programs under the Mental Health Services Act might contact the MHSA department of their County Mental Health Departments for more information on how to submit proposals for programs introducing NVC into their local Mental Health Delivery systems.

=References=

[[NVC_at_Atascadero_Sate_Hospital| Aichner,K. NVC at Atascadero State Hospital, personal communication, 2008]] 
[http://insightcommunications.ca/documents/FORENSICS.pdf Reimer,D. Corwin C. Application of Core Strategies: Reducing Seclusion & Restraint Use, On The Edge, 13(3) (2007)] 
[http://www.iafn.org/displaycommon.cfm?an=1&subarticlenbr=302 Reimer, D. Creating Sanctuary: Reducing Violence in a Maximum Security Forensic Psychiatric Hospital Unit, On The Edge - Spring 2009] 
[http://www.amazon.com/Choose-Your-Words-Compassionate-Communication/dp/0979620627/ref=sr_1_1?ie=UTF8&s=books&qid=1239214602&sr=8-1 Sears, M. Choose your words, CareInAction (2007)] 
[http://www.amazon.com/Humanizing-Health-Care-Nonviolent-Communication/dp/059540278X/ref=sr_1_1?ie=UTF8&s=books&qid=1239214715&sr=1-1 Sears M.,Humanizing Health Care with NVC, iUniverse, Lincoln Ne, (2006)] 

''Please add any other citations to the use of NVC in Mental Health Settings to this page. If you experience difficulty in adding to this page directly , please [mailto:support@dreamsharing.info e-mail] the submission to [[User:JohnM | John Mudie]] directly.''

Severe Mental Illness and NVC

2009-06-20T02:57:25Z

Johnm: Creating a page that discuses interactions between Severe Mental Illness and NVC

Severe Mental Ilness and NVC

2009-06-20T02:52:43Z

Johnm:

Severe Mental Ilness and NVC

2009-06-20T02:50:01Z

Johnm: Moving discussion about SMI from Mental Health Services Page