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Mutual Expectations: 'easing up' in mental health care


Discovering the Safewards Model has helped mental health nurse, Helen Croft, and her colleagues create an ‘air of positivity’ in their service by helping patients and staff understand each other better

Has anybody heard about an intervention in mental health called ‘Mutual Expectations’?

It comes from the Safewards Model and used in conjunction with a recovery philosophy supports the reduction of conflict and helps teams to ensure that mental health wards become more peaceful places. The model includes six originating domains and causes of conflict:

mutual expectations ease up

mutual expectations ease up

  • the staff team;
  • the physical environment;
  • patient characteristics;
  • the community;
  • outside hospital;
  • and regulatory frameworks.

Evidence suggests that modification of any of these six originating domains can result in more peaceful services, better patient, carer and staff experiences and improved outcomes for service receivers. Essentially it asks staff and patients to ease up a little.

Safewards has been implemented in my own service: I work with people who experience serious mental health problems in a rehabilitation and recovery service and well, I think it’s brilliant. And I am not the only one!

mutual expectations

mutual expectations

Mutual Expectations: turned into art

Safewards in my own service has created an air of positivity: we have created a Discharge Tree – where service users who are moving on leave positive messages to those who are working hard to create a meaningful life for themselves too. We have developed a ‘Getting To Know Each Other’ folder, where staff don’t just ask patients to ‘tell all’ about themselves but give a little back, through the use of one-page profiles. And, we have implemented Mutual Expectations too.

So what is it?

Mutual Expectations: it does what it says on the tin!

It helps nurses understand what patients expect from them and vice versa. It clarifies relationships and in doing so reduces anxiety and stress.

In my own service, we turned these expectations into a piece of art (pictured left). It reminds us about the important little things that in nursing are often the most powerful and memorable to our service users. It supports our recovery approach and ensures that we practice holistically.

“Mutual Expectations allowed registered and unregistered staff to be listened to and valued”

But this intervention is not only useful for creating positive relationships with our patients and carers, but within our teams as well. I recently used it on a nursing assistant development day to understand what nursing assistants expect from registered nurses and vice versa.

We know that good communication is essential for effective team working and that it contributes to safer, more effective and caring services. The use of Mutual Expectations supports this communication. It allowed registered and unregistered staff to be listened to and valued. It highlighted our joint strengths and our weaknesses and allowed us to reflect on our own individual practices.

“It turned out it was the little things that mattered”

Like the Mutual Expectations we created with our service users, it turned out that it was again, the little things that mattered. Things like ‘speaking to each other nicely’ when for whatever reason it is a tough shift. Things like saying ‘thank you’.

That is what Safewards and Mutual Expectations is all about: ‘the big, little things’ that make our wards and teams more peaceful places.

Helen Croft is a registered mental health nurse, Rehabilitation Services, Derbyshire Healthcare Foundation Trust


Readers' comments (2)

  • Mental health care needs a revolution, it is outdated and all about restrictions rather than real patient care.

    We still lock folk up for silly little thjng's because staff can't cope, not because patients are so seriously at risk.
    When a patient talk of suicided, they are told by staff 'you don't really mean that do you?' only to have the patient go off and do the inevitable.It is always so sad, yet because the patient is not in hospital at the time, the hospital is cleared of any failings.
    Then we have the case of the patient sectioned due to suicidal activity, admitted to hospital where he hanged himself!

    Where is the care ... who really cares, we need to look at mental health care, how it is delivered and what is really best for the patient.

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  • Don't mention smoking though, that is when the hospital dictates and doesnt listen to the needs and anxieties of its patients.

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