View source for Severe Mental Illness and NVC

==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 <br> 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. It provides treatment for '''patients with a history of agression'''. 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 as seen in the accompanying figure.  The top bar shows that the number of injuries to staff 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 for use in emergnecy situaitions. The nexy bar on the graph (ERP) shows that tier use dropped from 7.5 to 6.7. The use of specially trainined Emergency Intervention Teams (EIT) dropped from 62 to 32.  MTU has a system of using Emergency Codes and Individual Response Plans when a violent or potentially violent situation occurs. The use of Eergency Codes  dropped from 14 to 5  The usage of these methods dropped from by 64% from fourteen to five after introduction of the Sanctuary Model and NVC. It is important to note that the number of Cides and EIT's declined despite the fact that were being managed with less realiance on restirctive measures.
Patient grievances against staff also went down by 54% from 133 to 61.

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 due to patient violence went down from 135 to 18 and light staff days went down from 41 to 17]

''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]] <br>
[http://insightcommunications.ca/documents/FORENSICS.pdf Reimer,D. Corwin C. Application of Core Strategies: Reducing Seclusion & Restraint Use, On The Edge, 13(3)  (2007)]  <br>
[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]  <br>
[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)] <br>
[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)]  <br>


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