Safety and contagion in acute psychiatric wards: How the milieu is implicated in the occurrence of clustered safety incidents

In psychiatry, clustered safety incidents are often attributed to behavioural contagion. Drawing on Kindermann and Skinner’s conceptual work in our analysis of staff accounts, we explored whether clustered safety incidents could be attributable to contagion and the role played by staff and the psychiatric milieu (as a physical, cultural, and therapeutic space). Our analysis suggests that whether the clustered incidents identified by staff are attributable to contagion depends on how broadly the “incident” is defined, with clear implications for the over or under identification of contagion. We also identified the role of staff and the milieu in what was often perceived as contagion. We argue that the pursuit of safety by creating a predictable milieu may paradoxically contribute to this clustering of safety incidents and staff’s perception of them as contagious via the mechanisms of risk amplification, involuntary convergence (increased exposure to safety incidents), and depletion of the milieu’s therapeutic potential.