There is a growing momentum for the creation of community-based safe spaces for people experiencing emotional distress or suicidal crises, as an alternative to visiting hospitals and emergency departments.

In Australia, some safe spaces have been established, however many are housed within or near hospitals.

Hospitals come with many barriers when it comes to responding to people with mental health difficulties, said Edith Cowan University’s (ECU) Dr Lesley Andrew who has recently led a study on the design of safe spaces

“A lot of the people we spoke to have been in emergency departments when they’ve been in crisis and it can be traumatic.”

“The hospital environment with nurses, uniforms, sterile places, smells, are places for people who have had a car crash or physically unwell; they’re not for people who need to feel a sense of belonging and that they’re welcome and safe. Staff do their best but it’s the wrong environment to meet the needs of these people.”

The main aim of safe spaces is to provide somewhere for people to go when they are feeling distressed, need somewhere to feel safe, or are in crisis already and do not wish to engage with emergency services, the hospital system or other supports that previously caused distress, Dr Andrew said.

The Mental Health Commission’s ‘Suicide Prevention 2020’ report outlined the urgent need for proactive community-based mental health services, while the National Mental Health and Suicide Prevention Plan cites ‘prevention and early intervention’ as the first of its five pillars.

To ensure they are implemented appropriately, the ECU research is aiming to assist with the design of safe spaces.

A recent study asked people who had visited hospital emergency in emotional distress or suicidal crisis, what features community safe spaces should and shouldn’t have to make them welcoming and effective for those wishing to use them.

Positively, a community safe space has recently been opened in Busselton as a drop in style space for people experiencing emotional distress or suicidal thoughts, with another centre planned for Bunbury.

Dr Andrew said people could visit whenever they needed support, be it talking with peers, mental health professionals – or not to speak at all but have a friendly place to decompress.

There are currently six safe spaces open, with non-government organisation Roses in the Ocean planning to establish a further 11 across Australia.

Some models, often called Safe Havens, offer a combination of clinical staff and peer workers, while the community-led Roses in the Ocean safe spaces offer a purely non-clinical, suicide prevention peer-led option.

“Hopefully before they get to crisis point, they can just drop in and feel safe and have a chat or get whatever support it is they need in that moment,” Dr Andrew said.

“It could just be feeling panic, feeling low, anxious – anything affecting their day-to-day living, ability to function and their wellbeing.”

Evidence from overseas safe spaces showed they often reduced pressures on the healthcare and policing systems.

“In the UK, they were putting a lot of healthcare resources and police resources towards performing mental health and wellbeing checks in the community, and these safe spaces have reduced the need for that,” Dr Andrew said.

What ‘safe’ looks like

Researchers interviewed people who had been to hospital emergency departments for mental health reasons to find out what they felt would make them feel safe, ranging from features, sounds, smells and their ideas for the running and management of the space.

“It really just takes it away from a medical model and more to social model,” Dr Andrew said.

Safe space dos

• Sofas and beanbags. ‘Non-uniform’ furniture with plants and tables
• Calm and tranquil, low stimulus atmosphere with warm colours
• Signs that welcome in a number of languages
• Functional spaces
• Board games, videos, colouring, guest arts and crafts displayed-cushions etc.
• Pet therapy/fish tanks
• Hot beverages and food
• Crèche
• Alcohol and Other Drugs protocols and hotline to Emergency Department
• Smoking area
• Open unsocial hours
• Peers as staff including people with lived experience of suicide
• Professionals, multidisciplinary clinicians (safe haven model)
• Connection pathways to a wide range of other support services in a community
• Appropriate suicide prevention training/upskilling for all staff
• Staff representative of the community in which it is located

Safe space don’ts

• Clinical ‘uniform’ furniture and tinted windows
• Clinical posters or signs that mention mental health
• White walls and colours that are too bright or too neutral
• Physical barriers between staff and clients such as reception
• Staff uniforms
• ‘Clinical’ labelling of spaces
• Clinical smells
• Triggering discussions such as past crises, medication, diagnosis
• Bureaucracy-form filling. Recording of past visits (except demographics)

‘What makes a safe space? Consumers’ perspectives on a mental health safe space’ was published in International Journal of Mental Health Nursing.