Background and aims
Background
Some difficult and challenging behaviours are due in part to lack of clarity about how patients are expected to behave or lack of consistency about what the expectations are.
Aims
•	Create an egalitarian social unit
•	Set clear standards for staff and patients
•	Hold people to account 
•	Build consistency and predictability while allowing flexibility
•	Clarify staff-patient relationships so staff can be consistent
•	Ensure patients understand their obligations and those of staff

This can particularly affect those who:
•	aren't thinking clearly
•	are distracted by psychotic thinking or are preoccupied
•	have difficulty interpreting communication
•	experience changes in mood 
•	have a distorted view of world and others
•	have history of trauma

Task: Examples of clear expectations 
Task: Review of clear mutual expectations
How are the clear mutual expectations developing?

Is the list of expectations for everyone?

Task: Moral dilemma
Scenario
In pairs, one person identifies the three mutual expectations they feel most uncomfortable explaining.
They explain these to the other person, who is someone they admire and who has just arrived on the ward. This person may have inspired or mentored them in their work or personal life. It could be a family member, friend, public figure, manager, coach or colleague.

Group discussion questions 
Which expectations are the most difficult/uncomfortable to explain? 
Did you change your approach in any way e.g. different language? 
Did you consider modifying any of the expectations?
Clear mutual expectations in practice
How have you used these expectations in your practice?
Have you seen patients referring to these expectations?
Feedback from the patients
Paste some quotes/feedback from patients on your ward about how they find clear mutual expectations

Clear mutual expectations – long-term implementation
•	Periodically renegotiate expectations between the staff and patient group to prevent the intervention from becoming out-of-date. 
•	Have resources for printing and poster design whenever you renew the expectations
•	Vary the design for the posters

Clear mutual expectations fidelity
•	Codifying rules for patients so staff have an easier time telling patients what to do
•	A pretty poster or mission statement to point to when things get tricky