Hostname: page-component-77c89778f8-9q27g Total loading time: 0 Render date: 2024-07-18T12:44:12.788Z Has data issue: false hasContentIssue false

The psychiatric intensive care unit: A prospective survey of patient demographics and outcomes at seven English PICUs

Published online by Cambridge University Press:  01 December 2008

Steve Brown*
Affiliation:
Consultant Psychiatrist, Hampshire Partnership NHS Trust
Navjyoat Chhina
Affiliation:
Specialist Registrar, General Adult Psychiatry, Oxford Deanery
Stephen Dye
Affiliation:
Locum Consultant Psychiatrist, Central & North West London NHS Foundation Trust
*
Correspondence to: Dr Steve Brown, Cannon House, 6 Cannon Street, Shirley, Southampton SO15 5PQ. Tel: 02380 878051; E-mail: Steve.Brown7@nhs.net
Get access

Abstract

Background: Psychiatric intensive care units (PICUs) have become a standard part of UK mental health services. They treat patients who may be very unwell and who are usually compulsorily detained. There is little published data about the clinical activity of such units to provide an evidence base for clinical governance.

Aim: To describe the socio-demographic characteristics, mental state and outcome of treatment for 332 patients admitted consecutively to seven English PICUs.

Method: Prospective, multi-centre case note analysis.

Results: PICU patients were predominantly Caucasian males, in their mid thirties, with complex needs and chronic psychotic illness often complicated by substance misuse. Most were admitted because of perceived risk of violence to others. Whilst most admissions appeared to be broadly in line with Department of Health guidelines some patients experienced an excessive length of PICU stay. Patients from particular BME groups were over-represented.

Conclusions: PICUs appear to deliver effective treatment but are not always the least restrictive environment as envisaged by the Department of Health. Further work is needed to evaluate treatment interventions and develop valid measures of quality of care.

Type
Original Article
Copyright
Copyright © NAPICU 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Beer, M.D., Paton, C. and Pereira, S. (1997) Hot beds of general psychiatry: A national survey of psychiatric intensive care units. Psychiatric Bulletin. 21: 142144.Google Scholar
Beer, M.D., Paton, C. and Pereira, S. (2001) Psychiatric Intensive Care 1st Edition. London: Greenwich Medical Media.Google Scholar
Beer, M.D., Paton, C. and Pereira, S. (2008) Psychiatric Intensive Care 2nd Edition. Cambridge: Cambridge University Press.Google Scholar
Bowers, L., Simpson, A., Nijman, H. and Hall, C. (2008) Patient ethnicity and three psychiatric intensive care units compared: The Tompkins acute ward study. Journal of Psychiatric and Mental Health Nursing. 15: 195202.CrossRefGoogle ScholarPubMed
Brown, S. and Bass, N. (2004) The psychiatric intensive care unit (PICU): Patient characteristics, treatment and outcome. Journal of Mental Health. 13: 601609.Google Scholar
Department of Health (1999) A National Service Framework for Mental Health. London: Department of Health.Google Scholar
Department of Health (2002) National minimum standards for general adult services in psychiatric intensive care units and low secure environments. London: Department of Health.Google Scholar
Department of Health (2003) Mainstreaming gender and women's mental health. implementation guide. London: Department of Health.Google Scholar
Dix, R. (2005) Psychiatric intensive care and low secure units, past present and future – introducing the Journal of Psychiatric Intensive Care. Journal of Psychiatric Intensive Care. 1: 12.CrossRefGoogle Scholar
Dye, S., Johnston, A. and Pereira, S. (2005) The national psychiatric intensive care governance network 2004–5. Journal of Psychiatric Intensive Care. 1: 97104.Google Scholar
Feinstein, A. and Holloway, F. (2002) Evaluating the use of a psychiatric intensive care unit: is ethnicity a risk factor for admission? International Journal of Social Psychiatry. 48: 3846.CrossRefGoogle ScholarPubMed
Johnston, A. (2005) NAPICU activity and PICU/Low Secure news. Journal of Psychiatric Intensive Care. 2: 121129.CrossRefGoogle Scholar
Laidlaw, J. and Buckle, D. (2005) Informal patients in secure wards: Restriction of movement or deprivation of liberty? Journal of Psychiatric Intensive Care. 2: 6163.CrossRefGoogle Scholar
Leucht, S., Kane, J.M., Kissling, W., Hamann, J., Etschel, E. and Engel, R. (2005) Clinical implications of Brief Psychiatric Rating Scale scores. British Journal of Psychiatry. 187: 366371.Google ScholarPubMed
Lukoff, D., Nuechterlein, K.H., and Ventura, J. (1986) Manual for expanded Brief Psychiatric Rating Scale (BPRS). Schizophrenia Bulletin. 12: 594602.Google Scholar
Pereira, S., Chaudry, K., Pietromartire, S., Dale, C. and Halliwell, J. (2005a) Design in Psychiatric Intensive Care Units: problems and issues. Journal of Psychiatric Intensive Care. 1: 7076.CrossRefGoogle Scholar
Pereira, S., Sarsam, M., Bhui, K. and Paton, C. (2005b) The London survey of psychiatric intensive care units: Service provision and operational characteristics of National Health Service units. Journal of Psychiatric Intensive Care. 1: 716.CrossRefGoogle Scholar
Pereira, S., Dawson, P. and Sarsam, M. (2006) The National Survey of PICU and Low Secure Services: 1. Patient characteristics. Journal of Psychiatric Intensive Care. 2: 712.CrossRefGoogle Scholar
Royal College of Psychiatrists (1998) Not just bricks and mortar. Report of Royal College of Psychiatrists working party on the size, staffing, structure, siting and security of new acute adult in-patient psychiatric units. Council report CK62. London: Royal College of Psychiatrists.Google Scholar
Scott, H., Johnson, S., Menezes, P., Thornicroft, G., Marshall, J., Bindman, J., Bebbington, P. and Kuipers, E. (1998) Substance misuse and risk of aggression and offending among the severely mentally ill. British Journal of Psychiatry. 172: 345350.CrossRefGoogle ScholarPubMed
SPSS (2006) SPSS for Windows. Rel. 14. Chicago: SPSS Inc.Google Scholar
Wield, C. (2006) Life after darkness. Oxford: Radcliffe publishing.Google Scholar