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Over the next year there will be a major change in the way mental health services are funded within the UK. Block contracts will be dismantled and the future will be populated by clusters of patients along pathways that are costed for and agreed upon locally between commissioners (who will pay for the pathway) and service providers (who will deliver what is specified within the agreed pathway) (Department of Health, 2011). However, will these pathways lead to gold or be muddied by confusion within a maze of complexity due to variations of ill defined care? This paper highlights potential difficulties with the proposed arrangements and gives possible solutions.
Literature comparing the quality of care on psychiatric intensive care units and acute wards is sparse, but a review has found differences in key areas e.g. violence, drugs and alcohol.
This study compares the response to questionnaires completed by patients, carers and qualified nursing staff from PICUs and acute wards as part of the Accreditation for Inpatient Mental Health Services (AIMS) process.
There were few differences between the standards of care on PICUs and acute wards according to patients, carers and qualified nurses. Patients reported a more negative experience of care on PICUs than trained nurses, and in particular rated low standards on accessing records and counselling. Carers reported inadequate involvement in risk assessment an assessment of their needs. Nurses generally gave positive views of standards of care.
The challenging environment of the PICU does not appear to be compromising quality of care. There is however still room for improvement for both acute wards and PICUs in key areas, including full involvement of patients and carers and imparting information.
There is limited research on the attitudes of nursing staff towards psychiatric intensive care units (PICUs) for general adult populations, and none examining attitudes in older adult PICU populations. The aim of this study was to examine these attitudes in one Scottish health board region.
A semi-structured questionnaire was distributed to nursing staff working in general and older adult psychiatric admission and PICU wards.
Of 138 responders, PICUs were considered necessary by 96.4%, with 93.5% agreeing on the need for a separate older adult PICU. PICU staff had more influence on discharges from the PICUs compared to non-PICU staff. The main reasons for admission to PICU services were physical violence and absconding, and for refusing admission were acute ward containment and medication issues, with few differences between the general adult and older adult PICUs.
There were more similarities than differences in nursing attitudes between the general adult and older adult PICUs but many staff feel inadequately trained and supported. The combination of service-user reports, the demographic shift to an aging population and the increase in mental health detentions in the older adult population suggest a need to consider age-appropriate psychiatric intensive care services.
Interpersonal effectiveness and social competence are central issues in treatment engagement and recovery for women with a diagnosis of personality disorder or schizophrenia in secure psychiatric settings.
To assess the effectiveness of a manualized group cognitive behavioural treatment for women admitted to a secure inpatient unit.
Thirty four patients were divided into treatment completers and non completers on the basis of rates of attendance. Pre-post measures covered interpersonal problems, self efficacy, company, relationships and risk behaviours.
Completers show significant pre-post changes on all measures, in contrast to non completers. Completers were younger and more likely to have experienced psychotherapy in the past.
Results provide confirmatory evidence for the value of training in interpersonal and communication skills training for women in secure care. The failure of one third of patients to complete treatment raises issues about the timing and applicability of treatment for some patients.
To describe the characteristics of patients admitted over one year to two psychiatric intensive care units in one large mental health trust. To establish the number of admissions, reasons for admission, incidents on the PICU, bed days and destination after discharge. Differences in gender for these factors were explored. Secondary questions were whether patient factors predicted aggressive incidents or predicted requiring long term care.
The electronic notes for one year of admissions to the PICUs in one trust were examined; sociodemographic and clinical details were recorded. Reasons for admission and incidents on the PICU were coded. Data was analysed to establish significant sociodemographic or clinical differences within the cohort.
Men were much more likely to require PICU but women stayed longer. There was a trend for women to go on to long term secure placement. Aggression and sexually inappropriate behaviour were common but there were no demographic predictors of aggression. The only predictor of requiring long term placement was having been a long time on the PICU.
There is evidence that women and men use the PICU differently, with women staying longer. Further research is needed to see if this is a national trend.
While eating disorder symptomatology may be part of a broader picture of challenging behaviour for women admitted to secure care, little is known of the nature and incidence of such conditions. A survey of 131 women admitted to a secure psychiatric facility found 25 to have a recognized eating disorder, most with a diagnosis of eating disorders not otherwise specified (EDNOS) or binge eating disorder. However, few staff had experience of working with such patients and most expressed a need for training and support with such cases. The clinical and training implications of these findings are discussed.
Tasers are tools of law enforcement. With their increasing use, Tasers may also be deployed on those occasions where the person is both threatening and mentally ill. This article considers various ethical propositions and describes the ability of psychiatry to minimise the use of physical interventions.
The exceptional use of a Taser by the police on a low secure unit, and the extent to which the clinical team had gone to in managing the man, is described. A companion article discusses clinical and ethical aspects to taser use in psychiatry.