Characteristics and outcomes of patients admitted to a psychiatric intensive care unit in a medium secure unit

Abstract

Aims and MethodThere have been no reports on psychiatric intensive care units (PICUs) in medium secure psychiatric facilities. Using case files, we retrospectively examined the characteristics and outcomes of 73 patients who were admitted to a PICU in a medium secure unit between 1 July 1994 and 30 April 1998.ResultsThe PICU population was predominantly male, suffering from illness and detained under Part III of the Mental Health Act, 1983. Although the mean length of stay was 75 days, the majority were ultimately transferred to less intensive nursing environments and only nine required transfer to maximum security. In 10% of cases PICU admission was owing to lack of appropriate facilities elsewhere.Clinical ImplicationsAlthough the PICU was intended as a crisis facility for the management of challenging behaviours, its function was affected by the lack of clear admission and discharge criteria and appropriate facilities for patients with diverse mental, physical and security needs.

Psychiatric Intensive Care Units: a Literature Review

“…Nevertheless the following groups crop up with some regularity: personality disorder and substance/alcohol use (see Table 1). Some reported PICUs have significantly different diagnostic profiles, (Birnie & Natsuna 1988;Coldwell & Naismith 1989;Dolan & Lawson 2001a;Dolan & Lawson 2001b;Hyde, Waller, & Wyn-Pugh 1992;Jones 1985;Warneke 1986;Werner et al 1983), although the majority of these are in non-UK countries or forensic units.…”

“…Specialist settings tended to show a different diagnostic emphasis (Coldwell & Naismith 1989;Dolan & Lawson 2001a;Dolan & Lawson 2001b;Gordon, Hammond, & Veeramani 1998), although most still report an over representation of schizophrenia on the PICU. Two studies at the same hospital showed no diagnostic differences between PICU and general patients (Khan, Cohen, Chiles, Stowell, Hyde, & Robbins 1987;Rachlin 1973).…”

Hot beds of forensic psychiatry: Psychiatric intensive care units within medium security

“…We are aware of one MSU that has closed down a PICU due to lack of need (Dolan & Lawson, 2001). Fifty percent of the MSUs surveyed either have a PICU or are developing one.…”

“…It has been suggested that PICUs are a rarity in forensic psychiatry (Dolan & Lawson, 2001) but there is no published authoritative data. It has been suggested that PICUs are a rarity in forensic psychiatry (Dolan & Lawson, 2001) but there is no published authoritative data.…”

External validity and anchoring heuristics: application of DUNDRUM-1 to secure service gatekeeping in South Wales

“…3 Furthermore, consideration of a patient's clinical presentation, psychiatric history, diagnosis, comorbidity, developmental history, family history, employment history and ethnic/cultural background, 4 and the patchy information about outcomes achieved by secure services, complicates and compromises gatekeeping decisions further still. The challenge for forensic gatekeepers in matching patients to appropriate security levels is apparent in the reported heterogeneity of cases admitted by both medium 5 , 6 and low 7 secure services.…”