Philosophy, care and treatment on the psychiatric intensive care unit: themes, trends and future practice

Abstract

Psychiatric intensive care units (PICUs) were first developed in the UK in the early 1970s and have become an integral part of inpatient services. This paper reviews all aspects of PICU provision from its origins to the most recent studies of intensive care treatment and philosophy. A search of CINAHL, MEDLINE and British Nursing Index databases revealed ample research and discussion papers from the past 30 years to permit a thorough review of the available literature. This divides roughly into discussion and descriptive research on topics related to: (a) the infrastructure of PICUs, including bed numbers, staffing levels, admission criteria and aspects of the physical environment; and (b) the treatment provided to patients on the PICU, both pharmacological and psychosocial, plus a limited amount of evaluative research on the efficacy of PICU care. This paper provides a summary and overview of these issues based upon currently available literature. It concludes that there is strong evidence for wide variation in the provision and nature of PICU care, reflecting idiosyncratic and localized development of services. Moreover, there is an almost complete lack of evidence on the efficacy of PICU care for particular types of patients and problems, leaving a paucity of research upon which PICU infrastructure, policy and therapeutic approach can be based.

Psychiatric Intensive Care Units: a Literature Review

“…Further references were obtained by a process of snowballing and from two previously published discussion papers (Crowhurst & Bowers 2002;O'Brien & Cole 2003). This review covers published papers in the English language up to March…”

The Amsterdam Studies of Acute Psychiatry - II (ASAP-II): a comparative study of psychiatric intensive care units in the Netherlands

“…As both mental health providers and governmental authorities are increasingly emphasising the client perspective, the interest into admission- and intervention policies of PICU's has increased over the last 15 years [12-14]. At the same time, management- and financial entities also stress the importance of cost-effectiveness and uniformity.…”

What do acute psychiatric in-patient staff think about the Psychiatric Intensive Care Unit?

“…We suspect that it may be uncomfortable for staff to admit fears about their own clinical skills, hence we believe that even a small number of acknowledgements of feelings of de-skilling (Goldney et al, 1985;Brown & Wellman,1998;Crowhurst & Bowers, 2002) is evidence that this is a real issue.…”

“…It is also suggested that the presence of a PICU may lead to a loss of confidence among acute ward nurses in their ability to manage challenging behaviour (Goldney et al, 1985;Brown & Wellman, 1998;Crowhurst & Bowers, 2002).…”