Psychiatric Intensive Care: Principles and Practice of Recovery-Oriented Care
Psychiatric Intensive Care: What You Need to Know
If you or someone you love is experiencing a severe mental health crisis, you may have heard of psychiatric intensive care. But what exactly is it, and how can it help? In this article, we will explain what psychiatric intensive care is, who needs it, how it works, and what are some of the challenges involved. We hope that this information will help you understand this important service and make informed decisions about your mental health care.
Psychiatric Intensive Care
Introduction
Mental health problems can affect anyone, at any time, and in different ways. Some people may experience mild or moderate symptoms that can be managed with medication, therapy, or other forms of support. However, some people may develop more severe or complex mental health problems that require more intensive and specialized care.
What is psychiatric intensive care?
Psychiatric intensive care is a type of inpatient service that provides a high level of observation, assessment, treatment, and care for people who are experiencing an acute mental health crisis that poses a serious risk to themselves or others. Psychiatric intensive care units (PICUs) are usually located within or near general psychiatric wards, but they have a higher staff-to-patient ratio, more security measures, and more restricted access than regular wards.
The main goals of psychiatric intensive care are to:
Stabilize the patient's mental state and reduce the risk of harm
Provide a safe and therapeutic environment for recovery
Facilitate a smooth transition to a less restrictive setting as soon as possible
Who needs psychiatric intensive care?
Psychiatric intensive care is not suitable for everyone. It is only indicated for people who meet the following criteria:
They have a severe mental disorder that impairs their ability to function or communicate
They pose a significant risk of harm to themselves or others due to their mental state
They require a high level of observation and intervention that cannot be provided in a less restrictive setting
They are likely to benefit from short-term intensive treatment and care
Some examples of situations that may require psychiatric intensive care are:
A person with schizophrenia who has severe hallucinations or delusions that make them violent or suicidal
A person with bipolar disorder who has a manic episode that causes them to act impulsively or recklessly
A person with depression who has attempted suicide or self-harm and needs close monitoring and support
A person with borderline personality disorder who has severe emotional dysregulation and engages in risky behaviors
A person with substance use disorder who has severe withdrawal symptoms or complications that affect their mental health
What are the benefits of psychiatric intensive care?
Psychiatric intensive care can provide several benefits for people who need it, such as:
Reducing the risk of harm to themselves or others by providing a safe and secure environment
Improving their mental health and well-being by providing effective treatment and care
Enhancing their recovery and resilience by providing individualized support and interventions
Promoting their autonomy and dignity by respecting their rights and preferences
Facilitating their discharge and integration into the community by providing appropriate referrals and follow-up
How does psychiatric intensive care work?
The process of psychiatric intensive care involves three main stages: admission, treatment, and discharge. Each stage has its own procedures and protocols that aim to ensure the quality and safety of the service.
Admission and assessment
The admission to a PICU is usually initiated by a mental health professional, such as a psychiatrist, a psychologist, or a nurse, who has assessed the patient and determined that they need psychiatric intensive care. The admission may be voluntary or involuntary, depending on the patient's consent and legal status. In some cases, the admission may be ordered by a court or a tribunal.
Upon admission, the patient undergoes a comprehensive assessment that includes:
A physical examination and laboratory tests to rule out any medical conditions or complications
A mental status examination and diagnostic tests to identify any mental disorders or symptoms
A risk assessment and management plan to evaluate and address any potential sources of harm
A care plan and treatment goals to outline the interventions and outcomes that are expected
The assessment is conducted by a multidisciplinary team that consists of various professionals, such as:
Psychiatrists
Psychologists
Nurses
Social workers
Occupational therapists
Pharmacists
Peer support workers
The team works collaboratively with the patient and their family or carers to ensure that their needs and preferences are met.
Treatment and care
The treatment and care in a PICU is based on the principles of recovery-oriented practice, which means that it focuses on supporting the patient's strengths, goals, and values, rather than just treating their symptoms or problems. The treatment and care may include:
Medication to reduce or manage the symptoms of mental disorders or co-occurring conditions
Psychotherapy to help the patient understand and cope with their emotions, thoughts, and behaviors
Psychosocial interventions to help the patient develop skills and strategies for daily living, communication, problem-solving, and self-care
Recreational activities to help the patient relax, have fun, and express themselves creatively
Educational sessions to help the patient learn about their mental health condition, treatment options, and recovery resources
Family or carer involvement to help the patient maintain or improve their relationships and support networks
Peer support to help the patient connect with others who have lived experience of mental health issues and recovery
The treatment and care is delivered in a respectful, compassionate, and culturally sensitive manner, taking into account the patient's background, beliefs, and preferences. The treatment and care is also regularly reviewed and evaluated to ensure that it is effective, appropriate, and satisfactory.
Discharge and follow-up
The discharge from a PICU is usually planned in advance with the patient and their family or carers, as well as with other professionals or services that will be involved in their ongoing care. The discharge may occur when:
The patient's mental state has stabilized and improved sufficiently
The patient's risk of harm has reduced significantly
The patient no longer requires intensive observation or intervention
The patient agrees to continue their treatment and care in a less restrictive setting
Before discharge, the patient receives a discharge summary that summarizes their stay in the PICU, their progress and achievements, their current medication and treatment plan, and any recommendations or referrals for further support. The patient also receives a follow-up appointment with their community mental health team or service within 7 days of discharge.
The follow-up aims to ensure that the patient's transition from the PICU to the community is smooth and successful. The follow-up may include:
Monitoring the patient's mental health status and well-being
Providing ongoing medication management and psychotherapy
Offering practical assistance with housing, employment, education, or finances
Connecting the patient with peer support groups or other community resources
Addressing any issues or concerns that may arise during the transition period
What are the challenges of psychiatric intensive care?
Psychiatric intensive care is not without its challenges. Some of the common challenges that may affect the quality and effectiveness of psychiatric intensive care are:
Ethical and legal issues
Psychiatric intensive care involves making decisions that may affect the patient's rights, autonomy, and dignity. For example, the decision to admit or discharge a patient, to use medication or restraint, or to involve their family or carers. These decisions may raise ethical and legal dilemmas that require careful consideration and justification. Some of the ethical and legal principles that guide psychiatric intensive care are:
Respect for the patient's wishes and preferences, unless they are deemed incapable of making informed decisions
Use of the least restrictive alternative, unless there is clear evidence of necessity and proportionality
Protection of the patient's privacy and confidentiality, unless there is a risk of serious harm or a legal obligation to disclose
Promotion of the patient's best interests and well-being, while balancing the interests and rights of others
Compliance with the relevant laws and regulations, such as the Mental Health Act, the Human Rights Act, and the Mental Capacity Act
Safety and quality standards
Psychiatric intensive care involves providing a high level of care and support for people who are in a vulnerable and distressing situation. Therefore, it is essential to ensure that the service is safe and of high quality. Some of the safety and quality standards that apply to psychiatric intensive care are:
National Institute for Health and Care Excellence (NICE) guidelines on the management of violence and aggression in mental health settings
Care Quality Commission (CQC) standards on the safety, effectiveness, responsiveness, caring, and leadership of mental health services
National Association of Psychiatric Intensive Care Units (NAPICU) standards on the design, operation, staffing, and evaluation of PICUs
Royal College of Psychiatrists (RCPsych) accreditation scheme for inpatient mental health services (AIMS)
National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) recommendations on reducing suicide and self-harm in mental health settings
Staffing and training needs
Psychiatric intensive care requires a skilled and competent workforce that can deliver high-quality care and support for people with complex and challenging needs. However, staffing and training needs may not always be met due to various factors, such as:
Shortage or turnover of staff due to high workload, stress, burnout, or low morale
Lack or inconsistency of training opportunities or resources for staff development and supervision
Diversity or complexity of patient needs that require specialized knowledge or skills
Conflict or communication difficulties among staff members or between staff and patients
Limited or inadequate feedback or recognition for staff performance or achievements
Conclusion
Psychiatric intensive care is a vital service that provides a high level of care and support for people who are experiencing a severe mental health crisis that poses a serious risk to themselves or others. Psychiatric intensive care aims to stabilize the patient's mental state, provide a safe and therapeutic environment, and facilitate a smooth transition to a less restrictive setting.
Summary of key points
In this article, we have covered the following key points:
Psychiatric intensive care is indicated for people who have a severe mental disorder that impairs their ability to function or communicate, who pose a significant risk of harm to themselves or others due to their mental state, who require a high level of observation and intervention that cannot be provided in a less restrictive setting, and who are likely to benefit from short-term intensive treatment and care.
Psychiatric intensive care involves three main stages: admission, treatment, and discharge. Each stage has its own procedures and protocols that aim to ensure the quality and safety of the service.
Psychiatric intensive care is based on the principles of recovery-oriented practice, which means that it focuses on supporting the patient's strengths, goals, and values, rather than just treating their symptoms or problems.
Psychiatric intensive care faces several challenges that may affect its quality and effectiveness, such as ethical and legal issues, safety and quality standards, and staffing and training needs.
Recommendations for further reading
If you want to learn more about psychiatric intensive care, here are some useful resources that you can check out:
NAPICU website: https://napicu.org.uk/
NICE guideline on violence and aggression: https://www.nice.org.uk/guidance/ng10
CQC website: https://www.cqc.org.uk/
RCPsych AIMS website: https://www.rcpsych.ac.uk/improving-care/ccqi/quality-networks-accreditation/aims-inpatient-mental-health-services
NCISH website: https://sites.manchester.ac.uk/ncish/
FAQs
Here are some frequently asked questions about psychiatric intensive care:
What is the difference between psychiatric intensive care and general psychiatric care?
Psychiatric intensive care is a type of inpatient service that provides a higher level of observation, assessment, treatment, and care than general psychiatric care. Psychiatric intensive care is indicated for people who are experiencing an acute mental health crisis that poses a serious risk to themselves or others, and who cannot be managed in a less restrictive setting. General psychiatric care is indicated for people who have less severe or complex mental health problems, and who can be managed in a more open and flexible setting.
How long does a person stay in psychiatric intensive care?
The length of stay in psychiatric intensive care varies depending on the patient's needs, progress, and preferences. However, the average length of stay in psychiatric intensive care in the UK is about 28 days, according to a 2019 report by NAPICU. The aim of psychiatric intensive care is to discharge the patient to a less restrictive setting as soon as possible, once their mental state has stabilized and their risk of harm has reduced.
What are the rights of a person in psychiatric intensive care?
A person in psychiatric intensive care has the same rights as any other person who receives mental health care, such as the right to:
Be treated with respect and dignity
Be involved in their own care and treatment
Have access to information and support
Have their privacy and confidentiality protected
Make complaints or raise concerns
Have an advocate or a representative
In addition, a person in psychiatric intensive care may have specific rights depending on their legal status, such as the right to:
Consent or refuse treatment, unless they are deemed incapable or subject to certain legal provisions
Appeal or challenge their detention or treatment, if they are detained under the Mental Health Act
Have access to an independent mental health review tribunal, if they are detained under the Mental Health Act
Have access to a second opinion from another doctor, if they are subject to certain treatments under the Mental Health Act
What are the risks of psychiatric intensive care?
Psychiatric intensive care is not without its risks. Some of the potential risks that may affect the patient or the staff in psychiatric intensive care are:
Injury or harm due to violence or aggression from themselves or others
Infection or complication due to medication or medical procedures
Trauma or distress due to coercion or restraint
Stigma or discrimination due to negative attitudes or stereotypes
Lack of continuity or coordination of care due to frequent transfers or referrals
How can a person cope with being in psychiatric intensive care?
Being in psychiatric intensive care can be a stressful and challenging experience for anyone. However, there are some ways that a person can cope with being in psychiatric intensive care, such as:
Talking to their family, friends, carers, or peers for emotional support and comfort
Talking to their mental health professionals for information and guidance on their treatment and care
Taking part in activities that they enjoy or find relaxing, such as reading, listening to music, playing games, or doing crafts
Focusing on their strengths, goals, and values, rather than on their problems or difficulties
Seeking help if they feel unsafe, unhappy, or unwell at any time during their stay
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