Design in Mental Health 2016 Keynotes


Psychiatric intensive care is part of the acute care pathway, but provides ‘specialist’ care.


engineering. He acknowledged, however, that the draft might ‘change considerably’ within the coming months.


Many pages of the draft framework are already written.


medium secure settings, or could be back on their way to acute settings or the community, so it’s a complex environment that needs to cater for all these needs.” In fact, the Health Building Note, HBN 03-01,


Adult acute mental health units, the DH’s Environmental Design Guide to Adult Medium Secure Services, and the Royal College of Psychiatrists’ Standards for Low Secure Services, plus a ‘raft ‘of other guidelines, were all ‘instructive to a degree’, but there was currently no really cohesive document that gave the service a firm concept on how to ‘spec’ or build PICUs. Against this backdrop, when Dr Sethi and


DIMHN’s Jenny Gill had discussed the subject, they concluded that there was ‘a real synergy’ between the two organisations’ aims and objectives in the mental healthcare sphere. He said: “The Design In Mental Health Network is a not-for-profit social enterprise for anyone with an interest in design of mental health units and settings to improve and enhance the built environment. That ‘mission’ is not very different from our aims and objectives in NAPICU; we just come at things from different angles.”


SCOPING THE WORKSTREAM Between them, Dr Sethi said, the Board of DIMHN, and the NAPICU Executive, had ‘a wealth of expertise and experience’; what ‘shone out’ was their enthusiasm, and the length of time they had been so passionate about mental health and psychiatric intensive care matters. He explained that this January he and Jenny Gill had sat down to put together the scope for a workstream that would look to enhance the national minimum standards, with clear guidance on the design and construction of the PICU environment, and ‘to really expand and build on’ what was in the HBN. He explained: “It’s already been quite a journey.


‘The reality is that the PICU is part of the clinical model of psychiatric intensive care – the way it is planned and designed is inextricably linked to the way in which we operate within it’


1 0 THE NE TWORK J u l y 2 0 1 6


One of the things we did very early on was to put together a core working group co-chaired by two senior individuals from both organisations’ Executive Boards – Jenny Gill and Chris Dzikiti, ably assisted by four others – Roland Dix, Bernard Fox, Steve Jameson, and Cath Lake.”


THE NEXT STEPS Looking ahead, Dr Sethi explained that having ratified the proposals in January, and established the core working group in February, the scope of the work had been finalised in late February and the workstream had ‘gone live’ in March. He added: “Here we are today at the DIMHN conference letting you know about this work and what will happen next. We will be holding a stakeholder listening event later this year, and by late August will be aiming to have draft guidance complete. The NAPICU conference in September will then be the formal launch of a wider consultation among stakeholders. The aim is then to have the guidance completed by the year- end, and thereafter to devise a communication strategy to ensure that over the next 5-10 years we use this piece of work productively to make some changes.”


‘DROP-IN’ SESSION At this point he alerted the audience to a ‘drop- in’ session on the exhibition floor later in the morning, which would see individuals from the NAPICU Executive and the core working group available to discuss with delegates their thoughts on design for PICUs. He urged audience members to attend, and to think in particular about any ‘pearls of wisdom’ they could feed into the working group – especially in the key areas of ‘Staff issues’, ‘Interior design’, ‘Service-user issues’, ‘Maintenance issues’, Environmental issues’, and ‘Layout.’ Dr Sethi pointed out that these guidelines would not be revised again for perhaps another decade, so the input of delegates at the conference was much needed, and could prove invaluable. Before concluding, he was keen to give the


audience a flavour of where the working group had progressed with the workstream so far. He said many pages of the draft framework were already written; guidance drafted to date focused on areas including the service, the planning, the design, the adjacencies, the technical specifications, safety and security, infection control, waste management, and


REASONS FOR COLLABORATION Dr Sethi said he would complete his presentation by explaining why the two organisations had decided to collaborate to produce the new guidance: “I have been thinking about this, and one of the critical questions in any service is the clinical model. What is the clinical model in psychiatric intensive care, or in a PICU? Are they indeed the same thing? The


reality is that if somebody asked me that question: ‘What is the clinical model in a PICU?’, there are four elements – thinking about patients, their profiles, and their clinical difficulties; thinking about the multidisciplinary team – their expertise, and skills, the training they need, and how long it will take them to get there through their educational and training journey, and what they do once there, and, thirdly, all the clinical and risk-related interventions – treatments and therapies. The fourth dimension is the PICU’s design. The reality is that the PICU is part of the clinical model of psychiatric intensive care – the way it is planned and designed is inextricably linked to the way in which we operate within it.” NAPICU was fortunate to have ‘a lot of


clinical expertise; lots of patient and carer experience and involvement, and good knowledge of clinically derived standards’. Equally, it also delivered lots of research, education, and training. The Design In Mental Health Network, however, brought ‘everything we don’t have’ – expertise in planning and design, healthcare planning, building and construction, engineering, furniture, fixtures and fittings, and product/design standard setting. PICUs were, Dr Sethi stressed, ‘very challenging’ environments, and a PICU clinical team’s attitude, resilience, and self-awareness, were all crucial in enabling a focus on therapeutic containment and interventions; the interventions used in such units were ‘continuously developing’. Dr Sethi said: “When people ask me what the key attribute for a PICU clinical team is, I think – rather than psychiatric and nursing skills – it’s a sense of innovation, and this extends to design, planning, and build.”


AT THE FOREFRONT He concluded: “PICUs have been at the forefront of emergency inpatient psychiatry and the management of acute disturbance, so I am really excited and happy with the collaboration between NAPICU and the Design In Mental Health Network. I know we are going to create something which will improve the quality of care for PICU patients, and the experience of the staff working in such units, for at least the next decade. From a strategic perspective, the approach we have taken, and will continue to take in this piece of work, is really a model way of working for all mental health services planning and design.”


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