Design in Mental Health 2016 Keynotes
DIMHN and NAPICU to produce PICU design guidance
At this year’s Design in Mental Health conference, DIMHN and NAPICU (the National Association of Psychiatric Intensive Care and Low Secure Units) announced that they are collaborating to create new design guidance for psychiatric intensive care units. The initiative follows an initial meeting last year between DIMHN chair, Jenny Gill, and Dr Faisil Sethi, vice-chair of NAPICU, and a consultant psychiatrist and PICU lead consultant at the South London and Maudsley NHS Foundation Trust. The Network’s editor, Jonathan Baillie reports.
The announcement that the two organisations would be working together to jointly produce new guidance on the design of psychiatric intensive care units (or ‘PICUs’) was made by Dr Sethi, vice-chair of NAPICU, in the opening keynote speech on 18 May, the second day of the Design in Mental Health 2016 conference. In a short welcome address before Dr Sethi spoke, Jenny Gill described the collaboration as ‘the start of an exciting and challenging joint venture for DIMHN and NAPICU’, which would ‘improve the environment for service-users, staff, and all who use or visit, psychiatric intensive care units’. She then introduced Dr Sethi, who she explained she had met during late 2015: “At this meeting,” she said, “we discussed the aims and aspirations of our two respective organisations, and the fact that our common raison d’etre is to improve the service-user experience to enable recovery – NAPICU through clinical care, and DIMHN via the built environment.” NAPICU had recently published updated National Minimum Standards for Psychiatric Care in General Adult Services, and so an idea was born, which had culminated in the start of the collaboration ‘proper’ in early 2016, and the day’s announcement that the two organisations were now working together on design guidance to complement the standards. This would ‘pick up’ on the PICU-specific requirements not covered in HBN 03-01 and was, Jenny Gill argued, an ‘exciting and much-needed initiative’. Opening his presentation, Dr Sethi said he
and subsequent speaker, Roland Dix, an approved clinician, and consultant nurse in Psychiatric Intensive Care & Secure Recovery at the 2gether NHS Foundation Trust (who is also NAPICU editor-in-chief of the Journal of Psychiatric Intensive Care & Low Secure Units), would aim to give ‘a very clinical perspective on a very challenging area of mental health
8 THE NE TWORK J u l y 2 0 1 6
practice’, and explain the details of the joint venture between DIMHN and NAPICU. Dr Sethi is a consultant psychiatrist at The Maudsley Hospital in London, where he is the consultant lead for the women’s PICU. He has worked in PICU environments since 2007.
ABOUT ONE EIGHTH OF SPECIALIST CARE BEDS Psychiatric intensive care, he explained, was part of the acute care pathway in the UK, representing about one-eighth of all specialist care beds. The service was for patients ‘in an acutely disturbed phase of a serious mental disorder’, who had ‘lost their capacity for self- control, with a corresponding increase in risk’. The treatment given needed to be ‘patient- centred, multidisciplinary, and intensive’, and to have ‘an immediacy of response to critical clinical and risk situations’.
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INTERACTION WITH THE CRIMINAL JUSTICE SYSTEM Dr Sethi explained that, nowadays, virtually all patients in PICUs were detained under a section of the Mental Health Act, usually for anything from 4-8 weeks. PICUs ‘sat’ between a few other agencies and services, interfacing with the criminal justice system, forensic psychiatric services, rehabilitation services, general adult psychiatric inpatient services, and community psychiatric services. There were PICUs in both general services and secure services, with around 100 such facilities UK-wide, usually about 10-bedded. Dr Sethi said: “Ideally, from my perspective, with the national minimum standards in mind, we should be looking to have PICUs of 14 beds or less.” Today most psychiatric intensive care units
‘interfaced’ with the criminal justice system. It was thus now quite common to have prison transfers, court transfers, and patients who had recently had contact with the police, or been transferred to a place of safety, accommodated in a PICU. Dr Sethi said: “It is sometimes difficult to access a forensic inpatient bed fast, and hence PICUs do end up managing patients who are later destined for forensic transfer.”
HIGH RATES OF CONFLICT Drawing on recent NHS data on violence towards patients and self-harm events in relation to the various mental healthcare services, Dr Sethi said one of the reasons the living ‘environment’ within PICUs was key was
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Dr Faisil Sethi, vice-chairman of NAPICU, and DIMHN chair, Jenny Gill, gave details on the conference’s second day on the two organisations’ ongoing collaboration to create new design guidance for psychiatric intensive care units.
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