Psychiatric Intensive Care Units or PICUs are specialist twenty-four hour inpatient wards that provide intensive assessment and comprehensive treatment to individuals during the most acute phase of a serious mental illness.[1][2][3]
Psychiatric Intensive Care
Psychiatric intensive care is for patients who are in an acutely disturbed phase of a serious mental disorder. There is an associated loss of capacity for self-control with a corresponding increase in risk which does not allow their safe, therapeutic management and treatment in a less acute or a less secure mental health ward. Care and treatment must be patient-centred, multidisciplinary, intensive and have an immediacy of response to critical clinical and risk situations. Patients should be detained compulsorily under the appropriate mental health legislative framework, and the clinical and risk profile of the patient usually requires an associated level of security. Psychiatric intensive care is delivered by qualified and suitably trained multidisciplinary clinicians according to an agreed philosophy of unit operational policy underpinned by the principles of therapeutic intervention and dynamic clinically focused risk management
Most individuals only stay on PICU wards for a very short time and are moved as soon as the crisis is over or the risky behaviours are under control. 2014 guidance says that the maximum length of stay should be 8 weeks.[5] Normally, patients are discharged to acute psychiatric wards, but some patients go straight home.
PICUs have a diverse range of staff, including: mental health nurses, psychiatrists, psychologists, pharmacists, occupational therapists, social workers, activities co-ordinators, health care support workers, and ward managers.[1][2][6]
Adults who have been struggling with severe symptoms of certain mental or psychiatric health challenges can receive expert care via the psychiatric intensive care program at Rio Vista Behavioral Health. The psychiatric intensive care program at our location in El Paso, Texas, is a short-term experience that will prepare you or your loved one for long-term success.
Our psychiatric intensive care unit, or PICU, accepts adults of all genders age 18 and above. This program is designed for patients who have been experiencing severe symptoms of major depression, bipolar disorder, schizophrenia, schizoaffective disorder, and related mental health challenges or psychiatric concerns.
The psychiatric intensive care unit at Rio Vista Behavioral Health may be the optimal environment for patients who require more intensive services than can be provided in our adult inpatient program.
Each person who heals in our PICU will work toward specific individual goals. However, in general terms, the objective of the psychiatric intensive care unit at our El Paso, Texas, location is to help patients achieve stabilization and prepare them to return home or transition to a less intensive level of care.
As is the case with all of our programs, admissions decisions for our psychiatric intensive care unit are made on a case-by-case basis. We review all pertinent information and make our determination based upon what is in the best interest of the prospective patient.
Most patients remain in our psychiatric intensive care unit for about five to seven days. Our commitment to individualized care means that no two people will have identical experiences with us, but everyone can expect the following fundamental services and benefits:
When you enter our psychiatric intensive care unit, or when you entrust a loved one to our care, you will have the opportunity to work with a dedicated and experienced team. The professionals who serve in the Rio Vista Behavioral Health psychiatric intensive care unit are committed to patient-focused, results-oriented care, provided in a supportive and respectful environment. Depending upon your mental or psychiatric health needs, or those of your loved one, care may be provided by the following professionals:
Rio Vista Behavioral Health offers state-of-the-art inpatient psychiatric and detox services in the El Paso, Texas, area. Our commitment is to provide men, women, and children in our community with individualized treatment planning and ongoing recovery support.
Our goal is to stabilize patients and minimize the risk of harm to themselves and others, while helping our community healthcare providers place their patients in facilities with the most appropriate and effective level of treatment.
Background: Psychiatric Intensive Care Units (PICU) have been part of most inpatient psychiatric services for some time, although information about their functioning and outcome has not previously been collated.
Results: Over 50 papers in English containing some empirical data were identified. Most studies were retrospective. Typical PICU patients are male, younger, single, unemployed, suffering from schizophrenia or mania, from a Black Caribbean or African background, legally detained, with a forensic history. The most common reason for admission is for aggression management, and most patients stay a week or less. Evidence of the efficacy of PICU care is very poor.
In response to three reforms in Dutch mental health care, an organizational framework, including methods and interventions, was developed as part of a new model for acute inpatient care. Core elements of high and intensive care (HIC) include preventing seclusion by means of a stepped-care principle; a six-step process of admission, treatment, and care; combining medical and recovery approaches; combining professional and experiential knowledge; and providing a healing environment. The HIC model differs from the utilization of psychiatric intensive care units in that it focuses on collaboration with outpatient care; establishing contact between staff, patients, and relatives; and minimizing coercion.
In 2011, a literature study about methods and interventions aimed at the reduction of coercion was performed, resulting in a narrative synthesis. In addition, interviews and focus groups to discuss initiatives, successes, and bottlenecks were conducted in 26 mental health care hospitals in the Netherlands (8). The literature study and the qualitative data from the interviews and focus groups resulted in a proposal for a new approach to inpatient care: the HIC model. The model contains a structured set of requirements for the organization of inpatient care, including team structure, team process, treatment (interventions), organization of care, monitoring, professionalization, facilities, and (evaluation of) coercive measures. In three 2-day expert meetings with participants from 15 mental health care institutions in the Netherlands, the proposal was discussed, and the model was refined. Four psychiatrists, four nurses, two patients, two representatives of family organizations, two psychologists, two managers, and four researchers were present. The participating groups contributed on the basis of their experience and expertise. Patients mentioned the importance of recovery-oriented care and the involvement of peer workers. Family representatives emphasized cooperation with relatives and the possibility to stay overnight (rooming in). Nurses indicated that development of knowledge and skills is required to provide good care to patients in complex situations. Psychiatrists stressed the need for clear admission criteria and for giving attention to various treatment options (including medication) in the model. In several meetings, the model was presented to professionals and to patients and their families in all mental health care institutions in the Netherlands to elicit feedback and create support in the field. A writing team, working closely together over 3 months, described the model in a handbook. A model fidelity scale describing specific elements of the model was developed, which enables measurement of the level of implementation. This scale has been validated (9).
The main goal of the HIC approach is to provide optimal treatment and safety while restoring and maintaining contact between staff, patients, and relatives and promoting crisis prevention. Its aim is to provide safe, protective, and respectful care. Core characteristics of the HIC model are as follows.
The HIC model is based on the principles of stepped care. Admission is initiated by professionals in outpatient care only when care and support in the community are no longer possible. In the ward, the patient is admitted into the high care unit (HC), consisting of single-patient rooms, shared living areas, and a comfort room. If stress and anxiety rise, or whenever aggression is imminent, the patient can be accompanied to the intensive care unit (ICU) in the same ward. The ICU consists of large single-patient rooms where patients receive one-on-one care. Transfer to the ICU is limited to a maximum of 3 days. There is no staff for the ICU, which means that one of the nurses from the HC accompanies the patient to the ICU. The nurse will stay with the patient in the ICU full-time. In most cases, the patient settles down after a few hours in the ICU and can then return to the HC. When safety in the ICU is at stake, the high security room (HSR) can be used. The HSR is a locked room, which means that using it is a coercive measure. Thus, the HSR is a last resort.
Six phases in the process of admission, treatment, and care are defined. The first phase is getting acquainted. The patient and his or her relatives are welcomed to the ward, building rapport and trust. The second phase is risk assessment and crisis prevention. Within the first hour of admission, the nurse responsible for the patient carries out an assessment of risk of suicide and violent behavior. Structured risk assessment occurs daily during the entire admission, for example, by means of the crisis monitor. The third phase is psychiatric assessment. Directly after admission, the psychiatrist performs a psychiatric examination, including a family history, and information from the personal health record of the patient is retrieved. In the fourth phase, somatic assessment, the psychiatrist also performs a physical examination, including exploratory neurological assessment and laboratory tests. The fifth phase is treatment planning. The previous steps are integrated in a treatment plan to be drafted within 24 hours of admission. If possible, the treatment plan is developed with the patient. Finally, the sixth phase is the care planning meeting, organized within 24 hours after admission with the patient, relatives, the outpatient psychiatrist, and the HIC psychiatrist. In this meeting, treatment, time scales, and the division of tasks are discussed.
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