Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-16T10:19:14.473Z Has data issue: false hasContentIssue false
  • English
  • Français

Successful reduction of seclusion in a newly developed psychiatric intensive care unit

Published online by Cambridge University Press:  02 September 2009

Irina Georgieva ,
Geert de Haan ,
Wil Smith  and
Cornelis L Mulder
Irina Georgieva*
Affiliation:
Research Center O3, Erasmus MC, Rotterdam, The Netherlands Mental Health Center West North Brabant, Halsteren, The Netherlands
Geert de Haan
Affiliation:
Mental Health Center West North Brabant, Halsteren, The Netherlands
Wil Smith
Affiliation:
Mental Health Center West North Brabant, Halsteren, The Netherlands
Cornelis L Mulder
Affiliation:
Research Center O3, Erasmus MC, Rotterdam, The Netherlands Bavo Europoort, Rotterdam, The Netherlands
*
Correspondence to: Irina Georgieva, Erasmus MC, Department of Psychiatry, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. E-mail: [email protected]
Get access

Abstract

Introduction: Psychiatric intensive care units (PICU) are small wards, designed for the most difficult-to-manage patients. They have higher levels of nursing and other staff, are often locked, and sometimes have facilities for seclusion. Although PICU staff are often confronted with aggressive behavior, resulting in higher usage of coercive measures, there is need to increase understanding of the necessary infrastructure and treatment policy for successfully reducing seclusion and restraint.

Aim: To investigate whether patients transferred to a newly developed PICU, focused on the effective and non-coercive management of disruptive behavior, are secluded and restrained less than during earlier stays in a psychiatric unit.

Method: The effect of the newly developed PICU on reducing seclusion was evaluated in eight patients, six of whom had been diagnosed with a severe form of borderline personality disorder. The number of days in seclusion during the period before admission to the PICU was compared to the number of days in seclusion after admission to the PICU.

Results: After patients’ admission to PICU, the use of seclusion was almost completely eliminated, falling from 40% of admission days spent in seclusion before transfer to the PICU to 0.1% during their stay at the PICU.

Conclusion: When a special non-coercive infrastructure and treatment policy is applied at a PICU, seriously disturbed patients can be treated without coercive measures.

Keywords

Psychiatric intensive care unitcoercive measuresseclusionborderline personality disorder
Type
Original Article
Information
Journal of Psychiatric Intensive Care , Volume 6 , Issue 1 , June 2010 , pp. 31 - 38
Copyright
Copyright © NAPICU 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ainsworth, M. (1969) Object relations and dependency and attachment: Theoretical review of mother infant relationship. Child Development. 40: 969–1025.CrossRefGoogle Scholar
Allan, E., Brown, R.C. and Laury, G. (1988) Planning a psychiatric intensive care unit: Intensive care for people with serious mental illness. Hospital & Community Psychiatry. 39(1): 81–83.Google Scholar
American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders. 4th Edition, revised (DSM-IV-TR). Washington DC: APA.Google Scholar
Berghmans, R., Elfahmi, D., Goldsteen, M. and Widdershoven, G. (2001) Kwaliteit van dwang en drang in de psychiatrie. Eindrapport. Utrecht: GGZ Nederland.Google Scholar
Bowers, L., Jeffery, D., Bilgin, H., Jarrett, M., Simpson, A. and Jones, J. (2008) Psychiatric Intensive Care Units: A Literature Review. International Journal of Social Psychiatry. 54: 56–68.CrossRefGoogle ScholarPubMed
Brown, S. and Bass, N. (2004) The psychiatric intensive care unit: Patient characteristics, treatment and outcome. Journal of Mental Health. 13(6): 601–609.CrossRefGoogle Scholar
Cohen, S. and Khan, A. (1990) Antipsychotic effect of milieu in the acute treatment of schizophrenia. General Hospital Psychiatry. 12(4): 248–251.CrossRefGoogle ScholarPubMed
Crowhurst, N. and Bowers, L. (2002) Philosophy, care and treatment on the psychiatric intensive care unit: Themes, trends and future practice. Journal of Psychiatric and Mental Health Nursing. 9(6): 689.CrossRefGoogle ScholarPubMed
Dawson, D. and MacMillan, H.L. (1993) Relationship Management of the Borderline Patient: From understanding to treatment. New York: Brunner/Mazel.Google Scholar
Department of Health (2002) Mental Health Policy Implementation Guide for National Minimum Standards for General Adult Services in Psychiatric Intensive Care Units (PICU) and Low Secure Environments. London: Department of Health.Google Scholar
Donat, D.C. (1998) Impact of a mandatory behavioural consultation on seclusion/restraint utilization in a psychiatric hospital. Journal of Behavior Therapy and Experimental Psychiatry. 29: 13–19.CrossRefGoogle ScholarPubMed
Fisher, W.A. (1994) Restraint and seclusion: A review of the literature. American Journal of Psychiatry. 151(11): 1584–1591.Google ScholarPubMed
Fluttert, F., Van Meijel, B., Nijman, H., Bjørkly, S. and Grypdonck, M. (in press) Preventing aggressive incidents and seclusions in forensic care by means of the ‘Early Recognition Method’. Journal of Clinical Nursing.Google Scholar
Fonagy, P., Gergely, G., Jurist, E. and Target, M. (2004) Affect regulation, mentalization and the development of the self. London: Karnac.Google Scholar
Gaskin, C., Elsom, S., Happell, B. (2007) Interventions for reducing the use of seclusion in psychiatric facilities. British Journal of Psychiatry. 191: 298–303.CrossRefGoogle ScholarPubMed
Hoch, J., O’Reilly, R. and Carscadden, J. (2006) Relationship management therapy for patients with borderline personality disorder. Psychiatric Services. 57: 179–181.CrossRefGoogle ScholarPubMed
Iversen, K., Hoyer, G. and Sexton, H. (2007) Coercion and patient satisfaction on psychiatric acute wards. Science Direct. 30: 505–511.Google ScholarPubMed
Janssen, W., Noorthoorn, E., Vries, W., Hutschemeakers, G., Lendemeijer, H. and Widdershoven, G. (2008) The use of seclusion in the Netherlands compared to countries in and outside Europe. International Journal of Law and Psychiatry. 31(6): 463–470.CrossRefGoogle ScholarPubMed
Jeffery, A. and Goldney, R. (1982) An innovation: The psychiatric intensive care unit. Australian Nurses Journal. 12(5): 42–43.Google ScholarPubMed
Kasander, R., Hrachovec, C. and Hutschemaekers, G. (2002) Dwang en drang in Europees Perspectief. Wolfheze: Gelderse Roos Instituut voor Professionalisering (GRIP).Google Scholar
Lloyd, C. (1995) Forensic Psychiatry for Health Professionals. Therapy in practice. London: Chapman and Hall.Google Scholar
Marangos-Frost, S. and Wells, D. (2000) Psychiatric nurses' thoughts and feelings about restraint use: A decision dilemma. Journal of Advanced Nursing. 31(2): 362–369.CrossRefGoogle ScholarPubMed
Musisi, S.M., Wasylenki, D.A. and Rapp, M.S. (1989) A psychiatric intensive care unit in a psychiatric hospital. Canadian Journal of Psychiatry. 34(3): 200–204.CrossRefGoogle ScholarPubMed
Olofsson, B., Gilje, F., Jacobsson, L. and Norberg, A. (1998) Nurses' narratives about using coercion in psychiatric care. Journal of Advanced Nursing. 28(1): 45–53.CrossRefGoogle ScholarPubMed
Rachlin, S. (1973) On the need for a closed ward in an open hospital: The psychiatric intensive-care unit. Hospital and Community Psychiatry. 24: 829–833.Google Scholar
Sailas, E., and Fenton, M. (2000) Seclusion and restraint for people with serious mental illnesses. Cochrane Database of Systematic Reviews. Issue 1. Art. No.: CD001163. DOI: 10.1002/14651858.CD001163CrossRefGoogle Scholar
Schore, A. (2003) Affect Regulation and the Repair of the Self. New Jersey: Lawrence Erlbaum.Google Scholar
Warneke, L. (1986) A psychiatric intensive care unit in a general hospital setting. Canadian Journal of Psychiatry. 31(9): 834–837.CrossRefGoogle Scholar
Wynaden, D., McGowan, S., Chapman, R., Castle, D., Lau, P., Headford, C. and Finn, M. (2001) Types of patients in a psychiatric intensive care unit. Australian and New Zealand Journal of Psychiatry. 35: 841–845.CrossRefGoogle Scholar