Psychiatric Intensive Care Unit (PICU)

What is a PICU ward?

Psychiatric Intensive Care Units (PICU) are specialist wards that provide inpatient mental health care, assessment and comprehensive treatment to individuals who are experiencing the most acutely disturbed phase of a serious mental disorder.

Most patients are admitted to a PICU service from other hospitals or directly from the community if behaviour becomes concerning.  Others are sectioned by the Police under Section 136 of the Mental Health Act 1983 (2007), or on a Community Treatment Order.

Child and Adolescent Mental Health Services (CAMHS) cater for young people up to the age of 18 and adult PICUs admit patients who are over the age of 18. There is no upper age limit.

 

How is a PICU ward different to an open psychiatric ward?

PICU are small wards in terms of patient numbers compared to open psychiatric wards. They have with higher levels of Registered Mental Nurses (RMNs) and Health Care Support Workers (HCSWs), in addition to a full complement of Multi-Disciplinary Team (MDT) members including Psychologists, Occupational therapists, Art Therapists, and Social Workers.  The wards are built on an open plan design to ease observation. They are normally locked wards, usually single-sex occupancy, but not always, and they have facilities for seclusion. They provide a more secure environment beyond that, which is normally provided on an open psychiatric ward,

 

What conditions are managed on a PICU?

Patients that are seen on a PICU will be experiencing an acute episode as a result of one or more mental health conditions.  Common examples include severe depression, personality disorder, schizophrenia, mania or psychoses of some form.   Some individuals present with acute distress and maybe an absconding, suicide or self-harm risk.   Others may be unpredictable in their behaviour, outwardly aggressive to others, to property or to themselves.  For this reason, all patients on a PICU ward are detained mainly under Section 2 or Section 3 of the Mental Health Act 1983 (2007).   Patients detained under Section 2 remain in a PICU for up to 28 days for assessment, whereas patients detained under Section 3 stay longer (from three to six months).

 

How do you achieve good outcomes for PICU patients?

Because PICUs manage some of the most clinically unwell and acutely risky patients, it is essential that the clinical team work collaboratively with the patient, their family members, and other inpatient and community services.  Only by involving them every step of the way and placing the clinical need of each and every patient at the heart of service delivery can successful outcomes be achieved.

The aim of a PICU is to manage and reduce the risks associated with these acute episodes of illness as soon as possible.   PICU wards create a safe and controlled environment to look after acutely disturbed psychiatric patients whilst also respecting their privacy and dignity.   To achieve this, a PICU should have a fully engaged multi-disciplinary team (MDT) with clear clinical and operational leadership and have high staffing ratios to allow for intensive input at times of need to resolve any issues quickly.

 

What treatment and therapies are available on a PICU?

Most patients only stay on a PICU ward for a very short time and are moved as soon as the crisis is over or risky behaviours are under control.  However, despite this short stay, most PICUs do offer therapy and a programme of care to help develop individuals’ living skills, to provide insight into their condition, and to educate and help them gain the confidence to be safe in an open psychiatric ward or the community.

 

Does a PICU only offer treatment to patients in a crisis?

Whilst the majority of patients are admitted to a PICU as an emergency, some patients are admitted to a PICU ward as a “planned admission”.   In this situation, the MDT would assess the individual before admission to make sure that the service would be of benefit to the individual.  The MDT would determine if the patient had the potential to get engaged with treatment and whether the increased patient/staff ratio and a more controlled environment would help the individual achieve his or her personal treatment goals.

 

Where do patients go when they are discharged from a PICU? 

Commonly patients are discharged to an acute ward but some patients are able to go straight home if they have made a full recovery.   With certain conditions, such as drug-induced psychosis, patients may never require any further input from mental health services.

 

How do you get help for someone who starts to behave in a strange way?

If you are worried about a family member or friend you should call your GP or Local Authority and they will organise a Mental Health Assessment.  If you feel the situation is more urgent you should contact the Police, call an ambulance or take the individual to Accident and Emergency (A&E).

 

To find out more about Huntercombe’s PICU services:

Adult PICU – London

CAMHS PICU – Stafford and Maidenhead