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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: i.georgieva@erasmusmc.nl
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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

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