the london survey of psychiatric intensive care units: Service provision and operational characteristics of national health service units

Background: psychiatric intensive care units (picus) and low secure units (lsus) provide care for the most disturbed inpatients in adult mental health services. little is known about levels of provision or how these units operate within local services. in 2002 the department of health (doh) published national minimum standards of care for psychiatric intensive care and low secure environments, but there remains a paucity of service level data to inform the specialism. aim: to offer the first large-scale systematic survey describing service structure and functioning of picu and lsu. method: a questionnaire was sent to ward managers of every picu and lsu in london. information was gathered on provision, physical structure, staffing and aspects of unit functioning. results: 17 national health service (nhs) picus containing 193 beds, and 16 nhs lsus containing 199 beds were identified in london. an additional one third of picu provision was privately (non nhs) funded and managed. bed occupancy was high (90%, picus; 95%, lsus in the 8 weeks prior to census day) and waiting lists for lsu beds long (64 patients on waiting lists for lsu beds on the census day, mean waiting time for lsu bed, 93 days). the use of agency nursing staff was high (33% of staff per shift on picus, 28% of staff per shift on lsus). conclusions: all but two units failed to meet the national minimum standards for picu and lsu environments. improvements need to be made in provision and staffing levels for permanent nursing staff, psychology and other therapies. idiosyncrasies exist in admission criteria, particularly with regard to informal patients in lsus and personality disordered patients across the board. declaration of interest: the project was part-funded by department of health. © 2005, napicu. All rights reserved.