Suicide is a problem for society. On examination, current medical/legal concepts of suicide and responsibility rely on imprecise definitions and neglect aspects of suicide which are social rather than medical. A non-medical approach to those cases of people at risk who do not suffer a mental disorder is suggested, along with factors to be considered when the actions of mental health professionals are being evaluated.

Background: Psychiatric intensive care units (PICUs) provide care for patients who may demonstrate agitation and aggressive tendencies. Such behaviour has traditionally been managed using interventions such as seclusion and/or physical restraint. There is little published data about the use of these measures within different PICUs. This paper attempts to provide such evidence as a base for clinical governance.

Aims: To describe patterns of seclusion and restraint usage within the care of 332 patients admitted consecutively to seven English PICUs.

Method: Prospective, multi-centre patient case note analysis.

Results: Within the four units that utilised seclusion in the study period, it was used on 16% of patients who had been admitted. All seven units used control and restraint and 28% of admitted patients were formally restrained at some point during their admission. There was no significant difference in mean duration of restraint or proportion of patients who were restrained between the units that used seclusion and those that did not. Use of seclusion was significantly associated with patient violence and property damage in PICU. Restraint usage was also significantly associated with patient violence and property damage but also with higher two week BPRS scores and a younger patient age.

Conclusions: It appears that PICUs manage disturbed behaviour differently, either dependent upon facilities or local policies. In attempting to reduce the use of seclusion and restraint, a multi-faceted approach must be taken both locally and nationally. PICU clinicians and service users should be integral within this.

Aims: To compare the clinical characteristics of patients who absconded and those who did not abscond; and to show the types of absconding behaviour in a low secure challenging behaviour mental health unit.

Method: A retrospective case control study was conducted. Details of the absconding incidents were collected from an electronic incident database. Clinical predictors of patients who absconded (cases) and those who did not (controls) were compared. Statistical analysis was performed to determine statistical significance of the observed differences.

Results: 80 admissions resulted from 78 patients during a period of 6½ years. 22% of the inpatients absconded from the unit. 84% of the incidents occurred while patients were utilising their unescorted leave. Only one patient escaped from the building. No serious incidents resulted from any of the abscondings. On univariate analysis, the following predictors were more likely to be statistically associated with patients who absconded from the unit: a history of absconding behaviour and a history of substance misuse or dependence. A history of non-compliance with treatment, a history of sexually inappropriate behaviour and a history of childhood conduct problems showed a trend towards statistical significance.

Conclusion: The clinical characteristics of patients who abscond from low secure units show similarities with those who abscond from other psychiatric inpatient settings.

Declaration of interests: None.

This article presents the initial implementation and adaptation of a group for people who hear voices in a psychiatric intensive care unit (PICU) using a cognitive behavioural therapy (CBT) approach. It highlights the lack of evidence-based psychosocial group interventions designed specifically for the PICU environment and challenges the traditional medical-model of PICU care. It also highlights national policy and guidelines advocating the implementation of CBT approaches for severe and enduring mental illness. An overview of the group sessions is described, with particular focus on adaptations of the group content and delivery for PICU populations. The authors note that twenty three clients have attended the PICU voices groups to date, demonstrating the feasibility of voices groups in PICU environments. Further work is currently being undertaken including formal evaluations of group outcomes using standardised measures.

Persons with mental diseases are admitted to acute care psychiatric units during the day and night. The distribution of diagnoses given to these patients according to time of day has not previously been studied. All referrals during one year to a 27-bed facility were studied using the computerized medical records. 998 patients were referred during the year, of whom 480 were female. 47% arrived within office hours, 41% in the evening and 12% during the night. In order of frequency, patients with psychotic disorders comprised 26%, narrowly followed by the affective disorders (25%), substance abuse disorders (17%), then personality disorders (13%) and crises and anxiety disorders (12%). There is a tendency towards patients with lower diagnostic ICD-numbers (especially psychotic and affective diagnoses) arriving earlier than the other diagnostic groups. The diurnal variations in diagnoses were otherwise small.

Women with personality disorders were almost thrice as frequent as males, whereas males with substance abuse were almost twice as frequent as females. Patients above 60 years of age with non-abuse related organic disorders were mainly males (26 versus 7).

Patients > 60 years of age (N = 57) had the following frequencies of admission through the 24 hour period: 54.4%, 36.8% and 8.8% (office hours, evening, night), whereas patients below 60 years of age (N = 941) had 46.7%, 41.0% and 12.3%, respectively.

The diagnostic process after referral to an acute psychiatric treatment facility consists of more than the clinical investigation and laboratory tests. Psychometric tests in a broad range of languages may be such an augmentation of our diagnostic armamentarium, especially for immigrants for whom oral understanding of a dialogue may be restricted. The aim of this study was to discover whether such tests are in use, and how they are distributed among different patient categories. All referrals in one calendar year (N = 1168), as they are depicted in the hospital computerized medical records, were investigated. Fifty-six (6.1%) out of 926 ethnic Norwegians and six (3.0%) out of 198 non-Western immigrants were tested, whereas none of the 44 Western immigrants were. The difference between ethnic Norwegians and the immigrants was significant (Z = −3.05 and p = 0.002). Psychometric tests were thus almost not in use, and even less so in immigrants.

The mean number of resident days was higher among those tested, 11.7 (SD = 11.2), versus those not tested, 7.4 (SD = 10.4) days (t = 2.97 and p = 0.004). Among those tested, length of stay was not significantly different; 11.4 and 11.7 days respectively. The patients tested were older than those not tested. Mean age was 43.0 (SD = 14.4) versus 38.8 (SD = 12.1), with t = 2.65 and p = 0.03. Ethnic Norwegians had the longest mean stay, followed by Western immigrants and non-Western immigrants. The difference in resident days between all immigrants and ethnic Norwegians was significant with Z  =  −2.232 and p = 0.026. There was no such difference between Western and non-Western immigrants: Z = −0.057 and p = 0.95. The level of testing was higher in ethnic Norwegians, and the tested patients stayed longer, maybe indicating more time for testing. Whether this low test activity influences treatment quality is an unsettled question.

In England and Wales, the law allows a mentally disordered person who is in a public place and requires care or control to be taken to a Place of Safety (POS) for assessment. Historically the POS has usually been the police cells but recent policy development has supported the provision of alternative POSs. In this article we describe how a new POS was set up on a hospital site in Gloucestershire.

This practice evaluation paper will present the case for the use of trampolining as a therapeutic activity within an acute care setting for people experiencing mental ill-health. A brief history of this activity within a therapeutic context will be outlined and a theoretically analysed rationale for the development of trampoline sessions explained. A case vignette will illustrate the argument that trampolining is a realistic and therapeutic option for people who need the care of a Psychiatric Intensive Care Unit (PICU) or Low Secure Unit (LSU). The paper will conclude that service users can find trampoline activity useful as part of a recovery journey from acute mental illness.