Aims: To describe the methods of self harm incidents in a low secure unit population and to identify and compare the clinical characteristics of patients displaying inpatient self harming behaviours with those who do not display such behaviours.

Method: A retrospective case control study was conducted. Details about the inpatient self harming incidents were collected from an incident database. Clinical characteristics of those who displayed inpatient self harming incidents (cases) and those who did not display such behaviours (controls) were compared. Analysis was performed to establish statistical significance on the observed differences.

Results: 80 admissions resulted from 78 patients during a 6½ year period. 21% of patients presented with inpatient self harming behaviours. 57% of the incidents were caused by 13% of patients. Clinical characteristics such as white ethnic background, histories of self harm, physical or sexual abuse, childhood conduct problems and lack of educational qualifications and having a diagnosis of schizoaffective disorder were more likely to be associated with inpatients self harming in low secure settings. Sexually inappropriate behaviours and a diagnosis of schizophrenia were less likely to be associated with this group.

Conclusion: The majority of self harm incidents are caused by a minority of patients. Most of the clinical characteristics associated with the low secure inpatient self harming patients are similar to those observed in other psychiatric inpatient settings.

Background: Refugees and asylum seekers may have other feelings and expectations about the future than immigrants do. The aim of this study was to explore and analyse the expectations for the future among populations of immigrants, asylum seekers and refugees admitted to Norwegian acute psychiatric departments.

Method: In a prospective study in the period 2005 to 2008, data were collected from two acute psychiatric departments.

Results: There were 48 immigrants, 24 refugees, and 21 asylum seekers. A significantly higher proportion of asylum seekers than refugees had nightmares (p = 0.04), feelings of guilt (p = 0.04) and feelings of hopelessness (p = 0.04). A significantly higher proportion of asylum seekers than immigrants had sleeping problems (p = 0.03), nightmares (p = 0.03), feelings of hopelessness (p = 0.03) and reduced appetite (p = 0.04). Significantly more asylum seekers than refugees maintained that life would change for the better over time (Z = 2.0; p = 0.04). More refugees than asylum seekers indicated problems judging life ten years from now (Z = 2.1; p = 0.04).

Conclusion: Being an asylum seeker seems to incur greater distress and higher negative expectations for the future. Preventive strategies should be created to improve refugees’ and asylum seekers’ life in exile. Priority and speed in processing of asylum cases should be given higher priority.

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.

An evaluation of the Extra Care Area (ECA) in a medium secure psychiatric facility for women is described. A retrospective case note audit over an 18 month period concluded that the ECA was used infrequently for the most disturbed service users who had previously been frequently secluded. Ongoing self harm and aggression in ECA was a feature of some cases raising the possibility that admission may be counter productive for some, particularly when it is combined with a lack of occupational stimulation. Service users valued the opportunity for reflection in a low stimulus environment and there were no repeat admissions. A number of initiatives to improve multidisciplinary care planning, documentation, therapeutic engagement and service user involvement to reduce risk have been actioned. Of particular importance is the need to begin ‘discharge planning’ at the first point of entry to avoid prolonged stays, isolation from peers and dependence on both individual staff attention and a special status living arrangement.

Psychiatric patients suffer high rates of mortality and morbidity. One of the major reasons for this is the high prevalence of physical health problems in psychiatric patients. Psychiatrists have tended to pay less attention to, and receive less training in, the management of the physical health of their patients with this role largely being left to general practitioners. Though there is an increasing awareness of long term physical morbidities in psychiatric patients, the literature on acute physical morbidity is sparse. In this article we aim to emphasise the importance of recognising serious physical illnesses that could arise in the acutely unwell psychiatric patient.

The scope of this article is not to provide a comprehensive list of physical complications and management strategies but to provide the psychiatrist with a conceptual framework to assist with the management of co-morbid physical and psychiatric illness.

Although psychiatric intensive care is a relatively new speciality, it has been well defined. The use of lean management techniques in association with accurately defining services lends itself well to treating patients in an effective and efficient manner. This paper summarises the development of lean management, its use in health services, and its early application within psychiatric intensive care units (PICUs) when examining quality of care provided. It then discusses its possible function in conjunction with robustly describing needs of patients within psychiatric intensive care and how this further enhances patient care by grouping these needs into different types.