Benchmarking psychiatric intensive care units (PICU) in a metropolitan area

Background

With the deinstitutionalization of the last 30 years, psychiatric patients who where formerly housed and treated in large-scale mental hospitals in the country-side, were transferred to the cities and encouraged to rehabilitate and reintegrate in society, with the help of ambulatory psychiatric care and small-scale community admission units. In the same era, the number of compulsory admissions, and the turn-over on PICU's has steeply increased. The city of Amsterdam has six PICU's under the aegis of three distinct mental health care institutions. The nature and extent of differences in organizational structure, treatment policy and patient population between the units were largely unknown. The aim of this study was to evaluate the functioning of these units.

Methods

A semi-structured interview was held among leading representatives (psychiatrists, managers, nursing staff) of the six Amsterdam units and a comparable psychiatric admission unit in a small Dutch town. In addition, prospective figures were obtained from their computerized registration systems. A large number of organizational, patient and treatment variables were compared.

Results

Significant differences and similarities in the operation of the psychiatric units were found. Divergences can partly be explained and justified by differences in patient characteristics and differences in the organizational culture of the mental health care institutions.

Conclusion

Differences in acute psychiatric care between The Netherlands and other European countries, and prevailing standards for 'good clinical practice' for closed psychiatric wards in the respective countries are discussed. In the Netherlands, a generally agreed upon standard for adequate care on PICU's is lacking. Based on the results of this benchmark study, a prospective registration study is in progress to investigate the quality of caregiving by the participating units, aimed at the effectuation of such a standard.