National Standards and good practice

Abstract

Introduction By the very nature of its practice, psychiatry today continues to be influenced not only by mental health professionals but also by the framework within which care and treatment are delivered. In the UK this includes legal [e.g. The Mental Health Act dealing with compulsory detention of patients (Department of Health 1983)], social (e.g. family and carers), user involvement (e.g. user groups) and political interventions (e.g. Department of Health guidelines). Given the rights of patients enshrined within statute and other government guidance, e.g. Care Programme Approach (Department of Health 1999a), in no other subspeciality is the interface with legal, ethical, political and social issues more acute than within locked Psychiatric Intensive Care Units (PICUs). Yet astonishingly, up until relatively recently, it is the one area within which these issues had been most neglected. The publication of the UK National Minimum Standards (NMS) (Department of Health 2002) gave clinicians, managers and commissioners a framework to deliver high-quality services and care to some of the most severely and acutely unwell patients treated by the mental health system. This chapter will outline development of the standards, summarise and review their structure and content, as well as describe evidence of practice in UK PICU and Low Secure Unit (LSU) settings. National Association and need for Standards In the UK, the National Association of Psychiatric Intensive Care Units (NAPICU) was established in 1996.