Scoping review of intensive psychiatric inpatient care provision for young people in Scotland: report

Recommendations

Recommendation i) The review team wish to emphasise the importance of ensuring equality of access and recommend that an Equality Impact Assessment (EQIA) is undertaken as part of any future adolescent IPCU developments. It is crucial that steps are taken to provide for the needs of patients from different backgrounds (including BAME) and to ensure equality in relation to other protected characteristics.

Recommendation ii) Current service specifications, which were consulted for this report, do not specify standards for working with young people who are transgender or non-binary. Furthermore, a disproportionate number of young people who are LGBT+ are at risk of developing mental health problems (Plöderl & Tremblay, 2015). The review team therefore recommend that any future service providing intensive psychiatric care to young people take appropriate action to ensure comprehensive guidance is in place regarding supporting patients who are transgender or non-binary.

Recommendation iii) Referrals to an Intensive Psychiatric Care Service for young people should generally come from open adolescent inpatient psychiatrists, or be made by community child and adolescent psychiatrists in liaison with inpatient psychiatrists.

Recommendation iv) NES should provide specific training for staff in intensive psychiatric care services, to cover nursing models, multi-disciplinary models of care, management of challenging behaviour, and risk to self and others in an intensive psychiatric care setting.

Recommendation v) All least restrictive alternatives for care of a young person should be exhausted before admission to a psychiatric hospital is considered, and before admission to an Intensive Psychiatric Care Service is instigated.

Recommendation vi) Future development of IPCU provision for young people should include consultation with organisations in the local community of the proposed site(s), as well as consultation with appropriate third sector/voluntary organisations.

Recommendation vii) There should be a national steering group to allow economies of scale and consistency in service delivery if regional services are commissioned.

Recommendation viii) Liaison with young people and carers is required before commissioning of any service is implemented to consider the views of those with lived experience. It is recommended that carers/young people are involved in any design of intensive psychiatric inpatient facilities.

Recommendation ix) The planning and design of any intensive psychiatric care facility should consider the importance of a specific environment that is designed to meet patients' sensory needs in a way that will contribute to emotional regulation.

Recommendation x) IPCU service provision should be designed with violence reduction measures in mind when considering environmental and procedural planning. National Association of Psychiatric Intensive Care and Low Secure Units (NAPICU) guidelines should be instrumental in this. Violence Reduction Services should be consulted to provide training to staff working in any new intensive psychiatric care facility.

Recommendation xi) Exploration of care options with multi-agency partners as a team around the child should be in place before referral to an IPCU is made.

Recommendation xii) Even with the introduction of dedicated IPCU provision for young people, the review team anticipate there will remain a service gap for young people with a severe learning disability who are experiencing acute distress, and for whom a restrictive approach would not be appropriate. The review team wish to emphasise the importance of developing guidance for providing the correct support for these young people.

Recommendation xiii) While it is difficult to infer from available data the number of beds that would be required, the review team recommend two beds per regional site are factored in to planning for the development of future adolescent intensive psychiatric provision.

Recommendation xiv) On the basis of the findings of the review, and the outcome of the Options Appraisal, the review team suggest Regional purpose built adjacent units would best meet the requirements for adolescent intensive psychiatric provision in Scotland.