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

2 Methods

2.1 Design

This review adopted a mixed methods approach to gathering data to inform this report. Quantitative data was sourced to inform current use of IPCUs by adolescents, and qualitative data was gathered to provide insight into clinical experiences and recommendations from health and social care staff. Due to the large volume of transcripts from consultations, it was not possible to conduct a formal thematic analysis, however the review team have made use of a process whereby two team members coded all transcripts, identifying key issues and recommendations.

2.2 Quantitative data

Data was requested from each consulting region through use of a data template that was circulated to clinical staff and data analysts from each region. The template asked staff to complete tables indicating details of referrals to IPCU provision in their area.

2.3 Qualitative data

The review team met virtually to consult with individuals from various NHS and non-NHS organisations. This process provided input from those in a role pertinent to the use of an adolescent IPCU in NHS Scotland. A full list of individuals and organisations that were contacted can be found in Appendix III.

2.3.1 Regional Inpatient Unit discussions

There are three Open Psychiatric Units for adolescents in Scotland: Young People's Unit (Edinburgh), North of Scotland Young Person's Unit (Dundee) and Skye House (Glasgow). These units traditionally receive referrals from South East of Scotland, North of Scotland and West of Scotland respectively. The review team conducted a focus group discussion with staff from each region, to better understand the different processes that take place across the country for management of young people with a requirement for intensive psychiatric care. The consultation was opened to Senior Charge Nurses, Nursing Managers and Bed Managers of the Young People's Units, as well as Psychiatrists who worked within the Young Person's wards or the adult IPCUs that adolescents would be referred to if required and appropriate. Each of these discussions asked questions based on a pro-forma (see Appendix IV), the same questions were asked in each region.

2.3.2 National Secure Adolescent Inpatient Service discussions

A new National Adolescent Secure Service is currently being built, located in NHS Ayrshire and Arran. This will be the first of its kind for this age group in NHS Scotland. The review team consulted with the staff team involved in planning, setting up, and (in future) running this service to gain insight into developing a new service, as well as the relationship and pathways between this service and a potential IPCU for adolescents. Two separate discussions were held due to clinician availability. The regional pro-forma was adapted to reflect emphasis on issues pertinent to staff working in the Secure Service. The different discussions had slightly different pro-formas as they were further adapted to reflect the roles of the consulted staff in developing and working in the service.

2.3.3 Chief Social Work Officers (CSWOs) discussion

Social Care input is vital to informing this review of the current processes that exist between inpatient and social care services, and allowed the review team to reflect on how social work pathways would link to an IPCU setting. CSWOs across Scotland were invited to take part in a discussion, in order to gather viewpoints from local authorities in both rural and more densely populated areas.

2.3.4 Discussions with young people

Given that young people will be the patients in the type of service that this review will inform, it is obviously crucial to gather as much relevant input from young people as possible to provide a well-rounded review. This does provide challenges however: individuals who are currently accessing IPCU care in any setting may struggle to fully participate in discussions (e.g. these individuals may be experiencing disturbances, or be too unwell to take part). Advocacy services with involvement in two of the regional open wards were contacted to hold discussions on the review team's behalf and a questionnaire was developed. At the time of writing, due to COVID-19 and consequent circumstances within the wards, advocacy services have been unable to speak to patients in a capacity that would allow them to discuss the questionnaire.

2.3.5 Violence Reduction Service discussion

The review team consulted with a representative from the NHSGGC Violence Reduction Service to gain insight into the considerations that need to be taken into account in a service where there is increased risk of violence, and in relation to care planning to minimise violence.

2.3.6 NHS England consultation

Contact was made with NHS England as the review team was hoping to gain insight from NHS Trusts that have developed PICU provision for adolescents. The literature review that forms the introduction in previous sections involved the consultation of several documents and legislation that outline PICU service provision and pathways within NHS England and the rest of the UK. Positive contact was made with staff from NHS England, however, it has not been possible to formally proceed with the consultation. The review team feel that the evidence provided in this paper is sufficient to outline the processes and recommendations made by NHS England.

2.4 Ethics

This review is considered a service evaluation and audit, therefore approval to conduct the project was sought and gained from the NHSGGC CAMHS Research & Evaluation Group. Staff taking part in consultations that were recorded were asked to complete a consent form to agree to the use of the transcripts informing this review.