Helping solve the problem of drug use in psychiatric intensive care

20 March 2020

Helping solve the problem of drug use in psychiatric intensive care

People with mental health problems often misuse drugs and alcohol. This doesn’t just happen in their homes and communities, but in the very places they receive treatment for their mental health – psychiatric intensive care units (PICUs). What’s the impact of substance misuse in PICUs? And how do PICUs address it?

Patients’ stay within PICUs is usually relatively short (a few weeks to a few months on average) and tends to focus on crisis interventions. As a result, there is a misconception that patients and staff are not in need of interventions or training in substance misuse whilst on the ward. However, our research has found this not to be the case. In partnership with the Royal College of Psychiatrists, we explored this issue and the support mental health staff need to effectively tackle it.

What we did

We circulated a quantitative survey on substance misuse in PICUs using the Quality Network for Psychiatric Intensive Care Units (QNPICU) email distribution list and Knowledge Hub, which is an online forum for QNPICU member services. The aim was to highlight the main types of substances being used, the frequency of occurrence and the associated problems.

Using this information, we devised open-ended questions to use for follow-up telephone interviews, conducted with eight survey respondents. The questions focused on facilitating an open discussion around:

  • The main substances used and potential reasons why;
  • Access to training on managing substance misuse;
  • The key issues arising as a result of substance misuse; and
  • The effects on staff, patients and the ward environment generally.

The questions for the interviews were considered carefully, to avoid any leading questions and to encourage openness and honesty in the responses. Using this approach, we were able to identify the gaps in training and the areas of need and support.

The mixed methods approach to the research enabled us to gather rich detail in the responses following on from the key areas identified in the initial survey.

In response to the research, the QNPICU held a Special Interest Day on managing substance misuse in psychiatric intensive care, where we presented our findings:

  • Substance misuse is a serious issue affecting the majority of PICUs resulting in bullying, violent behaviour and patients disengaging with treatment
  • Despite the scale and impact of substance misuse, 40% of PICU staff had never received training on it
  • Only 27% received training on an annual basis and almost everyone we spoke to wanted more training

We ensured to make the presentation interactive to actively encourage participation and suggestions from experts in the field: staff members, patient reviewers and family and friends’ representatives. As substance misuse in PICUs was an issue that affected most attendees, we invited them to guess the different findings from the research throughout the presentation. This had the dual benefits of keeping the audience engaged and warming them up for the participatory session which followed.

In the participatory session, we generated focused discussions around:

  1. the ideal training programme for PICU staff members on managing substance misuse, and
  2. the required resources to efficiently and effectively manage substance misuse in a PICU.

This was a successful approach, as individuals were able to digest the findings of our presentation and apply them to their work. We did this by asking them to design their ideal substance misuse training programme. This was a simple way to uncover areas of need and support amongst the PICU workforce so they could appropriately manage substance misuse in PICUs and further reduce the associated problems caused.


 A call to action

This research, plus the participatory session resulted in a clear call to action for more substance misuse training for PICU staff. This is a workforce highly trained in supporting people with serious mental ill health, yet despite the scale and impact of drug use in PICUs, few of them receive training on substance misuse.

Training is only the first step in supporting mental health staff effectively tackle substance misuse. More resources such as reliable drug testing equipment, clear referral pathways and improved security are also needed.

Following on from the event, our aim is to further acknowledge the gap and create a solution-focused approach to tackling substance misuse within PICUs. Through the Quality Network we will be incorporating standards that are published by the Royal College of Psychiatrists to address training and intervention needs. Members will be subject to reflect on their current processes with the aim to identify training or connections to local organisations to support with interventions. 

Our longer-term plans resulting from this research include:

  • Publishing a peer-reviewed paper
  • Developing a training programme
  • Conducting further research into the scale and impact of substance misuse in PICUs
  • Widespread dissemination of recommendations with the ultimate aim of influencing policy

 Using this approach beyond PICUs

This approach can be used in any workplace or sector. If you want to solve a problem that affects how people do their jobs and how safe they feel at work, then staff will be motivated to get involved.

Those working on the ‘front line’ are often best placed to identify issues and when given the time and space to reflect on these, have the solutions.

If you would like to talk to us about how to turn research into practical applications – such as designing a needs-led training programme – please contact Hattie Moyes:

If you have any questions about the research project, please contact Kate Townsend:

Hattie Moyes, Senior Consultant, Traverse

Lana MacNaboe, Project Officer, Royal College of Psychiatrists

Kate Townsend, Deputy Programme Manager, Royal College of Psychiatrists

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