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Edited by
Roland Dix, Gloucestershire Health and Care NHS Foundation Trust, Gloucester,Stephen Dye, Norfolk and Suffolk Foundation Trust, Ipswich,Stephen M. Pereira, Keats House, London
When psychiatric intensive care units (PICUs) were first created in the United Kingdom, they were mixed-sex wards. As time progressed, evidence grew stronger for the need to create separate PICUs for men and women. Female-only PICUs have been around for about a decade, making them a relatively novel phenomenon within the existing mental health services in the United Kingdom. Nevertheless, they play a crucial role within the wide net of mental health services. This chapter summarises the history and development of female-only PICUs and describes some female-specific characteristics of such wards. It then focuses on describing women-specific perinatal mental health presentations and services, including existing provisions for women with mental illness to access family support and contact with their children. Lastly, it discusses the clinical considerations for patients with EUPD and ASPD to access PICU settings.
Chapter 14 outlines the range of mood difficulties and disorders in children and young people, including low mood and depression, bipolar affective disorder and emotion regulation difficulties. We also discuss the emerging personality difficulties and disorders. We consider treatment approaches and support for children and young people with mood difficulties and disorders.
An earlier evaluation (Fox et al., 2014) highlighted reductions in risk behaviours and restrictive practices for women admitted to low secure dialectical behaviour therapy (DBT) unit. Since then, a value-based healthcare model has been adopted.
Aims:
To explore changes in health, social and psychological functioning, risk, quality of life, and in incidents of violence and restrictive practices, over the initial 12-month period of admission to a specialist DBT service.
Method:
Data were extracted from electronic clinical records for 41 women with emotionally unstable personality disorder admitted to a specialist integrated practice unit (IPU) providing a comprehensive DBT programme. Secondary analysis was conducted on an anonymous dataset of routinely collected outcome measures at baseline admission, and 6 and 12 months post-admission. ANOVAs and pairwise post hoc comparisons, and non-parametric equivalents, were conducted to examine changes in outcomes.
Results:
Findings showed statistically significant improvements in mental health scores on the ReQOL (p<.01), global, wellbeing, problems, functioning and risk scores on the COREOM (all p<.01), and severe disturbance, emotional wellbeing, socioeconomic status, risk and need scores on the HoNOS-Secure (all p<.05). Significant reductions in risk behaviours (p<.01) and restrictive practices (p<.01) were also apparent. The most substantiative improvements were largely demonstrated over a 12-month admission period.
Conclusions:
Admission to the DBT IPU yielded significant improvements on outcomes pertaining to quality of life, psychological distress, and risk. Importantly, these are outcomes that aligned with patients’ perceptions of recovery.
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