This chapter defines the terminological differences between the terms 'fire-setting', 'arson' and 'pyromania', including their place in current diagnostic manuals. An epidemiological perspective on fire-setting in those with mental disorder as well as classification systems and theories of fire-setting with prevailing conceptual models of fire-setting and mental disorder is described. Current approaches in the risk assessment of fire-setting and psychological and pharmacological interventions in fire-setting are discussed. Finally, a care pathway to guide clinical and risk assessment of the patient with fire-setting as a feature of their behaviour or history is suggested.

Purpose This paper aims to explore the impact of the COVID-19 pandemic on mental health organisations in England. Design/methodology/approach A qualitative mixed-methods approach was applied, including a review of the academic literature, a review of the non-academic literature and a brief semi-structured survey. Respondents of the semi-structured survey included seven healthcare leaders from four different NHS Mental Health Trusts in England. This review applied thematic analysis to the data findings. Findings Mental health organisations in England have been significantly impacted by the COVID-19 pandemic. The analysis of the identified resources found four overarching areas for learning: organisational structures, approaches to practice (working and delivering care), leadership and staff support. Organisational structures refer to structural, systemic and procedural changes that have taken place. Approaches to practice relate to shifts in organisational work and delivery of care. Leadership identifies styles used to manage change and disruption. Staff support refers to measures and interventions applied to meet changing staff needs and well-being. Practical implications Mental health organisations can reduce the ongoing impact of the COVID-19 pandemic through continuous improvements in future crisis planning, innovations in clinical practice and a sustained focus on staff well-being. Originality/value A multi-dimensional exploration into the impact of the COVID-19 pandemic on mental health organisations was conducted. The review also provides insights into the experience of healthcare leadership in managing change during the COVID-19 pandemic.

Objectives To examine whether discharge destination is a useful predictor variable for the length of admission within psychiatric intensive care units (PICUs).Methods A clinician-led process separated PICU admissions by discharge destination into three types and suggested other possible variables associated with length of stay. Subsequently, a retrospective study gathered proposed predictor variable data from a total of 368 admissions from four PICUs. Bayesian models were developed and analysed.Results Clinical patient-type grouping by discharge destination displayed better intraclass correlation (0.37) than any other predictor variable (next highest was the specific PICU to which a patient was admitted (0.0585)). Patients who were transferred to further secure care had the longest PICU admission length. The best model included both patient type (discharge destination) and unit as well as an interaction between those variables.Discussion Patient typing based on clinical pathways shows better predictive ability of admission length than clinical diagnosis or a specific tool that was developed to identify patient needs. Modelling admission lengths in a Bayesian fashion could be expanded and be useful within service planning and monitoring for groups of patients.Conclusion Variables previously proposed to be associated with patient need did not predict PICU admission length. Of the proposed predictor variables, grouping patients by discharge destination contributed the most to length of stay in four different PICUs.

Background: Patients in mental health services' seclusion require regular physical health assessments to identify, prevent and manage clinical deterioration. Sometimes it may be unsafe or counter-therapeutic for clinical staff to enter the seclusion room, making it challenging to meet local seclusion standards for physical assessments. Alternatives to standard clinical assessment models are required in such circumstances to assure high quality and safe care. Aim: The primary aim was to improve the quality of physical health monitoring by making accurate vital sign measurements more frequently available. Secondary aims were to explore the clinical experience of integrating a technological innovation with routine clinical care. Method: A non-contact monitoring device was installed in the mental health seclusion room and was used in addition to existing clinical care. Over six months, adherence to local clinical guidelines was compared against a time- period prior to installation. Feedback was sought from staff and patients through questionnaires and focus groups. A quality improvement framework was used to continually improve the process using plan, do, study, act (PDSA) cycles. Results : The non-contact monitoring device enabled a 12.3-fold increase overall in the monitoring of physical health observations when compared to a real-world baseline rate of checks. Enhancement to standard clinical care varied according to patient movement levels. Patients, carers and staff expressed positive views towards the integration of the technological intervention.Conclusion: The non-contact monitoring device improved the quality and safety of care by increasing availability of physical health monitoring. It was positively received by patients, carers and staff.

Aims and method To assess the sexual and reproductive health (SRH) needs of women admitted to a psychiatric intensive care unit (PICU), and acceptability of delivering specialist SRH assessments and interventions in this setting. Within a quality improvement framework, staff were trained, a clinical protocol developed and clinical interventions made accessible. Results Thirty per cent of women were identified as having unmet SRH needs and proceeded to a specialist appointment, representing a 2.5-fold increase in unmet need detection. Forty-two per cent of women were assessed, representing a 3.5-fold increase in uptake. Twenty-one per cent of women initiated SRH interventions, of which 14% had all their SRH needs met. Staff, patients and carers highlighted the acceptability and importance of SRH care, if interventions were appropriately timed and patients' individual risk profiles were considered. Barriers to access included lack of routine enquiry, illness acuity and impact of the COVID-19 pandemic. Clinical implications SRH needs for PICU admissions are greater than previously realised. Providing a nurse-led SRH assessment is acceptable, feasible and beneficial for PICU patients.

ABSTRACT Introduction The COVID-19 vaccination service is a key component in the UK approach to reducing disease morbidity and mortality. Groups within the population at increased risk of severe outcomes from COVID-19 overlap with groups that are less likely to take up the offer of vaccination. This article outlines some learning from approaches within a large vaccination centre in the UK to reduce inequalities. Solution Continuous quality improvement processes were used to operationalise the mitigations to inequalities with vaccination uptake that were identified by a systematic equality impact assessment framework and continuous service feedback. Outcome Quality improvement processes and community engagement enabled tailored mitigations to vaccination uptake. Engagement with community ambassadors strengthened community relationships and the co-creation of bespoke sessions encouraged vaccination uptake within specific groups. Conclusion Recommendations for strengthening approaches to inequality reduction include having a systematic framework for assessment and mitigation of inequalities, embedding quality improvement, identifying resources, and taking a collaborative and co-design approach to services with underserved groups.

This article is part of a series exploring how the COVID-19 pandemic affected, and continues to affect, a psychiatric intensive care unit (PICU) in London, UK. The series so far has focused primarily on the systems, processes and practical challenges of managing acutely disturbed patients in the inpatient setting with the added complexity of COVID-19 infection. This article outlines the psychological impact on staff and patients on a PICU during this time.

Introduction PICU inpatients are likely to be at increased risk of having unmet SRH needs due to barriers to accessing services. Since May 2018, an in-reach SRH assessment has been available to all psychiatric inpatients on ES1 ward, if referred. Analysis of referrals over 15 months identified only 24 had been made during this time. Objectives To assess the SRH needs of women admitted to ES1 PICU, the feasibility of providing a SRH in-reach clinic, and the acceptability of delivering a nurse lead referral programme. Methods A bi-monthly SRH in-reach clinic and a nurse led SRH referral pathway were implemented on ES1 over a seven-month period. A staff training needs assessment was performed followed by training, a protocol was developed, staff attitudes were explored, and patient engagement was sought. Results A total of 41% (32/77) of patients were referred, which was a 29% increase. 53.1% (17/32) of the total referrals had a true SRH need, equating to a 10% increase and 22% (17/77) of all PICU admissions. 90% of referrals were made by nursing staff. A staff focus group (n15) highlighted the acceptability and perceived importance of offering SRH care in PICU, if interventions were appropriately timed and the patient’s individual risk profile was considered. Conclusions Results identify that SRH needs for PICU admissions are greater than previously realised. Providing a nurse led referral pathway for an SRH in-reach clinic is acceptable, feasible and beneficial for PICU patients. This project has resulted in service improvements including offering asymptomatic STI testing to all PICU admissions. Disclosure No significant relationships.

The COVID-19 pandemic has led to a rapid change in the way healthcare is provided. Pre-existing clinical models of care delivery have had to merge with a new way of working; driven by infection control and minimising the transmission of the virus. In an acute psychiatric setting, this has required many of the existing systems to be deconstructed and rebuilt in a way which at times is unrecognisable. For psychiatric intensive care unit (PICU) services, the clinical model is simultaneously suited and opposed to the approach adopted to contain and manage the COVID-19 pandemic. This article explores how systems and processes used on a PICU can be translated to tackle challenges imposed by the coronavirus disease.

The COVID-19 pandemic has put the UK's National Health Service under extreme pressure, and acute psychiatric services have had to rapidly adapt to a new way of working. This editorial describes the experience of a London psychiatric intensive care unit (PICU) where all nine in-patients ultimately tested COVID-19 positive.

In psychiatric and emergency healthcare settings, episodes of agitation and violence are relatively common. One meta-analysis reported that 32.4% of patients behaved violently during admission to a psychiatric ward; this was the mean rate of violence based on 122 studies from 11 countries (Bowers et al., 2011). The comparable rate in the UK studies was 41.7%. A study of general adult wards of a UK inner-city mental health trust found violence rates for 49% of men and 39% of women in the 6-month period studied (Hodgins et al., 2007).

This series of brief reports highlights the experience of a London psychiatric intensive care unit (PICU) that cared for patients with COVID-19 relatively early in the pandemic. The objective is to contribute to learning and consider the challenges for psychiatric intensive care services. This article will discuss COVID-19-related risk prevention and mitigation strategies in a psychiatric inpatient setting, followed by an overview of the legal and ethical challenges, relating to risk prevention, mitigation and restrictive practice, in psychiatric inpatient care during the time of the pandemic.

Summary The COVID-19 pandemic has put the UK's National Health Service under extreme pressure, and acute psychiatric services have had to rapidly adapt to a new way of working. This editorial describes the experience of a London psychiatric intensive care unit (PICU) where all nine in-patients ultimately tested COVID-19 positive.

It is widely acknowledged in hospitals that the quality of design and environment can influence the quality of patient care, the sense of therapeutic security and the experience of staff. This women's PICU collaborated with the charity Hospital Rooms to realise the valuable role of art within the clinical environment. Experienced artists were commissioned to work in genuine partnership with patients and staff to re-envision the physical environment with the installation of eight imaginative, inventive and PICU compliant art works. The implementation, and both patient and staff perspectives were evaluated. There was no disruption to clinical care and engagement and participation was enthusiastic. There were 35 patient encounters and 32 staff encounters, including creative workshops and an exhibition. Patient Experience Data Intelligence Centre (PEDIC) reports showed an improvement following artwork installation. Patients were more likely to recommend the ward, felt more involved in their care and that the ward was comfortable. The art transformed clinical spaces creating opportunity for patients to have exceptional experiences: 'being here feels like sitting in the park'. Staff evaluation through a 'visual matrix' method that explores shared experience, revealed that the art has introduced further possibility of 'respite and escape' for both patients and staff. There is a sense that 'you feel like it is leading you to somewhere, you feel like there is something more'. It has also engendered 'ownership and pride': it 'feels like pushing boundaries, things you thought could never be considered at all, are now being considered'.

Background: The use of sensory-based treatment developed in paediatric and neurodevelopment care is a relatively new practice in psychiatric intensive care and acute mental health settings. This report briefly reviews the literature on the use of sensory rooms in psychiatric intensive care units and acute mental health settings, and outlines the development of a sensory room in a female psychiatric intensive care unit. Method: We provide an account of the process of establishing a sensory room in a psychiatric intensive care unit setting, including considerations, protocol, training and feedback. The literature on sensory room use in psychiatric intensive care and acute mental health settings was reviewed using the PubMed database and Google Scholar for 'grey' literature. Results: Widespread positive patient and staff perspectives on sensory room use in psychiatric settings were identified in the literature. Some studies have identified links between sensory-based care and reduced rates of restrictive practice. Feedback from patients using the sensory room established in the report revealed themes of patients enjoying and valuing the practice, and highlighted the need for patient-centred choice in its provision. Conclusions: This report outlines the development of a sensory room in a female psychiatric intensive care unit and briefly reviews the literature on such, considering its efficacy in both patient experience and possible developments in reducing more restrictive practices in care in this clinical setting. It provides a basis for further evaluation and research on sensory room interventions and their effectiveness in improving clinical outcomes.

SUMMARYWhen a patient in an in-patient psychiatric setting allegedly commits a crime, psychiatrists are sometimes asked to assess their fitness to be interviewed by the police. This article describes how to conduct this assessment, outlines the criminal justice process leading to police interviews (with particular reference to the legal system in England and Wales) and highlights practical issues to consider when assessing fitness to be interviewed in this context.

The coronavirus disease 2019 (COVID-19) pandemic has suddenly changed the landscape for psychiatric intensive care services, demanding a rapid transformation in the way that mental health care is delivered. This is the first of a series of articles describing the challenges facing psychiatric intensive care services during the evolving pandemic. Each article will focus on one of several unique challenges encountered during the pandemic, offering a timely account to share learnings. This article sets the scene for how COVID-19 might change psychiatric intensive care services.

This series of brief reports highlights the experience of a London psychiatric intensive care unit (PICU) that had multiple cases of COVID-19 relatively early in the pandemic. The objective is to contribute to learning and consider future challenges for psychiatric intensive care services. This article will outline how the PICU adapted to the rapidly changing situation with consideration of prescribing in COVID-19 and the unique challenges faced by PICU services.