More Than Detox: The Role of the IPU

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More Than DetoxThe Role of the IPU

• Ed Day

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Outline

• Existing IPU provision
• Problems with the current situation
• The SCAN Consensus Group
• Summary

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Overall findings

• Estimated 10,700 admissions in the year 2003/4
  into beds purchased for drug detoxification

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Overall Findings

• Limited length of stay
• Poor buildings
• Staffing problems
• Range of practice procedures
• No consensus on medical or psychosocial
  management
• Limited integration into the wider treatment
  system
• Poor links to aftercare
• NHS Specialist vs. NHS General vs. Rehab/Private

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Recommendations

• Purchasing a few beds on a psychiatric ward does
  not provide the comprehensive service available
  from specialist units
• Inpatient services should be encouraged to
  provide more than just detoxification
• The need for staff with specialist skills to work
  in inpatient services should be recognised
• All inpatient services must be integrated into
  the wider treatment system, and aftercare should
  be considered and planned prior to admission

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Recommendations

• The data from this survey could be used to
  inform an expert advisory in producing
  recommendations for a model inpatient service

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The SCAN Consensus ProjectScope

• What are the aims and objectives of inpatient
  treatment?
• What are the appropriate elements of treatment?
• How should they be delivered?
• Who needs them?
• How should they be integrated into the system of
  care?

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Definition of an IPU

• Treatment involving 24-hour cover from a
  multidisciplinary clinical team with specialist
  training in managing addictive behaviours
• IPU treatment programmes include
• a range of prescribing and psychosocial
  interventions
• physical and mental health assessment
• harm reduction interventions
• relapse prevention work

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Definition of an IPU

• Medically-monitored treatment
• provided in non-acute medical settings
• Lower levels of dependence and without serious
  co-morbidity
• Medically-managed treatment
• Provided in a hospital environment
• Higher levels of dependence and
  physical/psychiatric co-morbidity

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The IPU and the wider treatment system

• Treatment should be individualised and
  assessment-driven, using care planning as a key
  implementation tool
• Good treatment planning combines modality
  matching with placement matching
• A care plan developed at a tier 2 or tier 3 level
  should use an IPU if this is the most suitable
  place to achieve a particular goal efficiently
  and successfully

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The Place of the IPU in the Treatment System
ASSESSMENT
STABILISATION
ASSISTED WITHDRAWAL
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The key features of an IPU

• Provides medically-managed care 24 hours/day
• Treatment is based on a pre-admission plan of
  care
• Staffed by a specialist multidisciplinary team
• Treatment is individually tailored, flexible, and
  makes use of a menu of pharmacological,
  psychological and social interventions
• The resources of a general acute care or
  psychiatric hospital are available - may include
  medical, surgical, antenatal, dental, dietary, or
  pharmacy advice
• The treatment programme incorporates activities
  beyond the medical or psychological treatment
  process (e.g. employment, housing, social
  activities)
• Treatment incorporates policies and procedures
  that set boundaries on behaviour whilst enabling
  patients to be treated in an empathic manner

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The services that a good inpatient unit can
provide

• The Core Work of an Inpatient Unit
• Assessment physical psychiatric
• Stabilisation including dose titration,
  stabilisation on maintenance therapy, combination
  assisted withdrawal stabilisation (e.g. drugs
  and alcohol)
• Assisted withdrawal
• Other Important Functions
• Psychological interventions
• Other activities education, housing etc
• Harm reduction measures
• Relapse prevention work

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Delivery issues

• The interface with other parts of the treatment
  system
• Pre-admission care
• Post-discharge care
• The service user perspective
• Staffing
• Training
• Environment
• Special populations
• Policies procedures
• Quality assurance

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Summary

• Medically-managed service for severe problems
• The effective delivery of elements of a
  community-based care plan
• More than detox
• Close ties to referring agencies and
  post-discharge care
• Recommendations about staffing, training and the
  physical environment