What is the purpose of Psychiatric Emergency Care Centres? A qualitative study of health care staff

Abstract

Background: Psychiatric Emergency Care Centres do not have a clear treatment model or evidence base. An understanding of the patient population, clinical practice and approaches is needed to develop an evidence-based framework.

Objectives: Identify staff perceptions of the purpose of Psychiatric Emergency Care Centres, who should be treated and how.

Methods: A multidisciplinary sample of clinicians and administrators currently working in, or with administrative oversight of, Psychiatric Emergency Care Centres were interviewed. All New South Wales Psychiatric Emergency Care Centres were approached and staff self-selected. A total of 36 people participated, including nurses, doctors, social workers and managers. A critical realist qualitative thematic analysis approach was used, with an inductive orientation.

Results: Having an achievable admission goal was important. Although ‘harm minimization’ was often cited as important, this meant conflicting, superimposed notions to different people, including minimizing self-harm, reducing iatrogenic harm from unnecessary or coercive intervention and limiting harm to a resource-constrained system. Participants reported significant clinical practice variation and confidence in their practice.

Conclusion: The approach to the primary goal of ‘harm minimization’ reflects conflicting priorities in a complex system which are often not explicit. However, we identified a clinical practice framework upon which to base care pathways, training, intervention development and outcome assessment.