The High Dependency Psychiatric Care Unit IMH

IMH Press Release 21 May 2009

THE HIGH DEPENDENCY PSYCHIATRIC CARE UNIT: HOW INTENSIVE CARE AND
HEALTH EDUCATION TRANSLATE TO BETTER HEALTHCARE AT THE INSTITUTE OF
MENTAL HEALTH

HDPCU, the High Dependency Psychiatric Care Unit at Ward 31A officially opens on 21 May 2009. Funded by the Ministry of Health (MOH) as a Healthcare Service Development Plan (HSDP), its objectives are to provide close monitoring and management of acutely disturbed psychiatric and actively suicidal patients within a safe and secure environment.

What differentiates this ward from the other wards within the Institute of Mental Health (IMH) is its stepped-up intensive care for the severely disturbed which includes close monitoring and frequent assessments of both emotional and physical states. With the use of higher doses of medication, care associated with higher doses of medication needs to be provided all within a safe and secure environment. And this is achieved through the intensive care implemented with a nurse-patient ratio of 1 nurse to 1 or 2 patients. With continuous monitoring, psychosocial interventions and health education on illness and treatment counselling sessions to patients and their families, HDPCU aims to achieve faster recovery therefore reducing patient hospitalisation days for this group of patients.

It has been demonstrated abroad in close-observation units in the UK, Canada and Australia since the 1970’s that such care leads to a decrease in staff and patient accidents, a decrease in constant observation and seclusion hours and a decrease in the number of nursing hours lost to injuries at work. Such consistency and control within the unit means that higher patient safety standards and shorter hospitalisation stay are possible. The following are the value-added features of the ward and its services:

Fully air-conditioned 10 beds separated into 2 rooms consisting of 6 beds for male patients and 4 beds for female patients. Nurses are able to view all beds from the Nurses’ Counter. Each male and female room is equipped with bedside medical equipment for prompt response to any medical emergency.

Recreational activities are used – with an emphasis on relaxation techniques such as music or art and craft activities using piped-in music; and board games which help refocus the individual’s mind, such as chess, scrabble, carom and physical exercise. An Activity Room with a 37-inch flat screen TV allows patients to catch up on the latest news or their favourite drama series. And, a cosy Visitors’ Room allows for private family sessions

Trained nurses in the management of psychiatric patients, encompassing de-escalation techniques which equip them with the skills and mental preparedness to assist when patients are aggressive as well as control and restraint techniques.

Inclusion and exclusion criteria to identify patients who will benefit most from HDPCU interventions. Patients from IMH’s other wards, Emergency services and Satellite Outpatient Clinics are reviewed by the HDPCU Specialists before transfer to HDPCU for treatment.

CCTV at strategic locations for close continuous monitoring, with all areas accessible only with the Staff Access Card. At least one nursing staff is in
each cubicle at all times. Each nurse carries a panic-alarm device that will
activate the same block wards as well as the hospital security personnel.......

FACT SHEET -THE HIGH DEPENDENCY PSYCHIATRIC CARE UNIT (HDPCU)

Patient Demographics

HDPCU manages patients from ages 19 to 65 years who suffer from Schizophrenia, Bipolar Disorder, Major Depressive Disorder and Anxiety Disorders.

Ward charges

Because the HDPCU is a ‘classless’ ward, charges at HDPCU will vary depending on the
class of the wards the patients were staying prior to transfer to HDPCU.

List of charges applicable to Singapore residents in Singapore Dollars are as follows for each day of stay at the HDPCU:

Ward Stay costs per day Treatment Fee
A1 $325 $60
A2 $300 $60
B1 $245 $50
B2 $75 $20
C $40 $15

A1, A2 and B1 denote patients from private care. These patients would need to pay the full amount of the ward and treatment fees. B2 and C denote patients who are fully subsidised under the programme --these patients have undergone means testing to verify their income levels for suitability to receive subsidies.

HDPCU has been in operation since 15 December 2009 and the occupancy rates for the
10-bedded ward are:

Dec 08 Jan 09 Feb 09 Mar 09
Days in operation per month 17 31 28 31
Patient days (cumulative) 66 171 139 201
Occupancy rate 39% 55% 50% 65%

Who are on the team at HDPCU

Headed by Project Director, Dr Chua Hong Choon, IMH’s Vice Chairman of Medical Board
and Co-Project Director, Dr Prema K, Director of Nursing Administration, the medical and nursing teams consist of the following:

Medical team:
Dr Alex Su, Consultant and Acting Chief of General Psychiatry 1
Dr Thong Juinn Yew, Associate Consultant
Dr Habeebul Rahman, Registrar

Nursing leads:
Ms Soh Lee Choo, Senior Nurse Manager, Nursing
Administration
Mr Aziz Abdul Hamed, Nurse Clinician, Nursing Administration

Allied Health leads:
Ms Clare Yeo, Head and Principal Clinical Psychologist
Ms Chan Lay Lin, Principal Medical Social Worker