The psychiatric intensive care unit--an in-hospital treatment of violent adult patients.

Within the past decade, changing mores within society, as well as involuntary commitment procedures, largely determined by "dangerousness," have resulted in greater numbers of patients who perform violent acts both in and out of the psychiatric hospitals. Such patients usually find their way to the state hospital, because most facilities are not geared to handle such behavior. Professionals are understandably uncomfortable with discharging assaultive patients resorting to state hospital transfer for further care and the deterioration of urban areas, where psychiatric beds are in shortage, leads to greater numbers of violent patients who have no place to go except the state hospital. In New York State, a legislative committee recently found that more than 12,000 violent incidents occurred each year throughout all twenty-eight of the State psychiatric centers. This committee recommended that "regularly violent patients" should be removed to more restrictive and secure surroundings in order to assure the safety of other withdrawn, harmless patients. 10 In addition, the matter of employee safety was spotlighted in five issues of the State civil service newspaper. 9 Within these contexts, the intensive care unit concept has evolved. This paper will describe one such unit that has been in operation for the past six years.