What makes an NHS Inpatient Detox Unit (IPU) unique?
The unique and invaluable NHS inpatient Units (IPUs) provide residential detox treatment for severe drug and alcohol addiction and is often a last hope for recovery for some of our most vulnerable members of society.
The medically managed detox services provide 24-hour care to those with acute substance misuse issues, and deal with complex physical, mental health, and behavioural issues.
The NHS inpatient units are fundamentally different to all other detox and rehabilitation services in England and help the most complex patients that other services can’t support.
Here are the top reasons that make the IPUs unique:
They are hospital-based
The NHS inpatient detox units are based on NHS Mental Health Trusts sites and each is linked to a local NHS acute physical health hospital through an on-call system.
This is key and central because the units have access to the full resources of a general acute care hospital or psychiatric hospital either directly (on the same site) or indirectly (through consultant referral), which manages acuity and prevents hospital admissions.
A hospital setting permits a higher level of medical observation, supervision, and safety for service users needing more intensive forms of care. The wide range of advice and care on hand includes: medical; surgical; antenatal; dental, and dietary. Furthermore, on-site pharmacy services provide ease of access to medications and the hospital site enables medication availability out-of-hours.
They are led by a Consultant Addictions Psychiatrist (CAP)
Unlike other rehabilitation and detox services, NHS inpatient detox units are led by a Consultant Addictions Psychiatrist (CAP). The Consultant Addictions Psychiatrist is an experienced doctor who has undergone approved training in addictions psychiatry as well as other psychiatric disciplines. The role of the Consultant Addiction Psychiatrist is uniquely commissioned in the NHS and is an indisputable asset when it comes to the successful and efficient running of addiction treatment services.
Consultant Addictions Psychiatrists develop practice, lead the inpatient service and links with other services, as well as in the NHS Trust in which the service is located.
Having these professionals with the most experience at the front end of a treatment system journey means that people can receive the right sort of treatment earlier on, rather than the consultants being at the back end of the process.
Due to their evidence-based backgrounds, the Consultant Addictions Psychiatrist also facilitates influence over how current systems might be modified to find new and increasingly effective treatments.
They have a strong, multi-disciplinary teamThe range of professionals at NHS inpatient detox services available 24 hours a day seven days a week, include: psychiatrists; psychologists; general practitioners; nurses; pharmacists; social workers, and pharmacists alongside physiotherapists, dieticians, and occupational therapists.
Having access to such a wide range of support and advice that is delivered in a safe, alcohol or drug-free environment with ready access to other medical or psychiatric hospital services is a key feature and means that NHS inpatient detox services can manage the complex range and severity of conditions commonly presented. For example, specialists in eating disorders, perinatal psychiatry, forensic psychiatry, crisis teams and other approved mental health professional services as well as wound care specialists and other physical health specialists are all available as needed.
The enhanced skills amongst this professional team allows for a multidimensional care package for the patient, focusing on all their medical and psychiatric needs, not just their current addiction problem.
This enhances the quality and suitability of the care packages and allows for treatment of comorbid physical, psychological and psychiatric conditions that will potentially impact on the long-term success of rehabilitation and the patient’s quality of life.
They provide complexity and acuity assessments
Pre-admission referrals are managed by a team of highly skilled professionals such as the Consultant Additions Psychiatrist, Nursing Managers, and allied professionals. The enhanced skills amongst this professional team allows for a multidimensional care package for the patient, which focuses on all their medical and psychiatric needs, not just their current addiction problem.
The extensive and ongoing assessment of complexity and acuity which takes place within NHS inpatient services ensures each patient receives the best quality care for all of their health needs.
This includes the prevention of Wernicke-Korsakoff syndrome, anaphylaxis, treatment for pregnant women and the foetus, and the provision of hepatitis B, C and HIV testing, and hepatitis B vaccination for any at-risk service user during an IPU stay.
They successfully manage cognitive impairment
Up to 40 percent of patients with chronic alcohol dependence have some degree of cognitive impairment and NHS inpatient detox units see a high prevalence of patients presenting with cognitive impairment.
This is predominantly due to other, non-NHS units feeling unable to accept these referrals because of the challenges in managing the risk factors associated with cognitive impairment while going through the detox process, such as a history of seizures or the severe level of alcohol dependence.
NHS IPUs use screening tools (such as ACE III or MOCAM) to detect problems associated with alcohol-related brain damage while also collating and reviewing information from multiple other sources to fully understand other potential causes.
Once causes of cognitive impairment have been ascertained, remedial action or treatment is undertaken, such as treating reversible causes, prescription reviews and referring for treatment of psychiatric conditions. These actions are reviewed, and the NHS IPU liaises with the referrer and other relevant agencies, to ensure that appropriate management and interventions continue once the patient is discharged from the IPU.
They manage complex mental and physical comorbidities
The medically managed IPU can deliver care-planned interventions to service users at any point in their treatment, allowing the effective management of acuity and multiple morbidities.
The majority of service users presenting to community substance misuse treatment services have mental health problems, most commonly depression, anxiety or personality disorders. Such disorders may be difficult to assess and treat in a community setting, particularly if alcohol or illicit drugs are used as a form of self-medication.
NHS inpatient detox services can respond to such complexity through structured, comprehensive, and ongoing assessments of patients conducted using rating scales and special investigations. Once symptoms of withdrawal and comorbid health conditions have been assessed or diagnosed, an individualised, recovery-orientated care plan is developed.
While service users with severe and enduring mental illness and substance misuse should have their care primarily managed by mental health services, in line with national guidance, IPUs have an important role in supporting such services through the assessment and on-going management of co-existing substance misuse problems.
They provide unique access to training and guidance
Each NHS inpatient detox unit has a wide range of professionals at different stages of training attached to it. This medicine; nursing; pharmacy; social work, and other disciplines. Junior doctors at all levels and types of training will rotate through an IPU. Students cannot get this medical training in alcohol and substance use detox and rehabilitation anywhere else, which means that IPUs are the only places in England to be training staff to enter this area of the medical field.
Why is this so important?
It is no exaggeration to say that these in-patient detox units bring the most vulnerable people with severe drug and alcohol addiction back from the brink of death, giving them a fresh chance at life beyond addiction.
Without access to the IPUs there is:
- An increase in premature death rates as patients living with the most life-threatening addictions will not receive the care and treatment that they so desperately need.
- A high risk of increased admission rates, readmissions, and lengths of stays with other healthcare facilities, including the acute hospital sector and mental health inpatient units.
- An increase in the number of drug and alcohol related deaths. This is not only a significant risk to patients, but also increases the likelihood of a huge burden being placed upon the wider healthcare system, other drug and alcohol services, and society as a whole.
With only five remaining units in England, all of which are members of NHS APA and the NHS Inpatient Network (IPN), there is already a postcode lottery for patients in terms of access to these vital services
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