This paper presents the psychometric properties, including factor structure, internal reliability and relative validity of a 16-item questionnaire measuring patients’ relative activation with milieu activities while hospitalised in an acute psychiatric inpatient unit.

24 hours after admission, and before discharge, psychiatric inpatients (N = 132) completed a set of validated self-reports and the pilot questionnaire, the Checklist of Unit Behaviors (CUB). The CUB outlines items that reflect the extent to which the patient avoided or engaged with the treatment milieu within the previous 24 hours. Factor analysis, bivariate correlations and repeated-measures t-tests were used to analyse the data.

Factor analysis identified two factors for the CUB: (1) Behavioural Approach; and (2) Behavioural Avoidance. Psychometric properties were satisfactory (Approach, Cronbach's α = 0.93; Avoidance, Cronbach's α = 0.79). Over the course of treatment, CUB-Approach increased (p < 0.001) and CUB-Avoidance decreased (p < 0.001). The construct validity of the CUB was supported through correlations with measures of positive and negative affect.

The CUB demonstrates strong psychometric properties, quantifying patients’ behavioural activation in the treatment milieu. Daily use of the CUB provides clinically useful information that has the potential to improve patient care and treatment planning.

There is limited research on the attitudes of nursing staff towards psychiatric intensive care units (PICUs) for general adult populations, and none examining attitudes in older adult PICU populations. The aim of this study was to examine these attitudes in one Scottish health board region.

A semi-structured questionnaire was distributed to nursing staff working in general and older adult psychiatric admission and PICU wards.

Of 138 responders, PICUs were considered necessary by 96.4%, with 93.5% agreeing on the need for a separate older adult PICU. PICU staff had more influence on discharges from the PICUs compared to non-PICU staff. The main reasons for admission to PICU services were physical violence and absconding, and for refusing admission were acute ward containment and medication issues, with few differences between the general adult and older adult PICUs.

There were more similarities than differences in nursing attitudes between the general adult and older adult PICUs but many staff feel inadequately trained and supported. The combination of service-user reports, the demographic shift to an aging population and the increase in mental health detentions in the older adult population suggest a need to consider age-appropriate psychiatric intensive care services.

Literature comparing the quality of care on psychiatric intensive care units and acute wards is sparse, but a review has found differences in key areas e.g. violence, drugs and alcohol.

This study compares the response to questionnaires completed by patients, carers and qualified nursing staff from PICUs and acute wards as part of the Accreditation for Inpatient Mental Health Services (AIMS) process.

There were few differences between the standards of care on PICUs and acute wards according to patients, carers and qualified nurses. Patients reported a more negative experience of care on PICUs than trained nurses, and in particular rated low standards on accessing records and counselling. Carers reported inadequate involvement in risk assessment an assessment of their needs. Nurses generally gave positive views of standards of care.

The challenging environment of the PICU does not appear to be compromising quality of care. There is however still room for improvement for both acute wards and PICUs in key areas, including full involvement of patients and carers and imparting information.