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Background and aims

Birmingham and Solihull Mental Health NHS Foundation Trust developed the psychiatric decisions unit (PDU) to provide an alternative pathway for patients accessing emergency departments and other services, such as the police and ambulance services. The PDU is an ambulant assessment area which provides a calming environment for the assessment and development of treatment plans for more complex service users who are in crisis and are accessing emergency services. 


The PDU was introduced to reduce time pressure which enables the service user to think through more clearly the nature of their crisis and the sort of help they need to recover, both over the short and long term.

Additionally, the PDU gives clinicians time for more thorough, ongoing assessment. This enables treatment plans to be tailored to the needs of the service users, making full use of community services, and is less likely to result in an inpatient episode.

Outcomes and benefits

Outcomes of the service include:

  • Positive feedback from patients, staff and other stakeholders about the service provided by the PDU as an alternative pathway out of acute hospital emergency departments
  • Results of patient satisfaction surveys have shown the vast majority of patients are extremely satisfied with the service provided to them at the PDU. Many have reported that they find the PDU a much better environment than acute hospital emergency departments
  • 6,900 inpatient bed days saved due to referrals to the PDU

A study that evaluated the PDU (Trethewey et al., 2019) found that:

  • The implementation of the PDU was associated with a reduction in the frequency of emergency department presentations and inpatient psychiatric admissions.
  • A 9% decrease in the number of patients taken to the emergency department by street triage
  • 26% fall in inpatient psychiatric admissions via the trusts' in-hospital liaison psychiatry team.
  • 98% of patients felt like they were treated with respect and understanding
  • 94% of patients reported that they were likely or extremely likely to reccommend the service to friends and family


Trethewey, S. P., Deepak, S., Saad, S., Hughes, E., & Tadros, G. (2019). Evaluation of the Psychiatric Decisions Unit (PDU): effect on emergency department presentations and psychiatric inpatient admissions. Postgraduate medical journal, 95(1119), 6-11. Available at:

Additional information

You can find out more about the PDU by accessing Birmingham and Solihull Mental Health NHS Foundation Trust service page. 

The aim of the ZSA Case Studies is to introduce users to a range of examples of new and innovative practice, with the broad aim of working to support people with their mental health, bring awareness to and help prevent incidence of suicide. Please seek further information by contacting the ZSA and appropriate professional input prior to making a decision over its use.

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Content last updated: 25/11/2022

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