Lelliott et al highlight some real and urgent problems in acute mental health services (Psychiatric Bulletin, October 2006, 30, 361–363). As the Psychology Lead on adult acute in-patient services in Lambeth I have a long experience of working on acute in-patient wards and agree with all the problems described: focus has been on community services; the environment is often not therapeutic; there is always a staffing crisis and the bed management system governing the functioning of the services is there to meet the needs of the service rather than the needs of the service users.

As Lelliott et al point out there is no shortage of guidelines, but they are not always easily implemented. In-patient care is overshadowed by the focus on community care, which, although important, cannot remove the need for a safe and therapeutic environment for those who require hospitalisation. To improve the quality of care and the therapeutic environment on the wards we need to focus on the ward itself. Some fundamental changes are needed to support frontline staff. This is where I see a role for my profession – psychology.

Apart from organisational and systemic needs, there is also the issue of staff training. The accreditation of acute in-patient mental health services as described by Lelliott et al would be an important development. For this to work, frontline staff would need to perceive any training as something which supports and helps them in their work, rather than yet another bureaucratic demand. In South London and Maudsley NHS Foundation Trust we have developed a 1-day training course on implementing the recommendations of the Department of Health guidelines on adult acute mental health care provision (Department of Health, 2002). One of the objectives was to train staff in skills conducive to developing a therapeutic environment on acute wards. The courses were well attended and well received, suggesting that frontline staff might welcome such initiatives. Details of the course are available from the author.