Introduction

Throughout the history of mental health care, the methods of managing patients with disturbed and aggressive behaviour have always been important and contentious. This has been particularly the case over recent decades, which have seen major changes in effective therapies and the style of delivery of psychiatric care. Since the 1950s the majority of mental hospital wards have been unlocked and there has been a shift in the philosophy (if not practice) of care towards the community. However, with the increasing development of effective and evidence-based models of community care, it has become apparent that there remain a group of patients whose symptoms and behaviour require special care in a dedicated inpatient unit, usually referred to as a Psychiatric Intensive Care Unit (PICU).

During the 1970s there were a number of descriptions in the literature of PICUs mainly from North America and Australia. The Royal College of Psychiatrists (1980), in its document ‘Secure Facilities for Psychiatric Patients: A Comprehensive Policy’, recommended a range of secure facilities that were necessary to support local mental health services, including local intensive care units.

In 1991, Dr John Reed led a complex review of services for mentally disordered offenders. By this stage, Government policy had been clearly articulated in the Home Office Circular 66/90. Offenders suffering from mental disorder should receive care and treatment from the health and personal social services rather than in custodial care.