Introduction

The Psychiatric Intensive Care Unit (PICU) is a place of rapid and constant change, with high levels of arousal experienced by staff and patients alike. Although the pace of change may be less rapid on a Low Secure Unit (LSU), other problems are very similar.

Effective management can ensure that key principles are not lost or compromised by a pressurised environment and that all actions and care are carried out within the context of safe practice.

One measure of effective management is the consistency with which the unit retains its place on the continuum between therapy and containment. The roles of the ward manager and multi-professional team are crucial in this process.

The increasing role of PICUs and LSUs in today's modern mental health provision has resulted in implementation guides developed by the Department of Health. These identify guidelines and evidence-based practice in support of the National Service Framework for Mental Health (Department of Health 1999a). The Mental Health Policy Implementation Guide: National Minimum Standards for General Adult Services in Psychiatric Intensive Care Units (PICU) and Low Secure Environments (Pereira and Clinton 2002) and Adult Acute Inpatient Care Provision (Department of Health 2002a) will be refered to within this text.

Key principles

• A clear sense of purpose for the unit is known and owned by the staff, and communicated clearly to patients

• The purpose of the unit is to manage acute mental ill health episodes and then return the patient to a more appropriate care setting

• As far as possible and practicable, patients and their relatives are actively involved in their care and how it is delivered to them

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