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This paper adds to growing research of psychiatric intensive care units (PICU) by recounting descriptions of psychiatric intensive care settings and discusses the perceptions held by nurses of the organisational interfaces, arrangements and provisions of care in these settings.

Data gathered from focus groups held with nurses from two PICUs was used to establish terminology, defining attributes, related concepts, antecedents, values, processes and concepts related to current practices. A literature search was conducted to permit a review of the conceptual arrangements and contemporary understanding of intensive care for people experiencing acute psychiatric illness based on the perspectives held by the nurses from the focus groups.

Dissonance between service needs and the needs and management of individual patients overshadow strategies to implement comprehensive recovery-oriented approaches. Three factors are reported in this paper that influence standards and procedural practice in PICU; organisational structures; physical structures; and subtype nomenclature.

Acute inpatient care is an important part of a comprehensive approach to mental health services. Commonly intensive acute care is delivered in specialised wards or units co-located with acute mental health inpatient units mostly known as PICU. Evidence of the most effective treatment and approaches in intensive care settings that support comprehensive recovery for improved outcomes is nascent.

Current descriptions from nurses substantiate wide variations in the provisions, design and classifications of psychiatric intensive care. Idiosyncratic and localised conceptions of psychiatric intensive care are not adequately entailing effective treatment and methods in support of recovery principles for improved and comprehensive outcomes. The authors suggest that more concrete descriptions, guidelines, training and policies for provision of intensive psychiatric health care encompassing the perspective of nursing professionals, would reinforce conceptual construction and thus optimum treatments within a comprehensive, recovery-oriented approach to mental health services.

This paper looks at the evolving nature of mental health services. While there has been a shift from asylums to care in the community in recent decades, what is now needed is another shift of acute inpatient psychiatric care, away from psychiatric units to community hospitals and other community settings. It is argued that this would be a further step forward in the evolution of mental health services as it would benefit the service users, their families, carers and staff working in acute psychiatric inpatient units.

The purpose of this paper is to investigate whether acute inpatient psychiatric staffs’ attitudes and self-efficacy towards adults with mild intellectual disability, were different than towards the general mental health population. And whether their understanding of the policy for those with mental illness and intellectual disability differed.

The study is a between-subject design, using a self-administered postal questionnaire. The sample was all qualified staff from the acute inpatient psychiatric provision of an inner London borough. Potential participants were randomly assigned to two research groups, half being given a questionnaire regarding people with intellectual disability and the other half an identical one regarding people with mental illness. Comparisons were made between the two.

The majority of staff were unaware of the current policy direction for adults with intellectual disability although were on the whole in agreement to the idea that they should access mainstream services. Staff overall did not have more negative attitudes to those with intellectual disability although were less likely to empower or encourage self-advocacy. Staff were significantly less confident that they had sufficient training and experience, and in their perceived ability to be able to communicate, assess and treat adults with mild intellectual disability when compared to those with mental illness.

The response rate and small sample size is a limitation. Further research could usefully look at whether self-efficacy and attitudes differ in different models of mainstream psychiatric care.

Government policy in the UK regarding services for people with intellectual disability advocates for inclusion and equality (Chaplin and Taggart, 2012). Those requiring psychiatric care should access this from mainstream services (Department of Health, 2001, 2009, 2011; Foundation for People with Learning Disabilities et al., 2004; Bradley, 2009.) There are, however, no UK-based studies investigating the views of mainstream acute inpatient psychiatric staff towards their role. Intellectual disability staff have concerns about their attitudes and self-efficacy and it is know that acute care is the setting where most adults with intellectual disability will come across mainstream psychiatric staff. Findings have relevance to managers and staff in both intellectual disability and psychiatric services and could be considered in the context of trying to work together as is the direction of policy.

The purpose of this paper is to summarise the development of a recovery-oriented and socially inclusive acute care clinical psychology service in one of the NHS Trusts based in East Anglia. It demonstrates the service's compliance with relevant national policies and guidelines, and addresses some of the criticisms directed at acute mental health care in recent years. Both achievements and difficulties are reflected on.

The paper employs an organisational development case example related to applicable clinical practice model, based on national guidelines and policies, in order to demonstrate that it is possible to develop and implement a recovery-oriented clinical psychology practice in acute inpatient mental health care. This is based on the authors, experiences as a public sector clinical psychologists specialising in complex, severe, and enduring mental health needs.

Clinical psychologists may effectively contribute to the development of psychosocially informed and recovery-based multidisciplinary attitudes towards emotional difficulties of individuals admitted to psychiatric wards.

Future service development project of similar nature ought to implement standardised measures (e.g. ward atmosphere scales) to increase validity of findings.

Despite limited, and continuously decreasing, resources in the NHS it appears possible to develop and establish a successful and objectively replicable provision of recovery-based psychological services across an entire acute care mental health pathway.

Recovery-enhancing clinical psychology interventions should not be limited to those receiving care from community-based services only. Building psychologically informed understanding of mental health needs should be employed on inpatient wards too, in order to counterbalance the dominating biomedical models of mental illness.

Dissemination of examples of effective psychosocial practice in acute mental health settings appears largely underrepresented.

The costs associated with staffing acute mental health wards is the largest expenditure in the inpatient budget. Exploring skill mix and its impact on outcomes, particularly service user outcomes should be of interest to all stakeholders involved in the commissioning, delivery and receipt of acute mental health care. This paper describes the findings of a literature and practice review of initiatives undertaken to improve staffing and skill mix, and their impact on service user outcomes. The practice review was necessary due to the paucity of published research in this area. Both research and practice initiatives do not appear to be driven by service user need. This results in a restricted and service driven range of outcome measures being used. The paper concludes by proposing recommendations for future workforce development in acute mental health settings.

This position paper focuses on the current tensions and challenges of aligning inpatient care with innovations in mental health services. It argues that a cultural shift is required within inpatient services. Obstacles to change including traditional perceptions of the role and responsibilities of the psychiatrist are discussed. The paper urges all staff working in acute care to reflect on the service that they provide, and to consider how the adoption of new ways of working might revolutionise the organisational culture. This cultural shift offers inpatient staff the opportunity to fully utilise their expertise. New ways of working may be perceived as a threat to existing roles and responsibilities or as an exciting opportunity for professional development with increased job satisfaction. Above all, the move to new ways of working, which is gathering pace throughout the UK, could offer service users1 a quality of care that meets their needs and expectations.

A Psychiatric Intensive Care Unit (PICU) and or High Dependency Unit (HDU) is a locked, intensive treatment facility available to people experiencing acute psychiatric distress. For many people who access public mental health services in Australia, the PICU/HDU is the primary point of admission, and should represent and facilitate timely assessment and an optimum treatment plan under a recovery framework. Nurses are the largest health discipline working in this specialty area of care. The paper aims to discuss these issues.

A qualitative study aimed to investigate the skills, experience, and practice, of nurses working in the PICU/HDU in relation to a recovery model of care. Identifying how nurses provide care in the PICU/HDU will inform a clinical practice guideline to further support this specialty area of care. Four focus groups were facilitated with 52 registered nurses attending.

The nurse participants identified specific skills under four distinct themes; Storytelling, Treatment and recovery, Taking responsibility, and Safeguarding. The skills highlight the expertise and clinical standard required to support a recovery model of care in the PICU.

The research findings highlight urgency for a National PICU/HDU clinical practice guideline.

A PICU/HDU practice guideline will promote the standard of nursing care required in the PICU/HDU. The PICU/HDU needs to be recognised as a patient centred, therapeutic opportunity as opposed to a restrictive and custodial clinical area.

Providing transparency of practice in the PICU/HDU and educating nurses to this specialty area of care will improve client outcome and recovery.

Very few studies have explored the skills, experience, and practice, of nurses working in the PICU/HDU in relation to a recovery model of care. A dearth of research exists on what is required to work in this specialty area of care.