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During the winter of 2007, the Journal of Psychiatric Intensive Care published a series of editorials questioning the role and future of psychiatric intensive care units (PICUs; Dix, 2007). Within the context of the care pathway, these papers reflected on the ways and means by which a modern mental health system may best respond to acute crises.
At that time, the UK's Mental Health Services were rapidly evolving towards services that were specialised, more specifically focused and often delivering time limited interventions. A significant objective for redesigning services was to increase effectiveness for engaging and resolving acute crises. This period in history was marked by many questions around the use of expensive mental health professionals and the rationale for the often expensive in-patient clinical environments in which they operated. The PICU of course, could not escape this scrutiny.
More recently, the Centre for Mental Health (2011) published a report pointing out the huge expense of the mental health secure estate. For every five pounds spent on adult mental health care, one pound goes to funding the secure mental health services. Once again profound questions are being raised as to the purpose and outcomes expected from PICUs which are one of the most expensive facets of mental health care.
The Journal of Psychiatric Intensive Care is very pleased to publish a paper by Professor Len Bowers on the characteristics of acute wards in the presence or absence of a PICU (Bowers, 2012; this issue). In this paper, profound questions are raised as to what the purpose of a PICU is and how effective it is in meeting that purpose. This is an important paper for the psychiatric intensive care constituency and I urge readers to reflect on it carefully. Professor Bowers asks us to consider what it is that we expect from a PICU. Once we have answered that question there is also a challenge of how we measure effectively the extent to which, if at all, this purpose is being fulfilled.
In the editorial that follows, Professor Bowers extends to debating...