Background: Psychiatric intensive care facilities have previously been poorly defined, with uncertainty existingabout the appropriateness of admissions. Aim: To offer the first large-scale systematic survey describing the clinical characteristics of patients admitted to Psychiatric Intensive Care Units. Method: A questionnaire was sent to ward managers of every Psychiatric Intensive Care Unit in London for completion on a chosen census day. Individual demographic and clinical patient characteristics were collected, along with admission and discharge pathways. Results: Of 186 patients on 17 NHS PICUs in London, we obtained data for 172. 80% of patients were male, with a mean age of 33; 50% were Black and all but 2 were involuntarily detained. 66% had a diagnosis of schizophrenia and 55% of admissions were due to physical aggression. 73% of the sample had at least one 'complex need',which was most commonly substance misuse. Black patients were younger, more likely to be male and to have a forensic history (54% vs. 31%) than white patients. A slightly lower percentage (70% vs. 79%) of Black patients were described as having complex needs. White patients were more likely to have a personality disorder or a second diagnosis. Conclusions: Patients admitted to psychiatric intensive care units were most likely to have major psychosis, complex needs and to use illicit substances. Ethnic variations warrant further study.

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Acutely ill patients may require short-term treatment in a locked Psychiatric Intensive Care Unit (PICU) when their level of disturbance is such that they are unmanageable on open wards (DHSS, 1974). Chronically disturbed patients may require longer-term care and treatment in Low Secure Units (LSUs) (including some units termed 'Challenging Behaviour Units'). LSUs also provide rehabilitation for patients who are returning from medium or high security or from special