ABSTRACT
During the de-institutionalization era, many long-stay wards in the United Kingdom were replaced by open and less restrictive acute environments. Subsequently, psychiatric intensive care units (PICUs) and low-security units (LSUs) evolved pragmatically to respond to the need for safe, therapeutic care of patients who display particularly disturbed or sustained risk behavior or whose offense (or charge) necessitates some security in their treatment. By the late 1980s these services were varyingly admitting patients from local acute open wards, known problematic patients directly from the community, and permanently disturbed patients who could not be safely managed elsewhere. They also admitted patients from courts (usually following conviction for minor offenses).1
