COVID-19 and acute inpatient psychiatry: the shape of things to come

Psychiatric services that provide acute inpatient care have to respond to the challenges brought about by the COVID-19 pandemic to consistently deliver high standards of treatment to patients and ensure the safety of staff. This can only be achieved by fostering a culture that rewards initiative and empowers inpatient teams to implement and comply with changes which everyone understands and benefits from. The experience of an inner London acute psychiatric unit has shown the value of combining proactive leadership, multidisciplinary decision making and good communication in adapting services to an everchanging environment. Practical solutions have emerged that have improved service delivery and patient care, and which will likely outlast the COVID-19 pandemic. These include changes to team work and routine, streamlining patient care with a focus on goal directed admissions, developing a healthier work environment and adopting novel technology in patient care and multidisciplinary collaboration.KEY POINTSPsychiatric inpatient units have to manage the COVID-19 crisis alongside the risk of acutely disturbed behaviour, while ensuring high standards of care and patient throughput.To respond to the COVID-19 crisis, inpatient units have to foster a culture that rewards initiative and empowers teams to implement and comply with changes that everyone understands and benefits from.Adaptive strategies should include good communication, a healthy work environment, flexible rules, dynamic infection control and adopting novel technology for clinical care and multidisciplinary work.Proactive leadership, multidisciplinary teamwork, transparency and a shared ethos of responsibility are the main tools to build effective inpatient teams.