This book is addressed to “All healthcare and related professionals working in, or interacting with, psychiatric intensive care units, as well as managers with a responsibility to commission, provide and monitor such units”. In addition to the three editors, there are 19 contributors. This useful book shows the strengths and weaknesses of a work written by a committee and for everybody. On the positive side, it is comprehensive and multi-disciplinary. It is clinically oriented and most chapters will be of interest to clinical staff working on intensive care units. Chapters deal with important issues such as seclusion, physical restraint and rapid tranquillisation.

On the negative side, it lacks the unity, simplicity and clarity that reflects the practice and experience of a single author or, at most, of a small team. The standard of individual chapters is uneven, and jargon and acronyms (such as PICUs, SCIPs and NAPICUs) abound. Also, it is difficult for this type of ‘comprehensive’ multi-author book to be really up to date. For instance, the otherwise useful sections on pharmacology and rapid tranquillisation do not do justice to recently published evidence on the risk of cardiac complications and sudden death from high-dose medication. The internet affords easy access to journal articles and reviews, and books trying to provide current information and reviews of the literature have an increasingly short shelf-life.

The potentially enduring chapters in this volume are those that provide some sort of manual for clinical procedures and practice. A useful section is devoted to the setting up and management of intensive care units. Such units require clear leadership and lines of responsibility. I would endorse the recommendation that there should be only one or, at the most, two clinical teams — although this often entails transfer of consultant responsibility when patients are admitted or discharged from the unit. A chapter on good practice raises the question of whether units should be mixed or single-gender. The move towards mixed-gender wards that gathered momentum in the 1960s was part of a well-intentioned effort to ‘normalise’ the culture of psychiatric hospitals. However, female patients are in a minority on intensive care units and are vulnerable to intimidation, violence and sexual harassment. At the very least, a newly designed unit should afford the possibility of very substantial segregation of women and men.

Unfortunately, the book does not deal with the important issue of resources. Standards are inevitably low in an over-crowded and dilapidated unit, unable to recruit or keep capable permanent staff and relying instead on locum and agency staff. Sadly, this is the situation throughout much of the country.