Why you should read this article:

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To understand the experiences of people who need intensive mental healthcare

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To learn about an approach to organisational change that involves collaboration with service users

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To develop ideas for how you can involve service users in organisational change

People who need care in a psychiatric intensive care unit (PICU) are often highly stigmatised and referred to using negative, dehumanising language, for example being described as ‘difficult’ or ‘problematic’ patients. They have also been described as ‘permanently disturbed’, which shows a lack of respect, value and hope for their recovery.

This article reports on a service development project that aimed to challenge the traditional paradigm of care provided in a PICU in North Wales. The project used the ‘TODAY’ (time, ownership, diagnostics, actions, you) approach as a model for implementing organisational change, which was modified to a more inclusive ‘Today We Talked’ approach. It aimed to involve PICU service users in decision-making about aspects of their care, and to ensure that this care was individualised. Outcomes of the project included reduced use of restrictive physical interventions, reduced stigma, increased opportunities for engagement, improvements in the use of space, increased trust and higher levels of service user satisfaction.