In the first of two articles, John Baker and colleagues examine the evidence to discover what changes to culture, processes and approach are effective in improving services

Service users, staff and carers have long expressed dissatisfaction with the quality of acute mental health inpatient care, particularly with perceived staff inaccessibility and poor environments.

Recovery-orientated organisational policies and staff training and practice have been shown to improve the situation. These have centred on integration with other services and collaboration with service users and their families. Whereas on wards, good risk management, therapeutic relationships, meaningful activities, attention to physical health and social inclusion all promote recovery and are cost-effective.