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The aim of this article is to present findings from observations of community meetings on acute psychiatric wards, and the implications of these findings for planning psychology and psychotherapy input to the acute care services. Community meetings were facilitated on a weekly basis on the acute wards and they were an opportunity for staff and patients to work jointly on various tasks. It was hoped that observations of these meetings would provide a greater insight into the nature of interactions between staff and patients and problems that staff might encounter in their work with acutely unwell patients, and that this would help in planning how to support staff in their work. Observations showed that in the context of community meetings, it was difficult for staff to engage with patients in a more containing and therapeutic manner, and that there were prevailing anxieties in work with patients who presented with severe emotional distress. The conclusion based on the Observation Project is that in addition to planning the provision of direct psychology input to patients, it would be equally important to plan indirect work, such as provision of staff groups facilitated by professionals who have specialist expertise in working with groups. 1

The author documents difficulties that arose in the work of a team working in a residential setting providing 24 hour care for patients with repeated or long-term admissions, and the different, inter-related and mutually dependent aspects of this work. Issues that emerged included the difficult nature of work with this patient group, collaborative work in the team, management issues and models of care, i.e. active rehabilitation ideology. Staff encountered problems which were not unique to this team, and which have wider implications for other staff working in similar roles and contexts with a similar patient group.