Therapeutic challenges identified while implementing a mission and cultural change on an acute inpatient psychiatric unit.

This article describes the transformation of a unit culture within a federal hospital inpatient psychiatric unit. A change from a 30-bed inpatient acute psychiatric unit to a locked acute psychiatric unit with a diversified complex mix of inpatients including management of medical comorbidities required a considerable effort. Extensive reorganization and changes were made through staff education, training and evaluation, unit policy and procedure revision, and unit physical reconstruction for safety and aesthetics. Issues and ongoing challenges are described.