we created a new care pathway from the community right through to developing a new, purpose-built psychiatric intensive care unit (PICU) which has just opened. As part of this work discharge co-ordinators are now based on each ward, a new team has been created for home treatment for older adults in crisis, a Crisis House was commissioned and the crisis and home treatment teams for adults were enhanced. This work has resulted in substantially reduced lengths of hospital stays and, most importantly, no one has been sent out of city due to lack of bed availability for acute adult beds for the last three years.