In order to understand the admission practices of secure psychiatric facilities and units it is necessary to combine two kinds of study: (1) an analysis of the factors associated with outcome in a large sample of cases and (2) a qualitative study designed to clarify the beliefs, assumptions, and modes of thinking that shape the judgments made by clinicians. In this chapter, the qualitative study is examined and reviewed. The study was based on interviews with a purposive sample of lead technicians which consisted of 55 clinicians. The study showed that a complex range of internal and external contextual pressures impinged on admission decisions. Within the medium secure units, important factors included the need to maintain a shared, collective view amongst staff, and patient turnover. Influential external factors included relationships with referrers and perceptions of local services. Admission patterns will reflect decisions that are highly discretionary and shaped by complex appraisals of context and professional values. References