A small minority of treatment-refractory patients who could benefit from treatment with clozapine, refuse to comply with blood tests or oral treatment. Treatment with clozapine can be enforced under the Mental Health Act.

An aide memoire was developed locally to guide clinicians through the process of enforcing clozapine treatment.

It is possible to enforce treatment with clozapine under the Mental Health Act and so offer a valuable treatment option.

The perceptions and expectations by referrers of assessments performed by a medium secure unit were examined in order to ascertain areas for possible improvement. All referrals to two teams at the North West Thames Regional Secure Unit were monitored over a 6-month period. A self-report questionnaire was sent to each referrer, in cases where an assessment and forensic report had been completed.

Assessments and forensic reports were completed (and questionnaires sent to referrers) in 63% of total referrals (32 out of 51). The response rate to the questionnaire was 81% (26 out of 32). Many referrers wanted the assessments and report to be completed in 2 weeks. Most referrers were satisfied with the quality of the report received and the majority were happy with the risk assessment.

Referrers want forensic assessments to be of a high quality and to be performed quickly. Recommendations for service development are suggested.

To explore the impact of adults with personality disorder on the professional groups that support them. Staff (n=72) from five agencies participated in interviews focusing on reactions to short case vignettes representing the three personality disorder clusters.

Each presentation was relatively consistent in its impact on staff irrespective of the agency or setting. Several agency-specific themes were also identified, some illustrating areas of potential difficulty in inter-agency working. Many non-mental health workers reported considerable contact with this client group, although most felt dissatisfied with the training available and suggested solutions.

Findings from this study may help to match the content of training courses to need. Similar vignette-based surveys could be used to investigate the impact of staff training over time.

With the changes introduced recently to the Part I clinical examination, trainers will be expected to modify MRCPsych course teaching accordingly. The aim of this paper is to describe the procedure for organising a mock objective structured clinical examination (OSCE) for MRCPsych trainees.

Prior to the introduction of the new OSCE, we organised an authentic mock OSCE for our trainees. We have now run three consecutive mock examinations which have been successfully evaluated.

A well-organised mock OSCE requires significant investment in terms of planning, resources and enthusiasm, but can have a potentially beneficial impact on and preparation for the real OSCE and training in general.

Electroconvulsive therapy should be effectively monitored and seizure duration accurately ascertained. We observed the seizure duration in both lower and upper limbs using the Hamilton ‘cuff’ method.

Thirty-nine seizures in 19 patients were observed. There were no statistically significant differences between cuffed and uncuffed limbs, nor between upper and lower limbs.

Alternatives to the Hamilton cuff method to observe seizure duration need to be considered.

To capture psychiatrists' reasons for ‘significant impaired decision-making ability’ (SIDMA) as there is no definition of SIDMA in the Mental Health (Care and Treatment) (Scotland) Act 2003. One hundred consecutive mental health reports from January to February 2008 were examined using a questionnaire.

More than half the mental health reports noted lack of insight as the main cause of SIDMA. Other reasons for SIDMA included limited cognitive function and presence of psychotic symptoms.

Five reasons for SIDMA were identified: lack of insight, cognitive impairment, presence of psychosis, severe depressive symptoms and learning disability. We recommend psychiatrists working in Scotland give full descriptions of SIDMA, indicating how this has an impact on the patient's ability to make decisions.

To understand experience of early imprisonment in one prison under low staffing levels. A researcher, independent of the prison, interviewed each prisoner soon after reception and 3–4 weeks later. The first question of the second interview was: ‘I’d like to start by asking you about your experience of the last 3–4 weeks in prison'. Data are verbatim answers to this. Narratives were brief, so responses from all 130 participants were analysed, using grounded theory methods.

The core experience was of ‘routine’ – characterised by repetitive acts of daily living and basic work, and little reference to life outside prison – generally resolved passively, towards boredom and ‘entrapment’.

This ‘routine’ seems akin to the ‘institutionalism’ described in the end days of the 1960s’ mental hospitals. In an earlier study of similar men at a similar stage of imprisonment, under higher staff:prisoner ratios, experience was initially more distressing, but resolved actively and positively, suggesting that staff loss may have affected rehabilitative climate.

To describe the work and patient characteristics of one of the first combined mental illness and drug and alcohol services (MIDAS) in the UK. We examined MIDAS as an assertive community service, for individuals receiving long-term community care. We selected the case files of the first 80 patients accepted over a 10-month period and examined variables including demographic details, diagnosis, associated substance use and length of engagement with the service.

Our findings show that there was no relationship between responders to the service and basic demographic data. Patients with bipolar affective disorder and personality disorders were more likely to use the service than patients with unipolar disorder or schizophrenia. Despite the use of an assertive service, there was difficulty engaging patients with schizophrenia and comorbid drug use. These same patients also had a high level of criminal convictions as well as a trend towards using alcohol and cannabis as their main substances of misuse. At 18 months 38% of patients had failed to remain engaged with the service.

This specialist type of service may be more useful than other services in engaging patients with comorbidity. Systematic research is required in the UK to explore the effectiveness of this type of new service. More innovative resources need to be identified to specifically deal with patients with severe mental illness and comorbid substance use.