Night-time confinement, locking patients in their bedrooms overnight, is practiced within high-secure hospitals in the UK. This article provides context, sets out the history and reviews the ethical and pragmatic issues at stake. Thought is given to the future, where we appear to be moving toward a different approach.

E.S. is a consultant forensic psychiatrist at Ashworth Hospital. All his patients are confined at night. He represents the Royal College of Psychiatrists Forensic Faculty at the National Oversight Group, which is the strategic advisory body providing assurance to NHS England regarding the commissioning and provision of high-secure services.

To describe an enforced but gentle transition from prescribed intravenous methadone to oral methadone in 14 opiate-dependent patients. We examined their case notes looking for ease of transition, evidence of illicit drug use before and during the 6 months following transition and progress 3 years later.

Eight patients immediately stopped injecting, the remainder used intravenous heroin in addition to prescribed oral methadone for some months. There were no serious adverse events. Three years later, four patients had ceased opiate use altogether and six were maintained on oral methadone (five of these without illicit use). Two patients were prescribed oral methadone by their general practitioner and one was no longer in treatment.

We show that it is possible to alter the formulation of prescribed methadone without deterioration in clinical stability or losing patients from treatment. This is an important conclusion as it is presumed that one of the aims of treatment with intravenous methadone is to move patients away from injectable to oral use. Offering patients a transition period of 6 months and a choice of the process of transition may be helpful.

Users of a substance misuse service were asked to complete a questionnaire, detailing information about driving habits as well as attitudes about substance use and driving.

Of 120 subjects, 94 had ever driven, with only 36 currently driving. Fifty-six subjects had been charged with a driving offence but only 18 stated that they had been involved in an accident while intoxicated. The majority would not use drugs before driving and remain within a safe level of alcohol use. Most subjects stated that they were not informed of current legal issues concerning driving and substance use.

Users of a substance misuse service were reasonably responsible in their driving habits, however, it is still important for clinical staff working in such services to make their patients aware of the danger of driving under the influence of substances.

Homelessness is associated with raised psychiatric morbidity. Case records for 597 consecutive attendees at a winter shelter medical service were retrospectively reviewed to assess routine recording of psychiatric morbidity and to examine associations between current psychiatric symptoms and health service use.

Previous psychiatric morbidity was recorded in 36.0% of attendees, including 20.4% with comorbid substance misuse. Current psychiatric morbidity was recorded in 31.3% of attendees, and was associated with reduced total medication prescription, increased referral to other services and increased re-presentation to the shelter medical service.

Psychiatric morbidity was frequently recorded in this population. Current psychiatric symptoms were associated with increased health service use. Improved training of shelter staff should be instituted to increase engagement with mainstream mental health services.

We used data from Domestic Homicide Reviews (DHRs) to describe the patterns of mental health service use by perpetrators of domestic homicide in England and Wales. In 186 DHR reports we compared the characteristics of perpetrators who accessed mental health services with those of perpetrators who did not. Separate analyses were conducted for perpetrators of intimate partner homicide (IPH) and family homicide.

Over two-thirds (64.5%, n = 120) of the perpetrators had accessed mental healthcare before the homicide. Perpetrators of IPH who had used mental health services compared with those who had not were more likely to have a history of substance misuse, contact with the criminal justice system and a history of self-harm or suicide attempts.

Our findings support the need for health services, particularly mental health, addictions and primary care, to take an assertive role in the prevention of domestic violence and abuse by identifying patients who are potential perpetrators of domestic violence and abuse.

Northern Ireland presents itself as an anomaly – a region in which only 31.8% of doctors enter into any training programme after completion of the Foundation Programme, but where Core Psychiatry has been consistently oversubscribed. Here, we aim to find what other regions can learn from this success. All doctors of any grade, working in psychiatry, who had been though the Foundation Programme were questioned on their motivations for becoming a psychiatry trainee.

Sixty-two doctors currently working in psychiatry responded, including over 60% of current trainees, and 45% stated they had not considered a career in psychiatry before their foundation attachment. Over 80% preferred foundation placements in FY2 only, rather than in either foundation year 1 or FY2.

This survey identifies that for the majority of people who ultimately chose to train in psychiatry, in a region that has consistently attracted candidates to core and higher level training, completion of a foundation psychiatry post was an influencing factor in this decision. A strong majority of doctors prefer the foundation psychiatry placement to be offered in FY2.

A questionnaire survey of all general practices in one health authority plus an assessment of a random sample of referrals were used to evaluate the impact of counsellors in primary care on referrals to mental health services.

A total of 91.1% of practices responded to the survey. A counsellor was present in 20.3% of these practices. A random sample of 180 referrals to community mental health teams was reviewed. There was a significantly higher referral rate from practices that employed a counsellor (P = 0.003). There was no evidence of a difference in rates of caseness of referrals between practices that employed a counsellor and those that did not.

Practices employing counsellors had significantly higher referral rates to mental health services, with no difference in the level of caseness between the two groups of referrals.

To investigate whether a psychiatry-specific virtual on-call training programme improved confidence of junior trainees in key areas of psychiatry practice. The programme comprised one 90 min lecture and a 2 h simulated on-call shift where participants were bleeped to complete a series of common on-call tasks, delivered via Microsoft Teams.

Thirty-eight trainees attended the lecture, with a significant improvement in confidence in performing seclusion reviews (P = 0.001), prescribing psychiatric medications for acute presentations (P < 0.001), working in section 136 suites (places of safety) (P = 0.001) and feeling prepared for psychiatric on-call shifts (P = 0.002). Respondents reported that a virtual on-call practical session would be useful for their training (median score of 7, interquartile range 5–7.75). Eighteen participants completed the virtual on-call session, with significant improvement in 9 out of the 10 tested domains (P < 0.001).

The programme can be conducted virtually, with low resource requirements. We believe it can improve trainee well-being, patient safety, the delivery of training and induction of rotating junior doctors during the COVID-19 pandemic and it supports the development and delivery of practical training in psychiatry.