We audited prescribing within our area to ascertain how widespread the practice of antipsychotic polypharmacy using clozapine was, and whether it was being carried out within existing standards, including those of high-dose monitoring when required.

Data on 169 patients were reviewed in year one, rising to 193 in year three. Around 30% of patients on clozapine received additional antipsychotic medication. A disturbingly low proportion of patients on clozapine whose antipsychotic polypharmacy brought them into the high-dose range were being monitored appropriately after three audit cycles (the proportion rose from 10% in cycle 1 to 28% in cycle 3). A wide range of additional antipsychotic medications was used.

Clozapine antipsychotic polypharmacy was prevalent at just below a third of all patients in this review. Prescribers should be alert to the fact that clozapine antipsychotic polypharmacy can push patients into the high-dose range and ensure appropriate monitoring.

Electroconvulsive therapy (ECT) often causes fear in the general public because of media representation and negative reported side-effects. This study evaluates a new video focusing on experiences of ECT and how this can aid communicating medical information to the public. Knowledge and attitudes toward ECT after watching the video were compared with a group that received no information and a group that read the current NHS leaflet on ECT. The role of empathy was also considered as a covariate.

The video was the only condition found to positively affect knowledge and attitudes toward ECT. The video was especially beneficial to those that possessed low perspective-taking trait empathy.

These findings demonstrate the video improved knowledge and attitudes toward ECT compared with current material or no information. We suggest that the addition of personal experiences to public information adds perspective, improving overall attitudes toward health treatments.

Very little research has been undertaken to characterise the service user groups served by the voluntary sector mental health services in Britain. In view of the high reported cases of dissatisfaction with the statutory mental health services in the population of Caribbean origin in Britain, we sought to compare the male service users attending a voluntary sector service in Brixton, South London with those attending a service run by the mental health hospital for that catchment area. The service users and their case workers were interviewed and their case notes reviewed to obtain demographic information such as employment and forensic history and contact with other services. They were also assessed using the Global Assessment of Functioning (GAF) and the Camberwell Assessment of Need (CAN).

The service users attending the voluntary sector were significantly more disadvantaged in the areas of unemployment and contact with other health services particularly general practitioners. They had significantly lower scores on the GAF and had more unmet needs on the CAN, including numeracy and literacy skills. Both patient groups, however, reported problems with intimate relationships.

Service users attending voluntary sector services are likely to be more socially and materially deprived than their counterparts attending statutory services and specific strategies are required to assist these organisations in meeting the many needs of the service users.

We aimed to examine clinical and risk outcomes at follow-up, and reoffending and readmission rates, for a sample of 50 admissions to a female medium secure unit (MSU). Demographic, clinical risk assessment (HCR-20 and HoNOS-Secure) and quality of life data were collected using validated measures for all admissions to a female MSU ward in London, UK, between April 2008 and November 2014.

All clinical and risk assessment scale scores had improved at follow-up. Quality of life compared favourably to community samples and was good for physical, social and environmental factors and acceptable for psychological health. Twenty-six per cent had at least one readmission, while 17.5% reoffended in the period studied. A longer duration of admission and use of restrictions on discharge was associated with reduced reoffending, but not readmission.

Admission is associated with improvement on clinical risk assessment at follow-up. Longer hospital admissions and use of restrictions on discharge may be necessary to prevent reoffending in this group.

None.

A questionnaire survey of psychiatrists and mental health nurses was conducted to look at their awareness of nurse supplementary prescribing and its impact on patient care.

Response rate was 49.5% for psychiatrists and 23% for nurses. Most nurses (96.2%) and psychiatrists (91%) were aware of nurse supplementary prescribing, but more nurses than psychiatrists felt that it will provide patients quicker access to medication (P=0.023) and improve patient care (P=0.0003). Although two-thirds of the nurses felt confident to be a nurse prescriber, only 13% had actually approached a psychiatrist to be their supervisor. Most psychiatrists (54.4%) did not feel confident to act as supervisors.

Unlike nurses, psychiatrists were cautious about potential benefits of nurse supplementary prescribing on patient care. Both nurses and psychiatrists expressed concerns. As the expansion of nurse prescribing occurs, it is important for trusts to work actively with nurses and psychiatrists to address these concerns.

The study reports findings of an investigation into the presence of severe and enduring mental health problems within the four statutory and non-statutory teams of an established substance misuse treatment partnership.

Of a total of 772 clients in the four teams surveyed, 69 (8.9%) were identified as having severe and enduring mental health problems and problem substance use in the past 12 months. Alcohol was the most prevalent substance used by this predominantly male group. Different rates were found across the four teams, with higher numbers in the non-statutory teams. The clients displayed significant levels of self-harm and suicide risk and were responsible for 131 acute service contacts over the past 12 months.

Clients with severe and enduring mental health problems engaged with substance misuse services display high levels of complex need. It is important to identify the best and most effective service response to this group.

We argue the case for In-patient liaison psychiatry In the UK. We undertook a case note review of the characteristics of a consecutive series of in-patient and day patient admissions to a specialist liaison psychiatry unit in Leeds. We reviewed the literature on in-patient units for the treatment of similar patients, most of which came from the USA.

Physical morbidity was high in the sample. Forty-four per cent had been admitted for physical problems in the year before admission to the unit. Twenty-three per cent were taking five or more drugs for physical disorders at the time of admission, 86% were not in paid employment at the time of admission. Treatment involved integrating treatment for physical Illness, and physical and psychosocial treatments for mental disorder. We identified no reports of in-patient units in the UK doing similar work.

In-patient liaison psychiatry is neglected in the UK, to the detriment of a small but important group of patients with coexistent severe physical and mental disorder.