The management of acute behavioural disturbance in psychiatric patients is an area that continues to require investigation, as it is potentially dangerous for both patients and staff. We conducted an audit of the management of these episodes, looking particularly at the drugs given, the doses and any polypharmacy. We also examined whether the issue of guidelines led to any changes in prescribing patterns. We found that we were prescribing appropriately and that the guidelines did lead to some shift toward safer prescribing.

Training in psychiatric work in prisons may not always receive adequate attention, as highlighted in the Reed Report (Department of Health and Home Office, 1992). As a first step in addressing this, a one-day induction procedure has been added to the Induction Programme for the Forensic Senior Registrars at the Regional Secure Unit (RSU) in Bristol. The contents of the programme were determined by discussion among prison medical staff, the Training Department and Forensic Senior Registrars, and are outlined in the following timetable:

Standards developed from the Royal College of Psychiatrists' consensus statement on the use of high-dose antipsychotics were audited. The baseline survey and two completed audit cycles are described showing improvement in the monitoring and management of out-patients on higher dose depot antipsychotics. Initially the main problem was poor attendance at hospital appointments. Practice was changed by (a) medical staff becoming more assertive and visiting non-attenders at home; (b) a phlebotomist visiting patients at home. Deinstitutionalisation has relocated many patients with chronic psychoses into the community, but services, including the ancillary services, have sometimes been slow to follow. This audit found that the most effective change was the provision of services to patients in their own home.