Psychiatry, behavioural disturbance and risk management have conceptually coexisted for hundreds of years, however, prior to the 1800 Criminal Lunatics Act, drafted exigently following an attempt on the life of the then King by the “insane” Hadfield, the only means of care was custodial, under arcane vagrancy legislation, such as the 1714 Vagrancy Act, or on the basis of the poor laws. Mentally disordered individuals were either incarcerated as criminals or paupers (Select Committee, 1807) falling under the responsibility of local parish councils. At this point, incarceration was just that, with prisons hosting most detained mentally disordered individuals, under the indefinite see of the monarch. The first vision for caring, secure, environments for mentally disordered individuals was in the development of asylums following the 1808 County Asylums Act, which recognised that detaining, “lunatics and other insane persons…in Gaols, Houses of Correction, Poor Houses and Houses of Industry, is highly dangerous and inconvenient.”

Background: Low Secure Mental Health Services provide care for highly disturbed psychiatric patients. Little is known about the characteristics of such patients in the UK.

Aims: To perform the first UK wide survey developing a national data set of low secure services.

Method: A cross-sectional census day postal survey design was employed.

Results: A total of 307 units were identified this comprised 170 Psychiatric Intensive Care Unit (PICU) housing 1,242 patients and 137 Low Secure Units (LSUs) treating 1,583 patients. The majority of patients in Low Secure care were male, white, single, unemployed and with a diagnosis of schizophrenia. Complex needs, violence and forensic histories were common. There was a clear overrepresentation of black ethnic patients.

Conclusions: Patients in Low Secure Services shared many characteristics. However, there were important differences between PICU and LSU patients. The overrepresentation of black ethnic groups is concern that requires NHS action to ensure that the specific needs of black patients are met.

Background: Low Secure Mental Health Services provide care for highly disturbed psychiatric inpatients. Little is known about the provision of such services in the UK.

Aims: To perform the first UK wide survey developing a national data set for Low Secure Services.

Method: A cross-sectional census day postal survey design was employed.

Results: A total of 307 units were identified in the UK, this was comprised of 170 Psychiatric Intensive Care Units (PICUs) housing 1,242 patients and 137 Low Secure Units (LSUs) treating 1,583 patients. The survey achieved a 98% response rate. PICUs on average had more qualified staff and were more medically oriented than LSUs. PICUs offer a time limited, medically oriented treatment strategy with a higher number of qualified nursing staff then LSUs. Whereas, LSUs placed more of an emphasis on long-term therapeutic treatment and rehabilitation.

Conclusions: Although there were a variety of names, Low Secure Services were organised into two main categories of unit: the PICU and the LSU. These names should be adopted nation-wide as standard. There is need for a national strategy relating to the way PICUs and LSUs are developed.

The National Institute for Clinical Excellence (2005) published guidance on the management of disturbed behaviour in mental health settings and emergency departments. The guidance included some of the recommendations made in the Independent Inquiry into the death of David Bennett (2003). One important recommendation requires that staff implementing physical interventions (restraint) and/or parenteral rapid tranquilisation are able to effectively manage the physical health of the patient including any immediate complications that may arise.

This article provides background and a syllabus for training for staff to be able to meet the physical assessment skills and interventions required by recent UK national guidance. Also reported is the creation, role and deployment of a 24-hour Medical Emergency Response Team in an in-patient mental health setting to ensure responses to both medical and psychiatric emergencies offer improved safety and adhere to the new guidance. The article describes the provision of a person with the sole responsibility monitoring a patients physical safety during restriant, 24 hour a day, 7 days a week.

The article will be of interest to those working in in-patient mental health and learning disability services, especially those where they are not served by a resuscitation team as part of a District General Hospital and where there is no resident Duty Medical Officer.

Little is known about how different groups of health-care workers compare to each other and to the general public in their opinions about involuntary admission and treatment. In the present study, 1,094 people in Norway responded to a questionnaire containing three cases with patients suffering from schizophrenia. They were asked in which cases they would admit involuntarily and treat involuntarily with neuroleptics. An overwhelming majority would coerce when the patients were violent. Between a third and a half would coerce when the patients had problems coping with activities of daily life, or when the patients were in an early schizophrenic development with few symptoms. In all the cases, significantly more would accept involuntary admission than involuntary treatment with neuroleptics. The results suggest that health-care workers' attitudes to coercion in psychiatric care are in line with the attitudes of the general public. Prior experience with coercion, female sex, not having a college/university education, having a profession other than social worker, and not currently being employed in the psychiatric services, were positive predictors of willingness to coerce.

We report on an adolescent with Asperger's syndrome who developed acute pancreatitis during treatment with risperidone and citalopram. On discontinuation of psychopharmacotherapy, he fully recovered. A rechallenge testing of citalopram did not result in a relapse of pancreatitis. Other known causes of pancreatitis were not obvious. Clinicians should be alert to this rare adverse event in patients who exhibit symptoms of an acute abdominal disorder during risperidone treatment.

Current western involuntary hospitalisation legislation is based on legal philosophy and the freedom of the individual. Legislation based on medical philosophy, which focused on the need for care has been deposed. Formerly, doctors had greater authority, but with this came the difficulty of balancing the opposing agendas from various quarters. This role has been adopted by Mental Health Tribunals. Eventually, doctors accepted the new system, which in some ways made their lives easier. They continue to be concerned that the emphasis on freedom leaves some non-dangerous disorganized patients without care.