Measuring outcomes is becoming an increasingly standard (and highly complex) part of what mental health services are expected to do. Practising psychiatrists will need to have a good understanding of approaches to outcome measurement: used well, they have the potential to amplify the patient voice, promote good-quality services and facilitate research. We discuss what constitutes an outcome measure, the different ways that such measures can be obtained and the mechanisms for assessing the quality and appropriateness of an outcome measure. We outline the rapidly evolving research and policy context regarding outcome measurement, with particular reference to the UK's National Health Service. We also consider the potential pitfalls to outcome measurement, such as added clinical burden, inappropriate incentivisation of behaviour and incorrect interpretation of results. We discuss ways that such difficulties can be avoided or their effects mitigated.

A significant proportion of individuals in contact with probation services have mental health problems. Joint working between psychiatrists and probation is crucial to both diversion and resettlement of offenders with mental health conditions. In England and Wales, probation services are involved in the supervision and management of offenders if they receive a suspended or community sentence, or when they are released into the community on licence after serving a determinate, extended or life sentence. This article aims to promote awareness of joint working between probation and mental health services and the role of approved premises. It also describes a successful example of such joint working at Elliott House, approved premises for mentally disordered offenders in Birmingham, UK.

No recent pandemic has had such a severe socioeconomic impact as COVID-19. Significant economic uncertainty and social restrictions have led to increased levels of stress for many. There has been increased social isolation, financial stress and alcohol intake, all of which can increase domestic abuse and other forms of household abuse. Increases in abuse in the home found in other public health emergencies and economic recessions can be seen now – reported UK domestic abuse rates have increased since the start of COVID-19. This article focuses on how COVID-19 and its anticipated aftermath exacerbate the risk factors for domestic abuse in the general population and discusses clinical implications for mental health practitioners in the UK. It aims to provide a point of learning based on previous disease outbreaks and recessions, with a focus on specific factors, such as unemployment and alcohol misuse, and how these contribute to increasing incidence and severity of abuse – and more importantly, how mental health professionals can mitigate these for patients, 1 in 3 of whom are estimated to have already experienced abuse before the COVID-19 pandemic.

Trauma-informed approaches emerged partly in response to research demonstrating that trauma is widespread across society, that it is highly correlated with mental health and that this is a costly public health issue. The fundamental shift in providing support using a trauma-informed approach is to move from thinking ‘What is wrong with you?’ to considering ‘What happened to you?’. This article, authored by trauma survivors and service providers, describes trauma-informed approaches to mental healthcare, why they are needed and how barriers can be overcome so that they can be implemented as an organisational change process. It also describes how past trauma can be understood as the cause of mental distress for many service users, how service users can be retraumatised by ‘trauma-uninformed’ staff and how staff can experience vicariously the service user's trauma and can themselves be traumatised by practices such as restraint and seclusion. Trauma-informed mental healthcare offers opportunities to improve service users' experiences, improve working environments for staff, increase job satisfaction and reduce stress levels by improving the relationships between staff and patients through greater understanding, respect and trust.

Sleep is essential for survival and humans spend approximately one-third of their life asleep. Adequate sleep is needed to maintain both physical and psychological health. Routinely getting less than the recommended amount of sleep for your age can have profound negative effects on health, such as increasing the likeliness of psychiatric illness, diabetes, cardiovascular disease and stroke. In children and adults with neurodevelopmental disorders, the prevalence of sleep disorders is significantly higher than in the general population. Given the relationship between sleep and psychiatric disorders, it is essential that psychiatrists have knowledge of the principles of sleep medicine. In this article, we focus on the common sleep disorders found in those with attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) and give an overview of screening, diagnosis and management.

Mental health services are recognised to have an important role in responding to domestic abuse, but approach across the UK's National Health Service (NHS) is inconsistent. We describe an example of taking a whole- organisation approach to responding to domestic abuse in one NHS mental health foundation trust.

Bed management and the transfer of patients is an area of clinical care that is frequently overlooked. Often, the lack of discussion leads to the patient perspective being ignored and to transfers to new hospitals without appropriate handovers, both to the detriment of patient outcomes. This article reflects on the real-world consequences of the bed management systems used within the UK's National Health Service (NHS), using the example of a patient in psychiatric services.