Aims: To measure the effectiveness of treatment in a low secure challenging behaviour unit and to identify predictors of change.

Method: Routine clinical data and outcome scores were collected on a case series of 86 patients admitted to and discharged from one low secure unit.

Results: Significant improvements were found on Health of the Nation Outcome Scale (HoNOS), Staff Observed Aggression Scale (SOAS) and the Global Assessment Scale (GAS). Improvements in GAS and HoNOS were associated with moves to a lower level of security. Patients with a history of conviction for property damage, cannabis use, who were admitted on a forensic section or with a diagnosis of personality disorder were more likely to move to a higher level of security. Increased length of stay was related to the presence of physical assault, physical health problems and anxiety symptoms.

Conclusions: Clinical outcomes and behaviour improve during admission to one low secure unit and characteristics of the type of patients who respond to this form of treatment are proposed.

Seclusion of psychiatric inpatients is used as a last resort in managing disturbed behaviour. Research on factors contributing to its use is limited. The aim of this study was to examine the effect of a change in unit size and other variables, such as time of day and nursing workload, on the rates of use of seclusion in an intensive care inpatient psychiatric unit. Rates of seclusion were examined in randomly selected nursing shifts across three time periods; one before and two after a change in the size of the unit. Effects on seclusion rates of size, shift and four nursing workforce variables were explored using multivariate analysis. Unit size, shift and nurse hours together explained 23% of the variance in seclusion use. Of particular significance was the change from a 20 bed unit to two separate 10 bed units. The findings have implications for the organisation of inpatient psychiatric units. Smaller units may allow better management of disturbed behaviour.

Background: Physical illnesses are more prevalent among patients with serious and enduring mental illnesses. This is mainly due to the association between mental and physical illnesses, complications of the mental illness itself and as a side effect of medication. Medical problems can be overlooked by psychiatrists due to several reasons. More research and audit of the existing services are necessary to establish the physical needs of patients with complex mental health problems.

Aim: To give an account of the causes of excessive mortality and physical morbidity among patients with serious mental health problems.

Method: Review of the worldwide literature.

Results: Physical problems are more common and the standardised mortality rate (SMR) is higher in psychiatric patients compared to the general population. The main causes are association between mental and physical illnesses, lifestyle including lack of physical activity, smoking and poor dietary habits, metabolic syndrome, diabetes mellitus and other cardiac risk factors. There is a close association between treatment with antipsychotic medication and weight gain, diabetes mellitus, sudden death, cardiac and endocrine complications such as QT prolongation and also hyperprolactinemia.

Conclusion: The paper highlights the importance of monitoring physical problems in patients with serious and enduring mental illnesses. Good practice points include help with smoking cessation, psycho-education about healthy lifestyle, close liaison between carers and professionals, the importance of taking baseline investigations before commencing antipsychotics, a shared care approach with primary care, early identification of the risk factors for physical illnesses and regular monitoring of physical health. Also important are social interventions such as appropriate accommodation and structured day, leisure and sporting activities.

Aims and method: We audited the caseload of an Assertive Community Treatment (ACT) team against National Institute of Clinical Excellence (NICE) guidelines in the treatment of schizophrenia. Care coordinators rated the work carried out by the team on an audit tool. Results were compared to a case note audit completed 2 years earlier.

Results: 61 patients had a primary diagnosis of schizophrenia. Rates of compliance with NICE guidelines varied from 0% (provision of advance directive) to 85% (written information given, no antipsychotic polypharmacy). Compliance was greater than in the earlier audit.

Discussion: When refusal, lack of capacity or indication were taken account of, guidelines were generally adhered to. Although a useful benchmarking process and an opportunity to identify skill deficits in the team, our findings raised concerns about simplistic notions of guideline implementation, as a means to improve practice. Patient choice is an important consideration.

People with SMI have high levels of physical illness and significantly raised natural mortality compared to the general population. This is largely explicable by altered exposure to ordinary environmental risk factors and to poorer quality of medical treatment; partly because SMI can interfere with the individual's ability to organise their healthcare and partly because it can affect the quality of treatment delivered by professionals.

People with SMI can suffer the same range of physical illnesses as anyone else in the population but are at significantly greater risk of developing particular illnesses. Admission to a PICU presents an excellent opportunity for assessment and management of their physical health needs. PICU staff have a responsibility to develop effective mechanisms for identifying and treating acute physical illness, they also need to think about how best to address the detection and management of chronic physical illness and about their responsibilities in respect of health promotion.