Background: Both the National Health Service (NHS) and the private sector provide psychiatric intensive care. To date little is known about the differences between the two sectors regarding the unit functioning and characteristics of patients who are accommodated in psychiatric intensive care units (PICUs).

Aim: To compare the unit and patient characteristics of NHS and private PICUs.

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

Results: A total of 170 PICUs (154 NHS, 16 private) were identified. NHS PICUs accommodated 1038 patients and the private PICUs housed 200 patients. Analysis of the data showed that some differences existed between the two sectors related to unit characteristics. Private units reported having higher number of beds, more nursing staff, more unit facilities and more out of area referrals than the NHS Units. Regarding the patient characteristics, private PICUs had significantly more patients with personality disorders and forensic history than the NHS PICUs. NHS patients had a shorter length of stay compared to those in the private sector. The demographic profiles of NHS and private PICU patients were similar. The majority of the patients were white, male, unemployed and single.

Conclusion: The NHS and the private sector PICUs share many characteristics in terms of unit functioning and patient characteristics, however, some significant differences between the two sectors have also emerged.

Background: Both the National Health Service (NHS) and the private sector provide low secure care. Little is known about the differences between the two sectors regarding the unit functioning and characteristics of patients admitted to low secure units (LSUs).

Aim: To compare the unit and patient characteristics of NHS and private LSUs.

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

Results: The analysis is based on 128 LSUs (98 NHS, 30 private). NHS LSUs accommodated 1084 patients and the private LSUs accommodated 359 patients. Analysis of the data showed that some differences existed between the two sectors related to the number of beds, unit facilities, interventions and the referral-discharge route. The demographic characteristics of NHS and private patients were similar. The majority of patients were white, male, unemployed and single.

Conclusion: Although the NHS and the private sector LSUs work similarly and share many characteristics in terms of the unit functioning and the patient characteristics, a few very significant differences between the two sectors have also emerged.

Assessing a patient's risk of violent behaviour, predicting dangerousness and the development of a subsequent management plan have become integral and important aspects of contemporary mental health practices. What is less clear, and much discussed within the literature, is how we should best implement risk assessment and risk management practices within mental health care. The aim of this paper is to critically discuss risk assessment practices in order to propose a systematic approach to the effective assessment and management of aggression and violence in mental health settings. A critical review of the risk literature in mental health was undertaken. The literature search highlighted different generations or approaches to risk assessment methodology, which were critically reviewed. From this critical review a proposed model entitled ‘risk analysis’ is argued from the appraisal and critique of the literature as a more encompassing and collaborative approach to the assessment and management of risk.

Aims and method: To measure the numbers of staff and patients experiencing physical assault, and identify the perception of staff and patients regarding alcohol and drug related violence on Psychiatric Intensive Care wards (PICUs), acute adult wards and forensic wards. Postal questionnaires were received from 2761 individuals. They yielded quantitative and qualitative data. Further information arose from discussion groups of staff at feedback events.

Results: Nurses on PICUs (61%) were more likely to report assault than those on acute wards (45%) or forensic wards (33%). Patients on PICUs (25%) were significantly more likely to report assault than those on acute wards (14%) but not forensic wards (23%). Nurses were more likely than patients to report that drugs and alcohol had caused violence on their ward. Nurses on PICUs and forensic wards thought drug use was more likely to cause violence than alcohol. Compared with PICUs, more nurses considered that violence was due to alcohol and drugs on acute wards but not on forensic wards. Many nurses on PICUs carried out personal searches but few had received training in this.

Conclusion: Nurses on PICUs appear to be at particularly high risk of violence. Reducing the availability of illegal drugs on PICUs and improvement of staff training could be important means of reducing violence.

The assessment of judgment has a central role in court-appointed evaluation, especially when criminal responsibility is in debate. Psychiatry and the law view the concept of judgment differently. The legal system aims for clear determinations of right or wrong, guilty versus not guilty. In psychiatry, judgment is a more complex concept; it involves analytical thinking, socio-ethical behaviors and insight. In clinical practice, these are inter-related and affect each other. The two viewpoints meet in court where they sometimes clash. Judgment is considered preserved when all three components are intact, or when only one is impaired. Impairment of two components inevitably leads to compromise of the third and to judgment impairment as a whole, resulting in criminal non-responsibility.

Clinical vignettes, mainly from acute secured wards, will illustrate the dynamic inter-relation among the different components of judgment and show the influence of judgment evaluation as a whole in criminal law.

The anti-psychotic drug management of patients with schizophrenia and HIV-1 infection is problematic. Such individuals are prone to extra-pyramidal reactions on account of HIV-1 induced sub-cortical involvement and exacerbation of cognitive impairment due to underlying CNS infection. Compliance with treatment can be problematic due to a disordered mental state and bone marrow toxicity may also result from the combined effects of anti-psychotic and retroviral agents. It is generally thought that atypical anti-psychotic drugs are the treatment of choice in such cases.

We present the case of a 30-year-old man with a history of schizophrenia who was successfully treated with clozapine following an admission to a psychiatric unit with acute confusional symptoms secondary to HIV-related central nervous system (CNS) involvement.