BackgroundSchizophrenia is known to be associated with a range of adverse outcomes, which have an impact at the societal level and are therefore of public concernAimsTo examine the epidemiology and methods for measuring six adverse outcomes in schizophrenia: violence, victimisation, suicide/self-harm, substance use, homelessness and unemploymentMethodAreview of the literature was carried out for each adverse outcome, with attention to critical appraisal of existing measurement toolsResultsSchizophrenia is associated strongly with all six outcomes, although research has mainly focused on violence. Each outcome acts as a risk factor for at least some of the other outcomes. There are few standardised or validated measures for these'hard' outcomes. Each measure has inherent biases but a growing trend is for these to be minimised by using multiple measuresConclusionsAsingle instrument which systematically measures multiple societal outcomes of schizophrenia would be extremely useful for both clinical and research purposes

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Although screening has become an established procedure in prison health care, some difficulties persist. In attempts to improve this, many local adaptations have been introduced, but few have been evaluated. We introduced an adaptation -mental health expertise (a Community Psychiatric Nurse, CPN) -into the reception area of a busy remand prison, and compared standard and enhanced assessment procedures over a six-month period. Referrals (n = 67) were significantly more likely to be suitable for onward caseworking by the clinical team after a CPN was introduced. The team showed little evidence of the 'mission creep' (where teams operating at a secondary level absorb mental health problems at a primary care level) that has been described elsewhere in the literature. Despite its limitations, this evaluation suggests that prison pathways can be improved by relatively inexpensive local initiatives, and that advancing specific mental health expertise into prison reception areas can enhance existing processes.

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