Aims and MethodTo evaluate the effects of a crisis resolution and home-based treatment team upon in-patient admission rates. We collected data for 2 years prior and 1 year post-implementation of such a service in Leeds. The chosen time frame allowed the new service to settle in and controlled for seasonal variations.ResultsThere were 4353 admissions during the period of the study, with 3325 in the 2 years prior to the service and 1028 in the year after. Generalised linear analysis found a 37.5% reduction in monthly admissions after the introduction of the team (P < 0.0001).Clinical ImplicationsThis study shows that in everyday clinical practice crisis resolution and home treatment teams lead to a sustained reduction in in-patient admission rates.

Aims and method To evaluate differences between male patients in secure psychiatric settings in the UK based on whether they are detained under civil or forensic sections of the Mental Health Act 1983. A cohort of patients discharged from a secure psychiatric hospital were evaluated for length of stay and frequency of risk-related incidents.Results Overall, 84 patients were included in the study: 52 in the forensic group and 32 in the civil group. Civil patients had more frequent incidents of aggression, sex offending, fire-setting and vulnerability, whereas forensic patients had more frequent episodes of self-harm.Clinical implications Secure hospitals should ensure treatment programmes are tailored to each patient's needs. Civil patients require greater emphasis on treatment of their mental illness, whereas forensic patients have additional offence-related treatment needs. Regular liaison between forensic and general adult services is essential to help ensure patients can return to appropriate settings at the earliest opportunity in their recovery.

Insufficient evidence exists to support the new legislation for England and Wales

Clozapine is often the drug of choice within patients suffering from treatment-resistant paranoid schizophrenia. It has a complex side effects profile which includes potentially fatal agranulocytosis. Clozapine has also become increasingly associated with a range of other side effects including constipation and pneumonia. We report on a case of clozapine-induced severe constipation leading to a silent presentation of pneumonia with a subsequent respiratory arrest. To our knowledge, this is the first case report of pneumonia secondary to severe constipation occurring in the absence of respiratory aspiration of feculent vomitus. We suggest a new pathological mechanism by way of severe constipation leading to diaphragmatic dysfunction and subsequent clozapine-induced pneumonia. In addition, implications for clinical practice are outlined.

Aims and methodTo evaluate patient awareness of the mental health tribunal and identify any association between capacity to request a tribunal and frequency of completed hearings. A cohort of detained patients within a secure hospital were assessed and data for past tribunals evaluated by presence of capacity and mode of application.ResultsOf the 65 patients evaluated, 78% were aware of the tribunal's power to discharge, 14% were aware of its power to recommend leave and 4% were aware of its power to recommend transfer; 12% lacked capacity to request a tribunal. Patients with capacity received more completed hearings per year than those without, both overall (0.58 v. 0.29 per year, P = 0.04) and by patient application (0.45 v. 0.12 per year, P = 0.03).Clinical implicationsHospital managers should ensure that all detained patients have regular assessments of their capacity to request a tribunal and that those who lack capacity are referred to the Secretary of State when it is considered that a tribunal would be in their best interests. Hospital managers should consider referring such cases to the Secretary of State every 12 months.