People with mental illness may be unable to provide critical input about the care they wish to receive during a psychiatric crisis because of altered mental states. It is therefore imperative that clinicians seek to understand service users' wishes for care while they are well and able to provide meaningful input into the discussion. Achieving such an end may be done by discussing and completing a psychiatric advance directive. However, very few Asian countries have legislation that supports such advance directives. The present article seeks to give physicians more information about advance psychiatric directives and the potential role they could play to improve the healthcare provided in Asia to people at risk of losing capacity due to a mental illness.The degree to which mental health legislation supports psychiatric advance directives is documented for each country of South

Introduction: Vitamin D deficiency and insufficiency have been shown to be prevalent in several populations, including in people who have a mental illness. Deficiency has been linked to specific mental health sequelae. Furthermore, deficiency may be perpetuated by medications routinely prescribed to people with severe mental illness. Therefore, symptoms of mental illness may be exacerbated by deficient levels of vitamin D, and treatments for mental illness may exacerbate deficiency. This study sought to determine the vitamin D levels of people hospitalized for a period longer than a year in an equatorial nation, Singapore. The inpatient population was then categorized according to levels to determine the need for supplementation. Methods: Total 25-hydroxy vitamin D in serum and plasma levels were tested in 403 individuals in long-term psychiatric wards. Blood serum and plasma levels were classified into three groups. Regression models were constructed to test the associations between levels and clinical covariates. Results: Forty (9.9%) people had vitamin D levels that were sufficient. A link was found between vitamin D levels and medications given for gastrointestinal illnesses (β −2.48, p = .014, 95%CI-4.46 to-0.51) and between vitamin D levels and length of stay (β −0.13, p = .027, 95%CI-0.24 to-0.01). No other relationships were statistically significant. Discussion: Despite its geographic location and opportunities for regular outdoor activity, vitamin D deficiency, and insufficiency are prevalent among people hospitalized for long periods of time in an equatorial nation. The level of deficiency is comparable to those observed in other settings.

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Introduction: Doctors working in a tertiary psychiatric hospital will have to treat acute medical ailments e.g. hypotension, seizures, in addition to psychiatric conditions. In our setting, doctors on call duty will attend to acute medical conditions for the psychiatric inpatients and decide which cases need a referral out for further treatment at the medical emergency department. Objective: To investigate the sentiments of medical officers working in a tertiary psychiatric hospital with regards to management of acute medical conditions. Methodology: An anonymous online survey was sent to 67 medical officers working in a tertiary psychiatric hospital to explore their sentiments with regards to managing acute medical conditions whilst on call duty. 3 of the questions were 'Do you feel confident managing acute medical conditions?", 'Would you be more inclined to refer a patient out for medical treatment if he/she wasn't from your own ward." and 'I feel unsure managing medical conditions of patients not directly under my care." Results: 39 (58%) medical officers completed the survey. 72% felt confident about managing acute medical conditions. 51% felt unsure managing medical conditions of patients not directly under their care whilst 62% would be more inclined to refer such patients out. Conclusion: Most medical officers working in our tertiary psychiatry hospital feel confident about managing acute medical conditions. The confidence drops however if the patients were not under their direct care prior to the call duty and they would be more inclined to refer such patients to the medical emergency department for treatment.

Reducing preventable transfer of inpatients from a psychiatric hospital to the emergency departments of general hospitals is a worthwhile endeavour. Such initiatives optimise use of healthcare resources, improve patient care and increase satisfaction.