Cannabis use is a significant predictor of lifetime violence among the severely mentally ill, while both alcohol and cannabis use predict self-harm. Few affected patients receive specific treatment for substance use comorbidity.

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Substance misuse in New Zealand patients with severe mental illness is common, particularly among younger patients and Maori, and differentially distributed across diagnoses.

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patient asleep. This is an area that would benefit from further research. Finally, the guidelines give some prominence to ECT with a 0.5-millisecond PW. The evidence base is probably too weak for it to have been included in Table 1 alongside the more robust options of 1-millisecond PW ECT and RUL UB ECT, but at least the guidelines do acknowledge the lower level of evidence for 0.5-millisecond ECT. However, I would take issue with their assertion that 0.5-millisecond ECT is 'at the lower end of the brief pulse range'. The evidence that exists about 0.5-millisecond PW ECT suggests it is fact closer to 0.3 milliseconds than 1 millisecond in terms of efficacy and adverse effects. In fact, Sienaert et al. (2018) argue persuasively that 0.5-millisecond PW ECT should be considered a wider form of UB ECT rather than a narrower form of brief pulse ECT. However, there is also a good argument for simply naming the actual pulse width in milliseconds and abandoning the terms 'ultrabrief' and 'brief pulse' altogether.