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This article examines the issues involved in the treatment with antipsychotic medication of forensic patients with schizophrenia. Poor compliance with medication may lead to a worsening of positive psychotic symptoms and increase the risk of re‐offending. Nurses and other members of the forensic multidisciplinary team spend long periods of time with patients and may form close therapeutic alliances with them. These staff have an important role in helping patients with medication‐related issues, thereby improving treatment outcome.

Obesity is an important contributory factor to premature mortality and morbidity. The purpose of this study was to survey inpatients at a secure psychiatric hospital in order to determine the proportion that was overweight and obese. Further aims were to identify variables associated with obesity and the proportion of patients being treated for diabetes mellitus, hypertension, and hyperlipidaemia.

A cross‐sectional survey of 234 adult male and female forensic and rehabilitation patients was carried out using routinely collected data.

Of the 144 males, 33.3 per cent were overweight and 47.2 per cent were obese. Of the 90 females, 20.0 per cent were overweight and 63.3 per cent were obese. More patients had gained weight in the last three months than had lost it. Being overweight or obese was associated with the prescription of antipsychotic medication and valproate. A total of 30.3 per cent of patients were being treated for hyperlipidaemia, 14.1 per cent for hypertension and 8.5 per cent for type II diabetes mellitus.

The survey was conducted in an independent hospital, thus the results are not readily generalisable to the wider NHS. The authors were unable to report on the prevalence of metabolic syndrome. This is a subject that merits further research.

Obesity is a major challenge in this patient population and requires active management to try and prevent complications. Patients need continuing education about healthy eating and encouragement to take exercise.

There is a paucity of published surveys of obesity and its complications in forensic populations.

Use of off-license medicines in forensic mental health settings is common and unlicensed drugs are sometimes prescribed. Despite their responsibility for administering medicines little is known about how mental health nurses view these practices. The paper aims to discuss these issues.

In total, 50 mental health nurses working in low and medium secure adolescent and adult mental health wards were presented with a clinical vignette about administration of unlicensed and off-license medicines. Semi-structured interviews about their likely clinical response to, and feelings about, this practice were conducted. Interview data were subject to a thematic analysis.

Analysis revealed six themes: status of unlicensed/off-label medicines; legality of administering unlicensed medicines; professional standards around administering unlicensed medicines; finding out more about unlicensed medicines; trusting medical colleagues; and decision making in uncertain cases.

Forensic mental health nurses take a pragmatic approach to the practice of administering unlicensed medicines and most are aware of their professional responsibilities.

This study provides the first evidence to inform the development of training for forensic mental health nurses about an issue that is common in forensic mental health practice.

Patients in secure units are at high risk of obesity because of antipsychotic medication, restrictions on freedom, and poor motivation to eat healthily and exercise. The aim of this paper is to investigate how consultant forensic psychiatrists address weight management, particularly with respect to inpatients.

Based on a review of the literature, a structured questionnaire was developed and piloted locally. After revising the questionnaire, it was sent to all 442 consultant psychiatrists listed by the Royal College of Psychiatrists as having a special interest in forensic psychiatry.

A total of 183 usable questionnaires were returned (response rate 45.9 per cent). Most respondents monitored patients' weight and had some access to a dietitian. Respondents rated a median of 40 per cent of their inpatients as obese. A total of 68.9 per cent said their patients did not have unrestricted access to food. Use of weight loss drugs such as orlistat was infrequent. A few patients had been referred for bariatric surgery but most had been judged unsuitable.

The responses reported in this paper are based on participants' self‐report and have not been confirmed by independent observation. Further research is needed to determine which weight loss measures are effective for psychiatric patients in real‐life situations.

Obesity appears to be common among forensic inpatients despite weight monitoring, dietetic interventions and exercise programmes. Comprehensive and continuing efforts are needed to help patients lose weight and lead healthier lifestyles.

This survey reports on clinicians' views and clinical practice.

The purpose of this paper is to describe the characteristics of adult male autistic spectrum disorder (ASD) patients admitted to low secure services and to compare them with non‐ASD patients.

Case‐control study of admissions to two ASD units and one non‐ASD unit at a tertiary referral centre. Subjects were compared on demographic, personal, clinical and offending behaviour variables.

In total, 51 ASD and 43 controls were studied. Median age at diagnosis of ASD was 21 years (range 6‐56). The ASD group were younger (median age 27 vs 33 years) and more likely to be single than controls. Their age at first contact with psychiatric services was lower and proportionally more were admitted from prison and courts. Almost three‐quarters had psychiatric comorbidity, most commonly schizophrenia, but unlike controls, personality disorder and drug and alcohol disorders were uncommon. Lifetime sexually inappropriate behaviour and physical violence were less common, as was non‐compliance with medication. However, 78 per cent had a lifetime history of physical violence and a third had a conviction for GBH or homicide. Offending behaviour was sometimes atypical in nature and some had convictions for unusual offences such as harassment and stalking.

The age difference between cases and controls is likely to have confounded the results. Findings cannot be generalised to the NHS.

This group of ASD patients in low security differed in several important respects from their non‐ASD counterparts, which highlights their differing treatment needs, strengths and weaknesses.

Little is known about complaints made by psychiatric patients. The aim of this study is to analyse complaints made by, or behalf of, inpatients at a large independent psychiatric hospital.

The hospital's complaints register was used to identify and study complaints made during 2006. A descriptive analysis was performed.

Of the 392 complaints, 39 per cent related to staff behaviour, 26 per cent to clinical matters, 18 per cent to the behaviour of other patients and the remaining 16 per cent to the physical environment and facilities. Action as a result of complaints was mainly taken at unit level but in 9 per cent of cases organisation‐wide improvements were made, for example to enrich patient treatment programmes, rectify staff shortages and improve the quality of meals.

The study took place in a specialist hospital and so the findings cannot be generalised to the wider NHS. Important differences exist between complaints made in psychiatric as opposed to general hospital settings.

Complaints are a valuable source of organisational learning for mental health services.

Given the paucity of literature on complaints in psychiatry, this study describes some in detail the nature of patients' complaints and one organisation's actions to improve patient services as a result of these complaints.

The purpose of this paper is to describe a completed audit cycle of the assessment and documentation of antipsychotic side effects reported by patients in a secure hospital setting.

The initial audit was carried out in 2012. As a result of the findings clinicians were recommended to use a brief structured side effect monitoring guide (the Glasgow Antipsychotic Side-Effect Scale (GASS-m)). The audit was repeated in 2015.

Of the 41 patients notes included in the initial audit, for only one (2.4 per cent) was there evidence of a systematic and structured approach to monitoring antipsychotic side effects. In the repeat audit this figure (and use of the GASS-m) had increased to 21/45 (46.7 per cent). For all patients where the GASS-m had been used (n=21) the overall severity of side effects was in the “mild” range (0-21).

Sample size was modest and the study was conducted in an independent secure hospital so may not be generalisable to the NHS.

Use of structured tools/guides to monitor patients’ side effects is recommended so that emergent side effects can be readily recognised, tracked and managed and, relapses made less likely through improved compliance and thus patients’ quality of life improved. This is very important for forensic patients since relapses are likely to increase risk to others.

Previous audits have addressed physical health monitoring of patients on antipsychotics but not by asking them about side effects.