Older adult psychiatric inpatients may have impaired balance and have an increased risk of falling for many reasons (Pellfolk et al., 2009; Ko et al., 2009). This population may be on psychotropic medication, which is in itself an independent risk factor for falls (Stubbs et al., 2009). This is a group that may also be at elevated risk of osteoporosis and osteopenia; should they fall, they are more susceptible to osteoporotic fractures which are associated with high morbidity and mortality (Stubbs et al., 2009). To counteract this risk, older adult psychiatric services should seek to adopt the strategies identified as being “gold standard” in general older adult rehabilitation settings, such as a multifactorial falls intervention program (Gillespie et al., 2009). This would typically include a review of medication; environmental falls risk assessments, the provision of walking aids and strength and balance training (Gillespie et al., 2009).

Modernization is a social and economic process consisting of three interrelated processes of industrialization, urbanization and secularization. The process of industrialization may provide greater economic opportunities in urban areas and facilitate migration of people from rural to urban areas. This process of urbanization may lead to a weakening of ties with family, friends, local religious institutions and original place of residence. Difficulties in adjusting to the new urban environment may increase the risk of suicide and see a rise in suicide rates (Stack, 2000).

Electroconvulsive therapy (ECT) has been reported to have efficacy in the treatment of depressive illness, mania and catatonia (U.K. ECT Review Group, 2003; National Institute for Clinical Excellence, 2003; Scott, 2004). The Royal College of Psychiatrists in the U.K. continues to support the use of ECT within the framework of its guidance on the use of ECT (Scott, 2004) and has developed an ECT accreditation service for clincal services that use ECT. In May 2003, the National Institute of Clinical Excellence (NICE) issued a technical appraisal on the use of ECT in England (NICE, 2003). This is essentially guidance on the use of ECT which clinicians are required to follow in their clinical practice.

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