Rapid tranquillisation (RT) aims to quickly calm the severely agitated patient, in order to reduce the risk of imminent and serious violence to self or others. While it is widely used within mental health care settings, there is little published information on patterns of practice. Retrospective data collection identified a total of 2267 incidents of RT within the Central and North West London NHS Foundation Trust over a 19 month period equating to a mean frequency of approximately four incidents per day. These incidents mainly occurred in acute inpatient services and two and a half times more frequently in PICUs than on open wards. Of all the PICUS, the female PICU used most RT. Intramuscular RT was reported more often in most services. Restraint was used in 57% (n=1300) of RT incidents and minor injury resulted in only 11% of these incidents overall. There were no reports of major injury or death in the data set. Variations in RT use were seen across the Trust’s geography and ward types.

Reducing the use of seclusion to deal with challenging behaviour is a priority in secure services for women. This study describes the concurrent introduction of a series of initiatives based on recovery principles and the full involvement of patients in their risk management plans.

Following change implementation, the first 19 patients who had completed one year of treatment were matched with 19 patients who had completed their first year of treatment before change.

A significant decline in both the number of seclusions and risk behaviour post-change was complemented by improved staff ratings of institutional behaviour, increased treatment engagement and a reduction in time spent in medium security. Staff and patients differed in terms of their ratings of the most effective strategies introduced. Patients favoured the Relational Security item of increased individual engagement and timetabled Behaviour Chain Analysis sessions. Staff viewed on ward training and use of de-escalation techniques as most effective.

Findings confirm results from mixed gender forensic mental health samples that seclusion can be successfully reduced without an increase in patient violence or alternative coercive strategies. Limitations of the study are discussed along with the need for future evaluations to address issues of fidelity and utilise vigorously designed case studies.

Section 136 of the Mental Health Act 1983 is routinely used by the police to remove a person thought to be suffering from a mental disorder, from a place to which the public have access, to a place of safety. Persons detained under Section 136 of the Mental Health Act 1983 routinely spend significant amounts of time in a place of safety whilst awaiting a mental health assessment. During that time it is feasible that the patient will require intramuscular medications for rapid tranquillisation, often with the use of physical restraint. However, Section 136 of the Mental Health Act 1983 does not grant the power to treat a person against their will and there is a lack of clarity on the most appropriate legal framework for physically restraining and administering intramuscular medications for rapid tranquillisation to a person detained under Section 136 of the Mental Health Act 1983. In this article, we attempt to explore the various legal frameworks available and identify the one most appropriate for this purpose.

Firesetting is traditionally a forensic problem which is nevertheless a frequent co-morbidity within mental health settings. The associations between mental health and firesetting are diverse and poorly understood, and with forensic services under increasing pressure, non-forensic settings may be increasingly expected to manage such presentations. With this in mind, and in the absence of a specific risk assessment tool, we propose a care pathway and rationale for its use in the assessment and management of individuals with firesetting behaviours as part of their presentation.

New psychoactive substances (NPS) or ‘legal highs’ are defined as unregulated psychoactive substances including synthetic and/or plant derived substances (marketed as research chemicals, party pills and herbal highs) that are intended to mimic the effects of controlled drugs. Psychiatric services around the country are seeing a rise in the use of NPS complicating mental health presentations. The challenge surrounding these substances is the fact that they are not under the international drug control system and are proving to have a detrimental health effect on users. This article reviews the current literature on this subject and discusses some of the most common examples of NPS and their potential effects on mental health.