A significant proportion of individuals in contact with probation services have mental health problems. Joint working between psychiatrists and probation is crucial to both diversion and resettlement of offenders with mental health conditions. In England and Wales, probation services are involved in the supervision and management of offenders if they receive a suspended or community sentence, or when they are released into the community on licence after serving a determinate, extended or life sentence. This article aims to promote awareness of joint working between probation and mental health services and the role of approved premises. It also describes a successful example of such joint working at Elliott House, approved premises for mentally disordered offenders in Birmingham, UK.

Over the past few decades, care for people with intellectual disability in the UK has moved from long-stay hospitals to the community. As in the general population, a number of these people have mental health and behavioural difficulties for which they may require in-patient services. Consequently, psychiatrists need to be aware of the in-patient mental healthcare provision for these individuals. This article describes the different categories of in-patient bed for patients with intellectual disability and ways to monitor the quality and outcomes of in-patient care.

‘Best interests' is a key principle of the Mental Capacity Act 2005 (England and Wales), Mental Capacity Bill (2014) (Northern Ireland) and Mental Health Act 2001 (Ireland), although there are currently proposals to remove ‘best interests' from Irish legislation. Legislation in Scotland refers to ‘benefit’ resulting from interventions. Judicious use of ‘best interests', in line with guidelines that prioritise the person's autonomy, will and preferences, is a powerful way to promote the values and rights that underpin the United Nations Convention on the Rights of Persons with Disabilities and to safeguard the dignity of individuals with mental disorder and/or reduced mental capacity.

Deciding on where the tipping point between restrictions and deprivation arises in care settings has important legal implications, but until recently case law has not much helped to resolve these challenging issues. An important milestone has been the Supreme Court judgment in the so-called Cheshire West case. This judgment, handed down in March 2014, set a low threshold to apply (the ‘acid test’) in deciding when someone may be being deprived of their liberty and therefore that additional legal authorisation is required. The application of the acid test is not straightforward and its effects are wide-ranging. In this article, I discuss the evolution of the concept of deprivation of liberty in health and social care, the implications of the judgment and the application of the acid test. I also briefly highlight the interface between the Mental Capacity Act 2005 and the Mental Health Act 1983.

Spirituality and religion have assumed importance in psychiatric practice in recent years because of both a growing evidence base and the desire of patients that such matters should be better addressed as an aspect of their care. However, there has been controversy regarding interpretation of the evidence base and issues of good practice, notably about defining appropriate professional boundaries. A sensitive and patient-focused clinical enquiry is therefore needed to discover whether and how spiritual/religious concerns are important to patients and, if they are, how they might most appropriately be addressed in treatment. Many of the concerns of patients and professionals regarding spirituality overlap with the recovery agenda and so are easily addressed implicitly and without need to impose the language of spirituality or religion. However, for some patients, transcendent concerns that are not a part of this agenda are easily overlooked.

Religious laws do not usually forbid the use of psychotropic medication, but many do forbid the consumption of animal-based derivatives of bovine and/or porcine origin (e.g. gelatin and stearic acid) such as are found in many medications. Demonstrating awareness of this, combined with a genuine concern about how it affects the patient, may strengthen the doctor—patient relationship and avoid non-adherence. In this article, we outline dietary requirements of key religions and belief systems that may have a bearing when prescribing medication containing animal-based ingredients. We identify common psychotropics that contain animal-based derivatives and suggest alternative prescribing options and approaches to dealing with sensitive ethical issues.

Obsessive–compulsive disorder (OCD) is one of the most debilitating psychiatric conditions in young people. In DSM-5 it is no longer characterised as an anxiety disorder, but instead is part of a group of ‘obsessive–compulsive and related disorders'. In the past 10 years, cognitive—behavioural therapy (CBT) has become well established as the first-choice treatment. This article explains some of the elements of CBT and describes new directions in research which might improve interventions.

This article summarises new research, together with core features, course and outcome of schizophrenia with onset in childhood and adolescence, and investigates its neurobiology and continuity into adult life. It concludes that, in conformity with other disorders of childhood, adult-based diagnostic criteria have validity in adolescence. Sadly, the disorder has a poorer outcome when onset is in youth.

At a time when patients are challenged to cope adaptively with both the diagnosis and treatment of cancer, clinicians need to respond appropriately to the many inevitable questions about the causes of cancer and contributing factors, including ‘Is this my fault?’. The evidence guiding answers to such questions has been confounded by many methodological challenges, but personality, stress and life events are no longer considered causes of cancer. However, social isolation, untreated depression and social deprivation continue to influence quality of life and reduce cancer survival times. Psychiatry might play a role in promoting lifestyle changes that reduce the risk of cancer, but more importantly it can influence disease progression by optimising patients' adaptation to the many challenges that cancer brings.

The psychological state of an individual affects the way in which they express themselves. Art has long been an outlet for self-expression, and painting is just one art form that individuals use to articulate their ideas and emotions. Edvard Munch (1863–1944) was an influential Norwegian artist who led a tortured life; his greatest artworks reflect the struggles he faced. This piece narrates the story of his life, exploring the ways in which his mental illnesses were related to his art, and how his art evolved as a result of this.

Disordered sleep has long been recognised as both a consequence of psychiatric illness and a contributory factor to its development. Significant sleep disturbance occurs in about 25% of children and adolescents and 80% or more of children in high-risk groups; it often continues into adulthood. All psychiatrists should therefore be familiar with the principles of sleep medicine and the impact of sleep and its disorders. In this article, the relationship between sleep disorders and the breadth of child and adolescent psychiatry in particular is explored. The classification, aetiology and implications of sleep disorders are discussed, as well as the practicalities of screening, diagnosis and management, with a view to informing readers how accurate diagnosis, prevention and successful treatment of sleep disorders can benefit patients and their families.

Matters relating to human rights arise in almost every area of psychiatric practice. Although some statements of rights are non-binding declarations (e.g. the United Nations' Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care), others are legally binding (e.g. the European Convention on Human Rights) and actively shape national laws. Persons with mental illness commonly experience violations of rights, including their economic and social rights. Psychiatrists can promote human rights through high-quality, evidence-based clinical practice; patient-centred service management; social awareness and engagement; and international activism to enhance protection and promotion of the rights of people with mental illnesses at global level.

This article provides an overview of classification and outcome of eating disorders, before focusing on current evidence-based treatment for the two main disorders of anorexia nervosa and bulimia nervosa.

Akathisia is a common and distressing side-effect of antipsychotic medication. The treatment of this condition is difficult and options are limited. This review of the literature was performed to develop an evidence-based algorithm for the management of antipsychotic-induced akathisia. There is limited high-level evidence to support the use of anticholinergics. Centrally acting β-adrenergic antagonists are potential treatments, although their use is limited by troublesome side-effects. Long-acting benzodiazepines and mirtazapine are potential well-tolerated treatments for the acute management of akathisia.

Methodological issues such as social desirability bias, subjective outcome measures, therapist enthusiasm and fidelity to the intervention remain a major problem in assessing the effectiveness of psychosocial treatments for substance misuse. Alcoholics Anonymous and other 12-step programmes are still widely used, although it is difficult to formally assess their effectiveness. Motivational interviewing is perhaps the most commonly used professional psychosocial treatment for substance misuse, but brief interventions based on this technique report a disappointing effect size (∼0.2). Contingency management is perhaps the most effective reported modality, although it remains politically controversial. Cognitive—behavioural therapy and community reinforcement have been widely studied, but the results are often disappointing (effect sizes seldom exceed 0.5, despite very large trials). Residential rehabilitation remains an established treatment, but patient selection prevents formal cost-effectiveness studies.

Economic evaluation involves the comparative analysis of the costs and consequences of alternative (different) treatment options. Economic evaluations provide decision makers with information about the relative value for money, or cost-effectiveness, of various treatment programmes. The relative cost-effectiveness of new interventions is a key consideration in health technology assessments by the UK's National Institute for Health and Care Excellence, and economic evaluations alongside randomised controlled trials are routinely requested by funders such as the National Institute for Health Research. This article outlines some of the key concepts and issues in the economic evaluation of mental healthcare.