Persons receiving care in forensic settings face unique challenges. Long hospital stay combined with other factors such as reduced physical activity, unhealthy diets, smoking, serious mental illness, antipsychotic medications, all add up to increase their risk of acquiring metabolic syndrome, thereby increasing morbidity and mortality.

Practice of monitoring for metabolic effects of an atypical antipsychotic- Clozapine was audited with the Maudsley Guideline as standard in 2 medium secure wards with 25 patients. It was conducted in 2011.

We checked whether blood lipids and body weight were monitored at baseline, at 3 months and then yearly; whether blood glucose and blood pressure were checked at baseline, at 4–6 months and then yearly.

Various sources of information were used including: paper medical records, electronic clinical entries, physical observation charts, medication prescription charts, Clozapine charts and acute hospital laboratory results

24 patients (96%) were on antipsychotic medication. Of these, 23 patients were on atypicals. Of the latter, 8 persons were on Clozapine. No patient on Clozapine achieved a 100% monitoring on indices. Baseline monitoring for cholesterol, weight, blood glucose and blood pressure were 88%, 50%, 75% and 88% respectively. At midterm they were 50%, 100%, 38%, and 25% respectively. There were variable compliance with other indices at stipulated times. Lack of supporting infrastructure to facilitate compliance was identified.

There was a need to adhere to existing guidelines which were also embodied in Trust policy to help manage metabolic syndrome.