We examined readmission to psychiatric hospital of 550 patients discharged from one medium secure unit over 20 years. Multiple sources were used to obtain readmission data.

Readmission was common, particularly to non-secure psychiatric hospitals. At least 339 patients (61.6%) were readmitted to any psychiatric hospital (mean follow-up 9.5 years), with over a third (37.6%) subsequently being readmitted to medium- or high-security or both. Of those discharged directly to the community, having previous in-patient treatment and a Mental Health Act classification of mental illness were associated with shorter time to first readmission.

The long-standing nature of disorders is evident in the high rates of readmission overall and the need for readmission to medium and high secure services, suggesting that these patients require long-term follow-up and support from mental health services.

Voice recognition software is promoted to improve clinician efficiency and decrease overall costs. Our aim was to compare its efficiency against the traditional method of dictation and typing in an older people's community mental health team. We compared the time taken to dictate, edit and type letters, and the total number of days required to send them out after seeing the patient, using the two methods. We also correlated the time taken by one doctor to dictate and edit clinic letters with the actual days on which they were dictated.

The voice recognition system reduced the time taken to turn around clinic letters but at the cost of increased doctor's time being spent on dictating and editing the letters. We found no increase in efficiency with experience.

The benefits of faster letter production may be outweighed by the effect of the extra time spent by clinicians to the detriment of their other commitments. The narrative form of psychiatry letters may make them less suited to computer transcription than those in other specialties.

In April 2007, the National Specialist Commissioning Team of the Department of Health commissioned a group of services to provide treatment to patients with the most severe and profound obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD). We decided to examine the usage of these services across England 4–5 years after the start of the new funding arrangements. This survey used data about patients treated in the financial year 2011–2012.

Despite the services offering intensive home-based as well as residential and in-patient services, there was a greater proportion of referrals from London, the South East of England and counties closer to London.

It is important that all patients, regardless of where they live, have access to highly specialist services for OCD and BDD. We discuss potential ways of improving this access but we hope this paper will act as a discussion forum whereby we can receive feedback from others.

To illustrate the clinical benefit of polygraph testing for mentally disordered sex offenders at a high secure psychiatric hospital. It is a retrospective review of two patients' case notes and of interviews with clinicians. Post Conviction Sex Offender Testing (PSCOT) was used to assist these patients in making disclosures regarding their sexual history and to aid their treatment.

Post Conviction Sex Offender Testing was responsible for bringing about new disclosures relating to the patients' sexual histories and aiding their treatment progression to lower secure settings. New information was incorporated into the patients' treatment programmes and risk management plans. Post Conviction Sex Offender Testing also encouraged a more honest and effective participation in sex offender treatment programmes and allowed the evaluation of antilibidinal medication.

Post Conviction Sex Offender Testing should be more widely considered among mentally disordered sex offenders who have been challenging to treat, as it has the potential to aid their management and progression to lower-security settings.