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Genetic and environmental factors are associated with psychosis risk, but the latter present more tangible markers for prevention. We conducted a theoretical exercise to estimate the proportion of psychotic illnesses that could be prevented if we could identify and remove all factors that lead to increased incidence associated with ethnic minority status and urbanicity. Measures of impact by population density and ethnicity were estimated from incidence rate ratios [IRR] obtained from two methodologically‐similar first episode psychosis studies in four UK centres. Multilevel Poisson regression was used to estimate IRR, controlling for confounders. Population attributable risk fractions [PAR] were estimated for our study population and the population of England. We considered three outcomes; all clinically relevant ICD‐10 psychotic illnesses [F10‐39], non‐affective psychoses [F20‐29] and affective psychoses [F30‐39]. One thousand and twenty‐nine subjects, aged 18‐64, were identified over 2.4 million person‐years. Up to 22% of all psychoses in England (46.9% within our study areas) could be prevented if exposures associated with increased incidence in ethnic minority populations could be removed; this is equivalent to 66.9% within ethnic minority groups themselves. For non‐affective psychoses only, PAR for population density was large and significant (27.5%); joint PAR with ethnicity was 61.7%. Effect sizes for common socio‐environmental risk indicators for psychosis are large; inequalities were marked. This analysis demonstrates potential importance in another light: we need to move beyond current epidemiological approaches to elucidate exact socio‐environmental factors that underpin urbanicity and ethnic minority status as markers of increased risk by incorporating gene‐environment interactions that adopt a multi disciplinary perspective.

The purpose of this paper arose out of a Public Mental Health Network meeting in September 2015 and a suggestion then by the editor of the British Journal of Psychiatry. The British Journal of Psychiatry had just published an editorial by the chief medical officer for England that challenged the current concept of wellbeing, within health policy.

The analysis is structured around three key elements of the chief medical officer’s challenge to the concept of “wellbeing”: has wellbeing been scientifically defined? Does improving wellbeing prevent mental illness? Is there any robust, peer-reviewed evidence to support a wellbeing “approach” to mental health?

Wellbeing is definable provided there is recognition that it has multiple dimensions. At least some of these dimensions relate to health, with most published research focused on personal wellbeing.

This policy analysis addresses the three questions above, within the context of mental health improvement and training for public mental health.

A consultant forensic psychiatrist and an individual with autism under his care discuss their experiences of working with autism in secure care. Dr Ghosh is a Consultant Forensic Psychiatrist who analyses some of the practice issues and concerns for clinicians working with people with autism in secure care. He includes comments on the issues raised by one individual with autism (who has consented to sharing his thoughts) in secure care based on his experiences. This is particularly relevant given the recent publication of Building the Right Support, which offers national guidance to develop community services and close inpatient facilities for people with a learning disability and/or autism who display challenging behaviour, including those with a mental health condition. The paper aims to discuss these issues.

X is an autistic patient on a medium secure unit. His viewpoint, together with his then inpatient consultant psychiatrist ' s view, is given.

There are multiple issues for patients and staff to consider when on a secure unit. The approach to take is focusing on holistic management.

This paper starts with the patient perspective of his experiences with autism in the community and in hospital. This provides a framework for the paper to demonstrate how theoretical knowledge and holistic, patient-centred management can be applied to address the issues raised for an autistic patient who has spent a number of years as an inpatient on a medium secure unit. It shows how such plans can directly involve the patient and be adapted to suit the patient ' s self-identified needs and wishes. It also looks at the challenges longer-term inpatients with autism face in their rehabilitative journey from the patient and clinician perspectives.

Provision of comprehensive diversion services for the mentally disordered who come into conflict with the law offers benefits for patients and all those involved in the process, including the police, crown prosecution service and other agencies. It gives access to the most appropriate disposal for this vulnerable group. This case study of a man who had multiple contacts with the diversion services in Birmingham illustrates the particular difficulties associated with diversion from custody for mentally disordered individuals, particularly where there are multiple problem areas. Examination of the case suggests that in spite of inter‐agency commitment to the philosophy of diversion, in some instances a period spent in custody is unavoidable.