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The purpose of this paper is to ascertain the current competencies and training needs for being an expert witness of trainees (CT3, ST4-6) and career grade psychiatrists (consultants and staff grade, associate specialist and specialty doctors) in a UK health and well-being Trust.

This was completed through an online survey, developed by the authors, of all career grade and trainee psychiatrists within the Trust.

Only 9 per cent of respondents reported that they felt they had adequate training to feel competent as an expert witness. Despite low levels of training and confidence, 73 per cent of respondents had written an expert report. As well as shortage of training opportunities for psychiatrics acting as expert witnesses, the findings indicated increasing fear of litigation and lack of direct experience of court proceedings during training.

Doctors need to be offered formal training opportunities including simulated training, ideally organised within Trust, Continuing Professional Development (CPD) committees or Education committees. Implementation of the RCPsych report guidance into speciality curricula and CPD opportunities for doctors would ensure a robust curriculum-based delivery of these essential skills.

A wealth of guidance is available for expert witnesses, but no previous study had identified the specific training issues and overall confidence in competency to act as an expert witness amongst psychiatrists. It will be valuable to all psychiatrists involved in court work and organisations involved in training psychiatrists, especially in light of recent relevant court cases and removal of expert witness immunity.

Mental health problems, particularly psychotic symptoms, are associated with polycystic ovary syndrome (PCOS) which may be linked to oestrogen signalling cascade following a period of sustained high oestrogen and dysregulation of cortisol. This case report aims to demonstrate a potential link and improvement following the use of Metformin.

The paper describes a case of a female with intellectual disability who presents with psychosis coinciding with PCOS and the aetiology of this association.

The case highlights some key points and complexities encountered in diagnosing and managing an individual with mental and physical health issues and an underlay of family dynamics and insecure attachment. A treatment approach involving recommendations from and joint working between professional groups including endocrinology, is highlighted.

There are very few studies to date that link PCOS to psychosis and only a single case report describes the use of Metformin. In a patient presenting with psychosis and PCOS, the consideration of an association with hormonal changes should be made, especially in patients with changing severity of psychosis and poor response to psychiatric medication. A “multimodal” intervention package needs to be considered for optimum benefit.

There is increasing emphasis on caring for people with intellectual disabilities in the least restrictive, ideally community settings. Therefore, the purpose of this paper is to explore the risk factors considered by clinicians involved in discharging people from secure services.

The views of five senior clinicians were sought in semi structured interviews. Data were analysed thematically.

Themes related to risk assessment, risk management, and multidisciplinary and multiagency working. Illustrative quotes are used to evidence themes.

This study described the risk assessment and management factors considered during the discharge of patients from secure to community services, which are of direct relevance to multiple stakeholders post-Winterbourne.

Challenges when facilitating discharge were highlighted, such as ongoing risk management issues, or unexpected discharge from tribunals, and how these were addressed, via the development of extensive risk assessment and management processes, and interdisciplinary and interagency working.