In the canteen of our psychiatric hospital I found myself standing behind an in-patient who had been escorted by a nurse from the ward. I was rather concerned to witness the patient request, and be sold, three hot dinners, three sandwiches, four packets of crisps and four bottles of an energy drink. The nurse escorting the patient confirmed that all the food was indeed for the patient himself and that he did this every day, which was also confirmed by the patient's obesity. I expressed my concern that the patient was putting his health at risk by being allowed to buy and eat so much food in the hospital. The reply given by the nurse was that the treatment team were all aware of the situation but were of the opinion that ‘Well, what can we do, the patient has rights to eat what he wants, who are we to stop him?’ Those responsible for the care and treatment of the patient (detained under the Mental Health Act) were aware of his extreme overeating but they were merely observing such behaviour, believing themselves to be attending to his mental health needs in isolation, even to the extent of escorting the patient on his bingeing trips.

We are all aware of the possible risks of metabolic syndrome associated with many of the physical interventions we prescribe, but awareness alone is of little help to our patients. The motto of the Royal College of Psychiatrist is ‘No health without mental health’, but we appear to be at risk of following an alternative motto, ‘No physical health, only mental health’. I would welcome some advice from the College or the thoughts of other members who have been able to implement a more useful response to the observed problem in their own clinical institutions.