There is limited literature regarding medical students’ expectations of psychiatry placements, although studies focussing on nursing students reveal fear and anticipation of aggression and violence to be prominent factors. Anecdotally, authors have been aware of medical students having reported impressions of psychiatric wards which were at odds with the reality. This study aims to explore what medical students specifically imagine and expect from psychiatric wards and psychiatric intensive care units prior to their placement. Psychiatric intensive care, arguably the most intense experience students will have in psychiatry, was used as a specific focus to highlight the full extent of their preconceptions.

Students undertaking their psychiatry attachment between July and December 2021 were invited to complete a semi-structured questionnaire, deemed to be more preferable to interviews as it was thought that anonymity would encourage more students to participate, provide open and honest responses, thereby exposing the full scope of presumptions. Question content was designed by 2 psychiatrists, with modifications after consultation with 2 student advisors. Questions explored student emotions regarding their visits to psychiatric wards and psychiatric intensive care, as well as expectations of the ward atmosphere, layout, activities, where patients would be, what they would be doing and how they would be managed. 37 responses were received. Analysis followed the well-recognised six stages of thematic analysis. Two authors read and coded all text independently, before discussing any discrepancies and then defining and refining themes with involvement from all authors, in a process of several reviews.

Five themes emerged from the data: 1) Mixed feelings about the placement (with anxiety being prominent), 2) Mixed views about patient behaviour with many assumed to be violent, 3) Caring and holistic-minded staff, 4) A restrictive and locked environment, 5) Assumed similarities to acute general hospital care. Some of the expectations of students were markedly different to the realities of psychiatric inpatient and intensive settings, with students reporting ideas of patients in locked rooms, physically restrained, sedated and attached to ventilators.

This study offers a unique insight into what medical students expect from their psychiatry placement, a key issue of which all educators and clinicians who supervise students should be aware. Results can inform better student preparation and placement supervision, leading to more meaningful learning and improved well-being.

A.O'B is joint debates and analysis Editor of the British Journal of Psychiatry. J.G. is the founder of Duty To Warn, an association of mental health professionals who advocate the president's removal under the 25th Amendment on the grounds that he is psychologically unfit and dangerous.

F.S. is a consultant psychiatrist in Psychiatric Intensive Care at the Maudsley Hospital, London. He is on the Executive Committee of the National Association of Psychiatric Intensive Care and Low Secure Units, and was a member of the National Institute for Health and Care Excellence Guideline Development Group for the Short-Term Management of Aggression and Violence (2015). J.P. is a senior lecturer at the Faculty of Health and Life Sciences, Coventry University. E.B. is a consultant and expert witness in violence reduction and the use of physical interventions, independent expert to the High Secure Hospitals Violence Reduction Manual Steering Group and a member of the College of Policing Guideline Committee Steering Group and Mental Health Restraint Expert Reference Group. B.P. is the clinical director for Crisis and Aggression Limitation and Management (CALM) Training and formerly a senior lecturer for the Faculty of Health, University of Stirling. He is a nurse and psychotherapist and presently chairs the European Network for Training in the Management of Aggression. A.O'B. is a consultant psychiatrist, the Director of Educational Programmes for the National Association of Psychiatric Intensive Care and Low Secure Units, and the Dean for Students at St George's University of London.

An original cohort study found that over half of the individuals detained under Section 136 (S136) of the Mental Health Act 1983 were discharged home after assessment, and nearly half were intoxicated.

To investigate whether the cohort was followed up by psychiatric services, characterise those repeatedly detained and assess whether substance use was related to these outcomes.

Data were retrospectively collected from the notes of 242 individuals, who presented after S136 detention to a place of safety over a 6-month period, and were followed up for 1 year.

After 1 year, 48% were in secondary care. Those with psychosis were the most likely to be admitted. Diagnoses of personality disorder or substance use were associated with multiple detentions; however, few were in contact with secondary services.

Crisis and long-term care pathways for these groups need to be developed to reduce repeated and unnecessary police detention.

Assaults on staff on psychiatric intensive care wards are unfortunately common and have a negative impact on morale.

Staff on one PICU completed a survey providing an account of any assaults they had experienced over the previous year and a separate survey regarding attitudes towards assaults.

65% of staff members reported having being assaulted over the year. Most did not take any time off work. Attitudes towards prosecution of patients varied. Staff valued training in this area.

Assaults are common on a PICU and staff are ambivalent about prosecuting patients. More training may be of value regarding prediction of assaults, and about the criminal justice interface.

Students at St George's, University of London, complete a long case with a reflective component as part of their psychiatry attachment. This consists of a case history and reflection about how meeting the patient has affected them and how it will change their practice. This study aimed to analyse the reflection content, to better understand the student psychiatry experience. A hundred consecutive assignments underwent content analysis to establish the main themes.

Six main themes were elicited: stigma, social and cultural aspects of psychiatry, fear of mental illness in the students themselves, fear of conducting the interview and criticism of the care the patient received.

Negative attitudes towards psychiatry are common among medical students, although many showed mature reflection. Anxiety about interviewing patients with mental illness should be acknowledged by educators.

To create a simulated patient with psychosis for psychiatric training within the online virtual environment of Second Life. After design and delivery of the scenario, medical students were asked to complete it and provide feedback.

A total of 24 students tried the scenario and gave feedback via an online survey. The project had been offered to 150 students so the take up was low. The feedback was predominantly negative with 53 critical responses to 32 positive ones. The consensus was that the scenario was cumbersome, did not imitate real life and was of little educational value. Multimedia representations of psychotic symptoms were more positively received and there may be scope for further development.

Interactive technology has a role in psychiatric education but we would not recommend the use of scenarios that rely predominantly on verbal communication within Second Life.

To describe the characteristics of patients admitted over one year to two psychiatric intensive care units in one large mental health trust. To establish the number of admissions, reasons for admission, incidents on the PICU, bed days and destination after discharge. Differences in gender for these factors were explored. Secondary questions were whether patient factors predicted aggressive incidents or predicted requiring long term care.

The electronic notes for one year of admissions to the PICUs in one trust were examined; sociodemographic and clinical details were recorded. Reasons for admission and incidents on the PICU were coded. Data was analysed to establish significant sociodemographic or clinical differences within the cohort.

Men were much more likely to require PICU but women stayed longer. There was a trend for women to go on to long term secure placement. Aggression and sexually inappropriate behaviour were common but there were no demographic predictors of aggression. The only predictor of requiring long term placement was having been a long time on the PICU.

There is evidence that women and men use the PICU differently, with women staying longer. Further research is needed to see if this is a national trend.