the columns Gay and lesbian partners of mentally ill patients

Sir: It is pleasing to note that one discriminatory aspect of law reported by the College's Gay and Lesbian Special Interest Group ([Bartlett et al , 2002][1]) was recently overturned in the courts.

In R on the application of SSG and Liverpool City Council and Secretary of State for Health (CO/1220

Sir: Harrington et al (2002), in their description of a one-day national survey of prescribing, speculate that poor documentation of the decision to prescribe high-dose antipsychotic regimes may be due to sub-optimal record keeping, lack of awareness that the regime was high-dose or both.We have recently completed an audit cycle, which sheds light on this issue in our unit.
We audited antipsychotic prescribing in Fromeside Regional Secure Clinic for the whole of 2000 and again in the latter 6 months of 2001 (43 patients), against standards based on the Royal College Consensus statement (Royal College of Psychiatrists, 1993).The patients were male forensic detainees, all factors associated with the prescription of high dose regimes (Lelliott et al, 2002).
Our audit showed rates of high-dose prescribing of 19% and of polypharmacy of 35% in the first period, and 31% and 46% respectively in the second period.In the first period, a clear statement of indication and decision to prescribe a highdose regime was included in only 25%, and an ECG had been performed in 0%.In the second, these standards were met in 0% and 25% of cases.Results of our first survey were presented to the teams involved and the standards circulated.It is therefore our suspicion that these poor results were due to a lack of routine prescription monitoring.We are incorporating monitoring procedures into prescription charts and case conference paperwork.Prescribing is a core medical responsibility; our patients deserve careful attention to detail.HARRINGTON, M., LELLIOTT, P., PATON, C., et al (2002) The results of a multi-centre audit of the prescribing of antipsychotic drugs for in-patients in the UK.Psychiatric Bulletin, 26, 414-28.LELLIOTT, P., PATON, C., HARRINGTON, M. et al (2002) The influence of patient variables on polypharmacy and combined high dose of antipsychotic drugs prescribed for in-patients.Psychiatric Bulletin, 26, 411-14.

ROYAL COLLEGE OF PSYCHIATRISTS (1993) Consensus
Statement on the use of High Dose Antipsychotic Medication.In R on the application of SSG and Liverpool City Council and Secretary of State for Health (CO/1220/2002, finalised  on the 7 November, 2002), the court declared that the homosexual partner of a patient can be treated as falling within the phrase 'living with the patient as the patient's husband or wife as the case may be' in s26( 6) of the Mental Health Act 1983.
This means that it is now possible to construe same-gender partners as equivalent, both in meaning and in effect, to 'husband or wife' at s26(1) of the Act.Same-sex partners so construed can, therefore, now be recognised as having priority when determining the identity of a patient's nearest relative.Bulletin, November 2002, 26, 346) perpetuates the belief that Durkheim was the first to use the term altruistic suicide.Altruistic suicide was described by George Savage as 'To save others from suffering.To benefit others', in his chapter on suicide and insanity in Tuke's Dictionary of Psychological Medicine in 1892.Further- more, the notion of suicide as self sacrifice was also described by Mercier in his book Sanity and Insanity in 1890.
Whilst the concept of altruistic suicide is usually attributed to Durkheim, the evidence is persuasive that Savage deserves scientific precedence in the use of this term.This has been discussed further in Pre-Durkheim Suicidology: The 1892 Reviews of Tuke and Savage (Goldney and Schioldann, 2002).
Council Report CR26.London: Royal College of Psychiatrists.