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The assessment of fitness to stand trial in Australian jurisdictions has been grounded in the R v Presser criteria for more 60 years. However, a range of subsequent precedents has assisted expert witnesses to ensure that clinical assessments can inform the legal process more effectively, as have changes in legal process. Awareness of particularly vulnerable cohorts, and of contemporary approaches to disability, has led some jurisdictions to introduce supports for defendants. The lived experience of those found unfit to stand trial reminds all who participate in the legal process of the importance of access to justice, and the possible outcomes of being found unfit. [ABSTRACT FROM AUTHOR]

Methamphetamine, particularly "ice", currently preoccupies the media and there are a range of government initiatives which seem to follow media interest. We summarise the progress of government attention, briefly review health concerns associated with methamphetamine use, and summarise the evidence for treatments, including psychosocial interventions and medications. Amid concerns that governments will seek to fund any promising initiative in order to be perceived as responding to an epidemic, we caution that existing treatments should not be abandoned in favour of untested but potentially attractive treatments. Harm reduction and outpatient psychological treatments remain the mainstay of drug treatment programs and may be more cost-effective and broader-reaching than inpatient, medication-based detoxifications. [ABSTRACT FROM AUTHOR]

The proposal of complete smoking bans in closed institutions, such as prisons and psychiatric hospitals, creates a tension between individual "rights" and the health of all members of that community. Smokers in closed institutions generally smoke more, suffer more health consequences and are less likely to quit than smokers in other settings. Complete smoking bans do not cause an increase in behavioural problems, nor do bans cause worsening of mental illness or quality of life. Although infrequently tested, the responsibility of public institutions to protect others from second-hand smoke has usually outweighed any individual "right to smoke" in legal judgments. A substantial cultural shift may be required from considering smoking a "rare pleasure" during detention to the realisation that smoking is the most significant reversible health risk factor for this population. The implementation of complete smoking bans in closed institutions is challenging and requires careful and proactive planning by staff. As complete smoking bans are being considered in many institutions and jurisdictions, this column presents a review of the evidence base and ethical issues involved.