Sexually abusive behaviours are common in a forensic psychiatric population, both before admission and while hospitalized. A survey of our medium security facility found that 41% of patients had a history of sexually abusive behaviours, ranging from convictions for sexual assault through to current episodes of sexual harassment. Most forensic psychiatric patients who raise concern with regard to sexually offensive behaviours do not fit the category of convicted sex offender and may not be good candidates for traditional sex offender treatment programmes. This article addresses some of the important questions that require clarification, in order to effectively address the risk of sexual misbehaviour in a mentally disordered population. Solutions for managing the problem and reducing risk are outlined, including the philosophy behind the development of a staff training programme.