To audit whether the introduction of a self-harm pathway and protocol increases the number of psychosocial assessments. All episodes of self-harm in a defined period during 2002 (n=335) and 2004 (n=390) were reviewed before and after the introduction of a self-harm pathway and protocol. Adherence to the protocol was also investigated.

After the introduction of the self-harm pathway and protocol, the proportion of psychosocial assessments requested had risen from 57% (2002) to 85% (2004). The proportion of psychosocial assessments completed had risen from 47% to 70%. Over the 2 years, the overall number of self-harm presentations was reduced by 27%.

The introduction of a self-harm pathway and protocol through a self-harm steering group is feasible, was well accepted and increased the number of psychosocial assessments after self-harm. It may also contribute to a reduction in the number of overall presentations with self-harm to the accident and emergency department.

We gathered detailed prospective data for first on-call activity of senior house officers (SHOs) in order to help plan changes in service provision so that SHOs in psychiatry complied with the Working Time Directive and to determine whether service changes affected training experience while on call. The incumbent SHOs designed a simple form to monitor on-call activity in West Berkshire.

Admissions and assessments make up a quarter of calls but three-quarters of the work. An overnight crisis service reduced the number of assessments made by SHOs out of hours by 68%. Screening of calls by a senior nurse reduced the number of calls about in-patients by 60% on weekday nights. Between 73% and 100% of calls about in-patients after midnight were for assessment of patients in seclusion and rapid tranquillisation.

This survey helped to plan service delivery and to monitor the training of SHOs during on call. Screening of calls by a senior nurse, alternatives to seclusion and nurse-led prescribing for rapid tranquillisation would have the largest impact on the work generated by in-patients. The overnight crisis service reduced the number of assessments, but might have an adverse impact on training.

Anecdotal evidence suggests that attention-deficit hyperactivity disorder (ADHD) is underdiagnosed in adults and people of all ages with learning disability. This study examines the clinical practice of Irish consultant psychiatrists when assessing and treating symptoms of ADHD in children and adults with and without a learning disability. A postal questionnaire was sent to 302 consultant psychiatrists working in Ireland.

Ninety-seven consultants (32%) responded, 62 working in general adult psychiatry, 23 in child and adolescent psychiatry and 12 in learning disability. Overall, respondents were more confident about making a diagnosis of ADHD in people without a learning disability. Those working with children were significantly more confident in diagnosing and treating ADHD than those working with adults, irrespective of whether the patient had a learning disability.

There is general agreement that symptoms of ADHD exist in children and adults both with and without a learning disability. It is likely that ADHD may be undertreated in patients with learning disability, especially in the adult population.

This survey set out to profile the case-loads of assertive outreach teams in North East England, to discover whether they were reaching the people for whom they were meant. A survey of case-loads of 29 assertive outreach teams was carried out using the MARC-2, HoNOS and GAS instruments. Findings were compared with earlier surveys of the case-loads of community mental health teams in parts of the same region.

Clients of assertive outreach teams proved to be at the more severe end of the spectrum on almost every measure: 95% were deemed ‘psychotic’ and 30% had three or more admissions in the previous 2 years.

Assertive outreach teams in the North East are reaching the people they are meant to target. The effects of this shift on existing teams remain to be evaluated.

Trainee psychiatrists often perform emergency mental health assessments. Traditionally, it has been considered that having access to past psychiatric records will reduce the likelihood of a patient being admitted. We examined whether the availability of records had an influence on admission by recording all contacts to the duty junior psychiatrist in two district general hospitals over a 6-month period.

For those with chronic or enduring mental illnesses there is a 27% increase in the likelihood of admission if past records are available. For all other patients the increase is 10%.

Contrary to our expectations, the availability of records increases the likelihood of admission to mental health admission units.

We surveyed the experience of working as a non-consultant career grade psychiatrist (NCCG). A postal questionnaire was sent to 140 NCCG psychiatrists in the south-west region.

A total of 90 doctors responded (65% response rate); 30 (33%) had never had supervision and 45 (50%) were not eligible to sit the MRCPsych examination. Only 41 respondents (46%) had administrative support for non-clinical work.

Good supervision, comprehensive job plans and opportunities for further professional development are essential requirements for this group of doctors.

Psychotherapy provided by inexperienced psychiatric trainees was assessed through comparison of post-treatment outcomes with a brief psychodynamic therapy and a brief integrative psychotherapy. A retrospective case–control design was applied to all patients seen by nine senior house officers (SHOs) during 6-month placements who provided follow-up data. Matching linked each patient offered simple cognitive–analytic therapy to one who had received brief psychodynamic therapy from the same SHO. Post-treatment changes were analysed by treatment received and differences between trainees were explored.

Seventeen cases in each group met entry criteria. Patients receiving the integrative treatment had more severe pathology and outcomes were more variable when this model was used. Eight of the nine SHO therapists performed better with the psychodynamic intervention.

Significant clinical improvements can be achieved by inexperienced psychiatric trainees providing brief psychotherapy under supervision. Patient selection is undoubtedly important. Fundamental psychotherapy competencies need to be mastered before structured hybrid models are attempted.

The aim of the study was to investigate whether psychiatrists consider that patients with schizophrenia present a greater risk of violence than patients with other forms of mental illness. Two pairs of clinical vignettes were devised. In each pair, one contained a history of violence and one did not. One vignette was mailed to each of 2000 consultant psychiatrists in the UK. Respondents were asked to give a preferred diagnosis. Rates of diagnosis of bipolar disorder, schizoaffective disorder and schizophrenia were compared within vignette pairs.

For each pair of vignettes, the rate of diagnosis of schizophrenia was higher (33 v. 21.5%, P=0.008 and 44.4 v. 32.1%, P=0.011), and the rate of diagnosis of bipolar disorder was lower (44.2 v. 62.6%, P<0.0005 and 34.9 v. 49.3%, P=0.004), among those who received the vignette containing a history of violence.

A history of violence may lead to an increased likelihood of receiving a diagnosis of schizophrenia as opposed to bipolar affective disorder. This bias in diagnostic decision-making may affect the treatment received by a patient and may perpetuate and exacerbate the stigma associated with a diagnosis of schizophrenia.

The aim of the study was to identify the employment rates of people using local mental health services and examine any evidence in care plans for vocational or occupational interventions. We investigated case notes retrospectively.

A total of 297 case notes were examined: 88% of the patients were unemployed, but there was evidence of documentation relating to vocational needs in only 18% of out-patients; 8% in patients of community mental health teams; and 39% in acute wards; 8% of patients were engaged in work schemes; 10% of patients were in education; and 9% were engaged in vocational interventions with their care coordinator; the latter was less likely if the patient was from a Black or minority ethnic group (OR=2.44, 95% CI 0.18–1.05).

Despite high rates of unemployment, patients with psychiatric disorders are not referred for vocational interventions. Growing professional awareness of vocational possibilities for patients with severe mental illness should mean that many patients could return to competitive employment and return to mainstream society.

To develop and assess the viability of a self-completion version of the Maudsley Addiction Profile for assessing and monitoring the functioning of opioid-dependent patients. A total of 206 treatment-seeking opioid-dependent patients completed the Maudsley Addiction Profile interview and a self-completion version at a single clinic appointment at a substance misuse facility. Scores from both formats were compared using correlation coefficients.

Non-parametric correlation coefficients between interview and self-completion version for alcohol, drug, psychiatric, family and legal problems correlated in excess of 0.7 for the majority of the 20 items that were compared.

A short, self-administered questionnaire version of the Maudsley Addiction Profile is a feasible alternative to the interview for assessing and monitoring treatment of opioid-dependent patients. The questionnaires were usually completed by clients within 15 min. These would be particularly useful in services with very limited staffing time, such as primary care.

To improve the quality of correspondence by identifying what general practitioners (GPs) regarded as the important attributes in patient letters from a substance misuse service. A postal questionnaire survey was carried out to determine the views of general practitioners in Brighton and Hove City.

Responses were obtained from 32 out of 45 GP surgeries (71%) and indicated that correspondence should be prompt, concise and regular. An assessment summary, management plan and clear medication prescribing arrangements between primary and secondary services were considered particularly important.

New quality standards for correspondence to GPs have been implemented by the Brighton Substance Misuse Service. These might be of interest to other such services.

We used a complete audit cycle to assess the quality and completeness of current admission bookings by junior doctors and whether the introduction of a standardised admission form led to improvements.

Following the introduction of the standardised form significant improvements were found in almost all areas, including the recording of basic data, history, mental state, physical examination, risk assessments and diagnosis.

The introduction of a standardised admission form improved the completeness of information obtained. The form may also be used as an educational tool and to assist trainees preparing for examinations.

We undertook an audit of hypnotic use on two functional older adult wards, followed by an educational intervention to all nursing staff and junior doctors. We then repeated the audit.

Our pre-intervention audit showed a hypnotic use of 48%. This decreased to 26% for the first month following the educational intervention. Usage increased gradually in proportion to time from intervention. However, over the 4-month post-intervention period hypnotic use remained significantly lower than pre-intervention throughout the time period studied.

As the study is an audit there is no control group, but our results suggest regular staff education is needed to sustain a reduction in hypnotic use.

A before-and-after design was used to evaluate whether the routine implementation of functionalised community mental health teams (CMHTs) would reduce demand for in-patient care. Residents of west Birmingham, aged 16–64 years, who were in hospital between 23 March 1992 and 22 September 1992 were identified. The same period was studied in 2003 by which time the newly introduced teams were well established.

The number of people in hospital fell by one-third between 1992 and 2003. There was no change in the number of admissions by each patient or the length of stay. The percentage identified as Black, single, living with other adults, resident in hostels and unemployed increased, as did the proportion with schizophrenia or manic depression and those detained compulsorily.

Functionalised CMHTs can decrease the use of in-patient care in inner-city areas. They may also attenuate, but by no means halt, the rise in compulsory admissions seen across the UK in the past decade.

The aim of the present study was to assess the current state of provision of psychological therapies for older people in Wales. A postal questionnaire was sent to all consultant old age psychiatrists in Wales, requesting information regarding the consultant's community mental health team (CMHT) and access to psychological therapies.

A response rate of 85% was achieved: 45% of CMHTs had team members providing psychological therapy; 31% of CMHTs had access to psychological therapy via the team and also generic services. The estimated average wait for generic services was 29 weeks. There was no access to psychological therapies for 17% of CMHTs.

In some areas of Wales there is limited or no access to psychological therapies via mental health services for older people. This may represent an important unmet need. Long-term strategies, taking into account recruitment and retention, training and new ways of working, need to be implemented.

The aim of the survey was to assess the attitudes of specialists in old age psychiatry towards the use of clozapine in elderly patients. A postal questionnaire was sent to a random sample of 155 consultant old age psychiatrists in England.

The response rate was 87%. A majority of respondents felt that clozapine had a useful place in the treatment of elderly patients, although they expressed concerns about the lack of published data and about safety and practical difficulties in monitoring. Prescribers of clozapine (n=45) were significantly more positive about its role in treating older patients than those who had not used it.

The findings suggest that familiarity with and confidence in clozapine and practical difficulties in monitoring are important determinants of its use in older patients.

To explore current practice in offering patients copies of correspondence, we audited the documentation of 422 patients of a community mental health team.

Discussion about copying letters was documented in 194 case notes (46%); older patients and those with medically unexplained physical symptoms were less likely to be offered copies. There were 159 patients (82%) that wanted to receive copies of letters; male gender was associated with declining this option. In 167 (87%) instances the professional completing the form was a psychiatrist.

Older patients need to be offered the opportunity to receive correspondence. Clinicians should record and substantiate their decision not to offer copies of letters to some patients. Professionals other than psychiatrists should be encouraged to discuss copying letters with patients.

We sought to identify changes in the quality of information in referrals to an old age psychiatry service before and after the introduction of the single assessment process. Referrals were compared in terms of length, legibility, information and clinical utility.

Compared with letters before the introduction of the single assessment process, referrals made on the new forms took longer to read (mean 96 v. 124 s, P=0.001), had more illegible sections (P=0.011), contained less information (P=0.026) and were judged to be less clinically useful (P=0.001).

The introduction of the single assessment process has impaired clinical communication between general practitioners and psychiatrists, and might be prejudicial to patient care.

To identify the experiences of patients pursuing a personal injury claim, we carried out a retrospective questionnaire survey.

Sixty-one patients from a regional traumatic stress clinic took part. Most were satisfied with the conduct of legal, medical and psychiatric personnel. Thirty-two (53%) reported that the legal proceedings had had an adverse effect on their health/well-being, and about a third reported an adverse effect on domestic relationships. Twenty-four patients (40%) were dissatisfied with the provision of information. More information about the whole legal process would have been welcomed by means of an information leaflet (n=57, 93%), a helpline (n=48, 79%), or a videotape (n=42, 68%).

Although seeking redress may contribute to the patient's adjustment, this survey demonstrates that it is not a step to be taken without consideration. As part of their therapeutic management, mental health professionals should consider the implications of such a step with their patients.