We evaluated the impact of implementing the individual placement and support (IPS) approach within eight community mental health teams (CMHTs) in two London boroughs. Demographic, clinical and vocational data were collected enabling a comparison of the number of people supported in work/education and individual client outcomes at 6 and 12 months.

Following the integration of employment specialists there were significant increases in the number and proportion of clients engaged in mainstream work or educational activity at 6 months and 12 months. The employment specialists supported 38% in open employment at 6 months and 39% at 12 months.

The results support the use of IPS in clinical practice in CMHTs.

Dialectical behaviour therapy is an evidence-based treatment for people with borderline personality disorder. We describe implementation and outcomes of a new service.

Hospital use and frequency of self-harm were reduced dramatically with dialectical behaviour therapy. Moreover, the therapy can be implemented successfully in a relatively short time at modest costs.

Dialectical behaviour therapy provides a useful model of treatment for people with borderline personality disorder and/or self-harm in community mental health settings.

To explore relationships between different styles of working and measures of occupational pressure in consultant psychiatrists. A random sample of 500 consultant psychiatrists were sent a questionnaire about working patterns and lifestyle factors, with other sections using validated tools (such as the 12-item General Health Questionnaire; GHQ).

There were 185 useable questionnaires returned (an adjusted response rate of 39%). Significant relationships were identified between job content and GHQ and burnout scores, indicating that occupational pressures are rendering some consultant posts ‘problem posts', leading to problematic levels of psychological distress among some consultants.

Although consultant psychiatrists are more satisfied than not with their jobs, steps need to be taken to address the causes of ‘problem posts', to reduce attrition in the most pressured individuals.

An audit in a general hospital accident and emergency (A&E) department and the subsequent development of a triage process for people presenting with self-harm is described. A random sample of 103 people attending with self-harm were selected and their treatment audited against standards derived from NICE guidelines.

The service provided by the A&E department was sub-standard. Of particular concern was the lack of processes addressing risk assessment and safe discharge. A pro forma was designed with the aim of improving assessment of self-harm. A repeat audit 3 months after introduction of the pro forma showed an improvement in the recording of relevant information underpinning risk assessment.

Procedures for those presenting to A&E departments with self-harm may not meet recommended guidelines. The use of a pro forma with staff training can improve risk assessment.