A questionnaire was completed by 135 of the 161 (83.9%) National Health Service (NHS) trusts who provide specialist health services for people with learning disabilities in England and Wales. From these, cumulative frequencies were calculated to describe the current level of provision of NHS beds. Results vary in different parts of the country, but the majority of NHS trusts provide assessment and treatment admission beds, long-stay beds (including those NHS trusts who have completed their resettlement process) and respite care beds. A half of NHS trusts directly manage NHS day places. The high response to questionnaires indicates the current high level of interest in this issue.

Because of the nature of some mental illness, care and compulsion in psychiatry are not always antithetical. However, it is no longer acceptable to link compulsory treatment almost exclusively to compulsory hospitalisation. Treatment should occur in the least restrictive environment possible. This paper looks at experience of extended leave of absence in Scotland, and in England and Wales before 1986, at the recent evidence for an increased risk of violence and homicide in schizophrenia and the danger of a backlash against community care if it is perceived as unsafe, and makes suggestions in relation to research and to provision for treatment in the community in the absence of consent.

This paper presents the literature on compliance as an ideology and then examines strategies to improve patient outcomes if non-compliance is identified as undermining the treatment regimen. We present strategies used by our team in a south London rehabilitation service for the severely mentally ill.

This survey examined Scottish psychiatrists' attitudes to physical examination and appropriate investigations in the routine assessment of new out-patients with a major depressive disorder. A discrepancy exists between current opinion towards and actual practice of physical examination in the assessment of new out-patients with depression. Numerous obstacles to performing investigations were identified including lack of time, inadequate consulting rooms, lack of equipment and lack of chaperon. The many obstacles identified are considerable but not insurmountable. Missed diagnoses may have adverse consequences for patients as well as medico-legal implications.

This paper describes the characteristics of referrals to a new direct access child mental health service for young people in the care of the local authority, during the first six months (n=32). Consistent problems emerged within four areas: their histories within the care service (n=18, 56% had had at least one more previous placement); their individual experiences of abuse (n=23, 72%) and the lack of mental health support provided to redress this; their overall poor educational status; and the psychopathology evident at the time of referral (n=29, 91% had ICD–10 diagnoses, mainly mixed depressive conduct disorders).

The Royal College of Psychiatrists has published national guidelines for services for those who carry out deliberate self-harm. This study aimed to discover whether these recommendations are being followed. We conducted a semi-structured interview with a professional from the accident and emergency service and one from the specialist service at each of 16 hospitals in the former Yorkshire Regional Health Authority. The findings are that services are not adhering to the guidelines. The production of guidelines without an adequate implementation strategy is ineffective. The Department of Health should endorse the College guidelines, and produce an implementation strategy to secure the involvement of purchasers and providers.

Over the past 20 years, with the closure of psychiatric hospitals, there has been a greater emphasis on treatment of the seriously mentally ill in the community. Recently, there have been untoward incidents involving psychiatric patients leading to increasing public concern over this policy. Steps to reduce this concern have included the care programme approach, the supervision register and the community supervision order. Each requires some form of risk assessment to be carried out prior to their implementation, although there is little guidance on what areas should be covered.

Ninety-six successive acute psychiatric admissions were assessed with regard to dress, level of hygiene, the presence of tattoos, bodily piercing/decoration and surface marks of self-harm. These features were also examined in relation to ICD–10 category diagnosis. One-third were described as ‘dishevelled’, 21% ‘unclean’, 7% had multiple pierced ears and 3% other pierced body parts. Sixteen per cent had tattoos, rising to 34% in the F10–19 (substance misuse) category, and 15% had scars of self-harm. People with schizophrenia and related disorders were more likely to present in an unclean state. Those with personality disorders were no more likely to bear the scars of self-harm, tattoos or body piercing.

The diagnosis of vascular dementia may often be made on the basis of structural neuroimaging, this may not always be reliable. In view of this, a retrospective study of 30 case notes with diagnosis of vascular dementia was undertaken to examine the documentation of vascular risk factors and presence of cerebrovascular disease. Specific recommendations were then made for the future case note documentation. Nine months later, 10 case notes were examined to assess the impact of the recommendations. A noticeable improvement in the documentation of most risk factors was observed. The wider implications of these findings are discussed.

The first part of this audit looked at the demographics of young people presenting to Monklands Hospital and the quality of their assessment. Precipitating factors and past psychiatric history were enquired of in the majority of cases but there was a dearth of information regarding alcohol/drug use and family history. A checklist was devised with the aim of improving the quality of these assessments. The second part of the audit cycle completed one year later revealed considerable improvement in all categories. It is hoped that this will be maintained by displaying the checklist in the accident and emergency department and continuing to include teaching about this vulnerable population to all new medical and nursing staff.

All higher trainees in psychiatry are required to spend one day a week in research or further study. A cross-sectional postal survey was used to investigate how senior registrars use their allocated research time, and to identify specific difficulties that prevent successful research being carried out. The instigation of the specialist registrar grade offers the chance to improve trainees' involvement in research. This has implications for the design and implementation of postgraduate teaching on research in psychiatry.

This article is one of a series dealing with training and employment in countries overseas, previous articles have covered Australia (Kisely, 1993) and Canada (Kisely & Jones, 1996). This paper updates an earlier report on New Zealand which was published five years ago (Timney, 1991). In particular it highlights important recent changes to registration procedures which will affect doctors wishing to go to New Zealand, for either temporary work experience or permanent settlement.

Regional Public Education Officers of the Royal College of Psychiatrists are strategically placed to influence and improve the coverage of mental health issues in the media. Their role needs to be enhanced and clarified, and a proposal is being put forward in the College to achieve this. One possible way of working locally is illustrated through the work of West Midlands Insight, which demonstrates the value of working with a wide group of people, including those who have experienced mental ill health.

The compulsory detention and treatment of patients against their will is unique to psychiatry. It is arguably the most stressful event in psychiatric practice, both for the doctor and for the patient, and yet, although much has been written about the details of mental health legislation (Clare, 1980; Fennell, 1995), very little has been said about the psychological impact that this procedure has on either the doctor or the patient (exceptions are Mills, 1962; Rogers et al, 1993). This paper will examine the emotional factors involved when a patient is deprived of his or her liberty, and will take as its point of reference the Scottish Mental Health Act.