The aim of the study was to evaluate the open referral system from social services to a community mental health team (CMHT) for older people. Referral letters from social services to the specialist team were reviewed, as were the case notes.

Of the 40 referrals, 95% (n=38) were accepted by the CMHT. Only 15% (n=6) fulfilled the team's existing referral criteria. The majority of referrals (n=36, 90%) had details of the patient's mental health problems. None of the referrals with memory problems had a cognitive assessment. Of the 38 referrals accepted by the CMHT, 36 were found to be suffering from a mental illness. The open referral system from social services did not increase the total number of annual referrals.

Social services play an important role in identifying and referring older people with mental illness and ensure a potentially rapid referral route bypassing primary care. The practice of accepting direct referrals from social services should be encouraged and made an integral part of the referral system.

Although the Health of the Nation Outcome Scales (HoNOS) were designed for routine clinical use, completion rates in clinical settings rarely exceed 60%. We evaluated two initiatives to increase completion rates: timely feedback to clinicians, useful at individual, team and service levels, and improved supporting materials (tabulated glossaries for all versions covering the life-span).

Clinicians in South Shore Health district provided ratings on all outpatient referrals over 12 months as part of routine care. Data were captured using the Nova Scotia routine administrative data system. Completion rates rose from 61% to 86% (n=1190). Clinicians' ratings of the instrument's ease of use were significantly improved.

Use of a tabulated glossary and enhanced feedback of clinically useful information improved clinician support for the routine measurement of health outcomes with HoNOS.

To evaluate the practical utility and face validity of a new risk assessment guideline, the Short-Term Assessment of Risk and Treatability (START), within a forensic mental health service. Staff attended training and subsequently used the START to assess and formulate risk. Staff then completed an evaluation questionnaire about their experiences of using the START.

The study proved useful in evaluating the practical utility and face validity of the START. the START demonstrated both good practical utility and face validity. Areas of difficulty in completing the START were identified and areas for developing the START were highlighted.

The service subsequently implemented a revised version of the START into routine practice. the results of the pilot study suggest that the START can usefully assist in structuring risk judgements in practice.

To elucidate and describe current neuropsychiatry service provision in the UK. A questionnaire was developed and posted to members of the Royal College of Psychiatrists who had expressed an interest in neuropsychiatry. the responses were tabulated and analysed using descriptive statistics and SPSS version 11.0 for Windows. the neuropsychiatry services provided, sources of referrals, setting of the services and funding streams are described.

Out of 251 respondents, 70 reported providing a neuropsychiatry service, 21 having been principally appointed as neuropsychiatrists.

Neuropsychiatry services in the UK are currently based in a few regional centres, representing a patchy and inadequate service provision.

To devise a simple technique to reduce stigmatised attitudes of the general public towards those with mental disorder (schizophrenia and substance misuse). Members of the general public (n=400) completed a questionnaire to measure stigmatised attitudes towards people with schizophrenia and substance misuse disorders. Participants were randomised to receive either a short, ‘upbeat’ leaflet with a description of a patient in remission and a photograph of a man in a business suit; or a simple description of a fictional patient. the 5-item Attitudes to Mental Illness Questionnaire (AMIQ) was used to measure the effect of the various procedures on stigmatised attitudes (score range −10 to +10).

Results were received for 310 (77%) participants. the leaflet produced a large, statistically significant reduction in stigmatised attitudes towards people with opiate dependence (effect size 1.53, CI 1.23–1.82, P < 0.0001; median change 4 units) and alcohol dependence (effect size 1.41, CI 1.12–1.70, P < 0.0001; median change 4 units) but less so towards people with schizophrenia (effect size 0.54, CI 0.27–0.80, P=0.0002; median change 2 units). There was no difference between participants in respect of the control group at 4-week follow-up (233 responses received; 78% response rate).

A short illustrated leaflet can be used to reduce stigmatised attitudes towards substance misuse disorders if patients are presented in a positive manner. This is less effective for attitudes towards people with schizophrenia, possibly because people have a more generous attitude towards patients who have overcome substance misuse disorders.

A postal survey of consultant psychiatrists was carried out to assess their level of knowledge about the role of the person representing the responsible authority at a mental health review tribunal (MHRT).

Consultants generally had a low level of knowledge and understanding of their responsibilities as representatives, which increased since appointment and with experience of MHRTs. They thought it appropriate that they continue representing the detaining authority in most cases, but recognised training needs.

Postgraduate training and continuing professional development should address the competencies required for the representative role. Trusts should review their practice in respect of legal representation at MHRTs.

We describe the development of a pilot personality disorder outreach service. A case series of 13 patients was studied. Data were collected using pro forma, semi-structured interviews and a structured assessment of personality disorder.

All personality disorder clusters were represented among the 13 patients. Treatment recommendations usually supported the existing approach – the ‘added value’ of the outreach service was that difficult interpersonal dynamics could be considered and thought through with an objective observer. Opinions differed on whether the service was more useful for the assessment and brief treatment or continuing care teams.

Personality disorder services need to develop expertise in all clusters. There is a need to moderate the harsh self-critical attitudes of the care coordinators. The national framework for personality disorder is useful for service development, but the services need to be tailored to the individual needs of specific teams.

To explore the smoking habits of in-patients on psychiatric wards, their beliefs about the effects of smoking on health, and their attitudes towards hospital and government smoking policies. Face-to-face interviews with 135 in-patients were conducted.

A total of 54.1% of participants smoked. Smoking was less prevalent in those aged 65 years and older (P<0.001). Non-smokers were more likely to believe smoking to be harmful to health (P=0.002). Overall, 71.1% of the participants favoured the existing smoking policy, with only 3.0% wanting a complete ban on smoking and 54.1% agreeing with banning smoking in public places.

Further studies are warranted into the views of in-patients elsewhere and to see whether attitudes change as trusts tighten their smoking policies. Outdoor smoking areas may need to be considered, although in practice this may not be possible in all trusts.

An audit of clients in specialist and shared care services was undertaken in 2003 and in 2005 to investigate the capacity, quality of prescribed medication and profile of clients, and to assess the impact of the new General Medical Services contract on drug misuse treatment.

Capacity in specialist services increased by 55% from 2003 to 2005, but not in shared care, and type and dosage of prescribed medication improved for shared care. Profile of clients suggests that stable clients are treated within shared care.

Attention should be given in training general practitioners to provide shared care treatment, increasing the number of clients accepted in shared care, and considering new treatment models.

To evaluate the effectiveness of treatment at the Traumatic Stress Service (TSS) by comparing pre- and post-treatment scores on patient self-report measures. Through a questionnaire survey, to explore therapists' views of problems presenting in addition to post-traumatic stress disorder (PTSD) and how, as a result, they adapted their approach to trauma work.

Therapists reported that their patients present with a range of complex problems, and self-report measures show that patients suffer particularly high levels of psychopathology. Therapists identified a number of adaptations to trauma-focused work to deal with these additional problems. Of the 112 patients who completed therapy, 43% filled in pre- and post-treatment questionnaire measures. Analysis showed clinically and statistically significant improvements in levels of PTSD, depression and social functioning.

The typical presentation of trauma survivors is often not ‘simple’ PTSD, but PTSD resulting from chronic and multiple traumas and complicated by additional psychological and social difficulties. Adaptations to trauma-focused work can successfully treat such ‘complex’ PTSD.

We looked retrospectively at referrals over 1 year and determined the length of time from receipt of the referral to the date when authorisation to see the patient was given, and the time from authorisation to first contact. For in-patients we determined the time from the recommendation for admission to the time authorisation was granted, and the time from authorisation to admission.

Of the 108 referrals, 80 (74%) were seen within 13 weeks (mean=53 days); 7 patients (6%) had to wait over 13 weeks, usually because of delays in authorisation; 10 patients were admitted; 14 were never admitted (although we had recommended admission). The time from recommendation to admit to authorisation of admission, 27 days, was the same as the time they waited for a bed once authorisation had been given.

Waiting for authorisation seemed in some patients to delay their access to tertiary services. Any advantage of using panels to authorise referrals, like ensuring better use of local resources, may be outweighed by patients taking longer to get the care that best meets their needs.

The internet is an important source of mental health information. Given variable literacy levels in the general public, patient information websites need to be easily readable to prevent misunderstanding and consequent misinformation about mental health problems being propagated. the aim was to ascertain the readability of websites containing patient information about schizophrenia. Twenty websites containing patient information about schizophrenia generated by Google® were analysed for Flesch Reading Ease and Flesch-Kincaid Grade Level.

According to standardised Flesch Reading Ease classification, 40% of the selected sites were classified as very difficult, 55% as difficult and 5% as fairly difficult. None were considered easy to read. There was a negative correlation of 70.798 (P < 0.001) between Flesch Reading Ease and Flesch-Kincaid Grade Level, which demonstrates the reliability of these results.

Easily accessed schizophrenia information websites do not score highly for readability. Those that produce websites should bear readability in mind when writing them in order to construct more readable sites. Ideally, these should be accredited by recognised organisations that evaluate readability. Clinicians should assess website information for readability before recommending them to patients or carers.

To collate referrers' views on primary consultations in child psychiatry, feedback data were collected by questionnaires over a 12-month period.

Referrers found reports clearly written, informative and helpful, but wished for further, more direct involvement, support and follow up, and also for a clear plan of action for the children referred.

Primary consultation clinics should be further developed and audited in the future, in view of the recent changes in child and adolescent mental health services.