The working relationship between consultant psychiatrists and crisis resolution/home treatment (CRHT) teams varies quite widely. Data from the national survey have been used to investigate the effects of consultant psychiatrist intput upon functions of the CRHT team. Logistic regression was employed to consider the effects of team size, team maturity and consultant input upon gate-keeping and fidelity to model (how many of six criteria teams' activities included).

There were statistically significant effects of size and maturity upon fidelity, and of maturity and consultant input upon gate-keeping.

The relationship between the consultant psychiatrist and other elements of the acute care pathway is an important determinant of how it functions. Depending upon how they relate to them, consultants can assist or hinder a team's capacity to fulfill their intended purposes.

To establish if participants with schizophrenia receiving depot antipsychotics had less insight than similar participants receiving oral atypical antipsychotics. We assessed the difference between these two groups.

Participants on oral antipsychotics had greater insight than those on depot antipsychotics (ITAQ, P=0.01). In the multiple regression analysis, only receiving depot antipsychotics contributed significantly to explaining variance in insight (adjusted R2=0.135, F=8.99, P=0.004).

Depot antipsychotics seem to be prescribed to a subgroup of people with schizophrenia who are likely to be less adherent because of lower levels of insight. These individuals are on significantly higher doses of antipsychotic medication. Clinicians should review their patients on depot antipsychotics at regular intervals.

To comprehensively describe a nurse-led consultation liaison service for older adults by retrospectively reviewing all referrals received in 2006 and comparing them against other services and benchmark reports.

Of the 298 individuals referred to psychiatric services from other hospital wards, 120 were aged 85–94 years old (40%), 193 were male (65%) and 152 were referred from geriatrics (51%). A majority of 204 have not had previous contact with psychiatric services (69%). the most common diagnosis was dementia (33%, n=88), with 27% individuals (n=65) being referred onwards to secondary care.

This nurse-led service, using a novel approach of a support worker providing further community support, functions well compared with traditional consultation models. It helps identify many individuals with dementia and engages them into community psychiatric services.

To describe the implementation of supplementary prescribing and nurse-led care in an acute in-patient unit. The issues of delegation and distribution of responsibility were explicitly addressed. Structures were developed for training and supervision, to ensure improved medicines management in the acute setting.

We present our five-step model of nurse-led in-patient care and our experience of using a clinical management plan for 33 patients.

Implementation of supplementary prescribing provides a model for new ways of working, requiring engagement of both doctors and nurses, clear delegation and distribution of responsibilities, and well-developed governance structures.

To investigate the effects of a standard National Health Service early intervention in psychosis service on bed days and engagement with services. We conducted a naturalistic before-and-after study comparing outcomes of individuals who received treatment from the service (n=75) with outcomes of individuals who presented to mental health services before the early intervention service was established and received treatment as usual (n=114).

People treated by the early intervention in psychosis service had significantly fewer admissions (P < 0.001), readmissions (P < 0.001), total bed days (P < 0.01) and better engagement with services (P < 0.05).

An early intervention in psychosis service compliant with current British mental health policy led to reduced use of psychiatric bed days confirming recent findings elsewhere. This leads to major financial savings, easily justifying the initial cost of investment in the service.

To investigate the experiences of Irish psychiatric trainees in relation to safety at work and the related training issues. A questionnaire was posted to 243 psychiatric trainees throughout Ireland.

We obtained 113 responses (46.5%). Results indicated that tutors appear to consider safety at work as an important component of training. The availability of breakaway or similar training is much bigger than previously reported in Ireland. The standard of induction courses appears to be high. However, problems in working environments were revealed: 16% of trainees had been physically assaulted and 72% have felt threatened in the workplace.

Despite improvements in training in Ireland, workplaces remain largely unsafe, putting staff and patients at risk.

A postal survey was conducted to gauge opinion of consultant psychiatrists in the west of Scotland with regard to consultant appraisal.

We received 158 responses to our survey (a response rate of 77%). The results showed mixed feelings about appraisal – for example, its purpose was felt to be about the development of consultants (72%) rather than the protection of patients (53%). Practical problems were highlighted, like the provision of accurate data and the amount of time spent on the preparation for appraisal.

Participation in 360-degree appraisal was scant, and no consensus on the use of outcome measures was reached.

More work needs to be done on the appraisal process for it to gain the full confidence of the profession.

To improve the level of insight (measured using standardised instruments) using a video interview and self-observation. Changes in levels of insight were measured using the Schedule for Assessing Insight (SAI) at the time of admission, at the time of discharge (both prior to and following the viewing of the videotape) and at follow-up a few months later.

The comparison of the SAI scores indicated a significant improvement in insight at the time of discharge (P < 0.005), with a further significant improvement after watching the video (P < 0.006). This appeared to be sustained at 3- to 6-month follow-up.

Video self-observation is a simple, inexpensive procedure that can be used to improve insight in psychosis. This study provides further support for the clinical utility of video self-observation in improving client's insight.

The aim of this study was to examine the subjective experience of the procedure for obtaining consent for electroconvulsive therapy (ECT) in an Irish setting. A total of 89 consecutively treated patients were sent a postal survey at an average of 17 weeks after ECT treatment.

This survey revealed low rates of perceived coercion in relation to consenting to ECT. Overall, there were high rates of satisfaction with the consenting procedure in terms of information and staff support.

In an accredited clinic, the consenting procedure can be conducted in an environment free of coercion, resulting in higher levels of patient satisfaction than previously reported.

To compare two groups of older people with chronic schizophrenia or delusional disorder living in the community and in care homes, along the domains of morbidity suggested by prior research. From the case-load of one old age psychiatrist, 22 individuals with chronic psychosis residing in care homes were compared to 23 living in their own homes. The measures used were: the Positive and Negative Symptom Score (PANSS; Kay et al, 1987); the Mini Mental State Examination (MMSE; Folstein et al, 1975); the Burvill Physical Illness Scale (Burvill et al, 1990); and an Activities of Daily Living Scale (IADL; Lawton et al, 1969).

Those in care homes had significantly higher PANSS scores (38.9 v. 21.0, P<0.01), largely accounted for by significantly more deficit symptoms (14.2 v. 5.6, P<0.01). They also had poorer cognition and significantly greater impairment in daily-life activities but their medical condition was not significantly worse. Most were seen only by a psychiatrist.

The greater morbidity and disablement of older people with chronic schizophrenia or delusional disorder living in care homes is likely to be intrinsic to the disorder but does not appear to be taken into account in current service planning or delivery.

To evaluate a new integrated weight management and fitness service for long-stay psychiatric patients who were obese or overweight with physical health risks. Body size and fitness were measured before and after each 10- to 12-week programme.

The number of patients referred to the programme was 145; 102 were accepted, 95 started a programme and 46 completed it. Analysis was by intention-to-treat. There were significant reductions in weight (P=0.001), body mass index (BMI, P=0.001) and waist size (P=0.001), and considerable improvements in hand strength (left hand, P=0.03; right hand, P=0.015), flexibility (P=0.022), lung function (P=0.001) and aerobic capacity (P=0.001).

An integrated programme of weight management and fitness is effective in reducing body weight and waist size, and in improving physical fitness in long-stay psychiatric patients. The long-term effect on patient's health and fitness needs to be monitored and strategies are needed to reduce patient withdrawal.

This study looked at patient aggressive behaviour on an Irish psychiatric intensive care unit, and whether it was related to diagnosis, patient's insight and symptomatology. Each aggressive incident was recorded throughout the patient's stay using the Staff-Observed Aggression Scale.

Ninety-nine individuals were admitted to the unit during the study. We recorded 82 aggressive incidents, with most occurring during the daytime and on weekdays. There was no statistical difference in BPRS scores between the aggressive and non-aggressive groups. the aggressive patient group had a lower insight score than the non-aggressive group (P < 0.05) as measured on the Schedule of the Assessment of Insight. However, when gender and verbal aggression only were included in the analysis, the difference in insight was less significant (P=0.07).

Aggression is common on a psychiatric intensive care unit. Low levels of insight in patients may increase the risk of aggression.

To investigate the feasibility of a clinical algorithm to assess capacity and examine the relationship between its results and the assessments of capacity by others involved in the decision of a patient to permanently enter a care home from a medical ward.

A total of 23 patients out of 38 (60.5%, 95% CI 44–77) had some mention of capacity in any type of record (medical, social work or nursing). At formal assessment 47% of older patients lacked capacity.

The absence of any recorded assessment in at least a third of patients is worrying, given the importance of the decision to the patients' lives and their financial status. It is to be hoped that the implementation of the Mental Capacity Act (2005) will rectify this situation.

We established two ‘dual diagnosis’ community psychiatric nurse posts within community mental health teams in Lanarkshire to improve the service care for individuals with comorbidity. A questionnaire-based evaluation of the service over a 2-year period was conducted.

Comorbidity was under-reported by community mental health teams and under-referred to specialist addiction services. The presence of new specialist nurses enhanced the detection of comorbidity, improved staff perceptions of working with patients that misuse substances, and was associated with a clinical and functional improvement in patients over 2 years.

Our findings support the recent trend to provide integrated care for comorbid service users within mainstream mental health services, and suggest a model of service delivery that might be more widely developed to address the concern that such users ‘fall through the gaps’ between services.

To describe patient characteristics and clinical activities at a British military department of community mental health (DCMH). Data were drawn from a clinical database over a 1-year period (n=409).

Mean age was 29 years, 50% were single and 76% were from the junior ranks. Women were over-represented compared with the wider military population. Mean length of service prior to presentation was 5 years. The main presenting problem was alcohol misuse (33%) followed by depression (19%). Twenty-five per cent were referred for psychotherapy and 68% returned to full employment after treatment.

Patient characteristics of those treated at a DCMH differ from those in the wider military. An out-patient occupational mental health service returns a substantial number of patients to occupational fitness within the Armed Forces.

To describe the profile of patients staying on acute wards for longer than 6 months and to compare staff appraisals of accommodation needs with patients' placements at 2 years.

Long-stay patients consistently occupied around a fifth of all acute beds. the nursing and medical staff recommendations and patients' placements at 2 years showed only moderate agreement. Aside from remaining in hospital, patients were most likely to be living in a residential or nursing home at follow-up.

There is a need to sharpen the focus of mental health strategy on non-acute hospital provision and 24-h-staffed community facilities. In particular, it is important to recognise the contribution of clinical expertise to the assessment and placement of long-stay in-patients.

To explore the feasibility of a randomised controlled trial of the effects of two anti-stigma films on medical students' attitudes to serious mental illness and psychiatry. Attitudes to serious mental illness, perceived dangerousness, social distance and psychiatry, were measured before and after watching the films and at 8 weeks.

Intervention films significantly improved general attitudes to serious mental illness and social distance, with a trend towards reducing perceived dangerousness. These effects appeared to attenuate during the students' clinical placements, suggesting a possible interaction with their clinical experiences.

Our results suggest both that it may be possible to conduct a substantive trial of the effects of the intervention films on a larger cohort of medical students and that the films may be effective in reducing stigmatising attitudes in medical students.

To determine the point prevalence of mental incapacity and the ‘Bournewood gap’ in general adult and old age mental health in-patients. The correlation of mental capacity assessment between doctors and nurses was investigated. Data were gathered on one census day for all general adult and old age psychiatric in-patients at three hospital sites.

Half the sample lacked capacity and one third fell into the ‘Bournewood gap’. The capacity assessment by nurses and doctors correlated highly (κ=0.719, P=0.0001).

‘Bournewood gap’ patients should have their needs assessed in order to identify and protect their rights. Appropriately trained mental health nursing staff can undertake this assessment.

To ascertain attitudes, awareness, knowledge and variations in prescribing habits of psychiatrists when addressing issues of faith, culture and dietary requirements (in keeping with the General Medical Council's and the Royal College of Psychiatrists' guidelines), and how these may affect the trust in doctor–patient relations. We undertook a cross-sectional postal survey aimed at clinicians in South West Yorkshire Mental Health Trust.

We obtained 38 responses (40% of the total number of questionnaires sent out) from two mailshots. Although the majority of respondents indicated that they were aware of the presence of potentially forbidden animal-derived ingredients in medication, only half expressed the view that a discussion regarding the above should take place prior to prescribing such medication.

Diversity training combined with taking a genuine interest in patients' wishes will not only minimise ‘mistrust’ but also facilitate prescribing in a therapeutic relationship.