We aimed to compare the practice of electroconvulsive therapy (ECT) in Scotland with the recommendations of the Royal College of Psychiatrists, to determine the characteristics of patients who receive ECT, to assess the outcome of ECT given in a routine clinical setting and to develop a system of quality assurance for ECT. Between February 1997 and March 2000, an audit of ECT measured the quality of treatment given at all clinics in Scotland. Audit tools were designed and standards set for the process, and outcome of treatment and interventions were identified to address any variance prior to each audit cycle. An electronic data collection system was developed and a website produced for the purpose of continued audit and information sharing.

The annual rate of ECT in Scotland was 142 individual treatments per 100 000 of the total population. Electroconvulsive therapy was given mainly to White adult patients with a depressive illness who had consented to treatment. Clinical improvement, as measured by at least a 50% reduction in the Montgomery–Åsberg Rating Scale for Depression (MADRS) score, was evident in 71.2% of patients with a depressive episode.

The audit of ECT is achievable at a national level, ECT is effective in a routine clinical setting and the standards at ECT in Scotland are higher than the UK average.

To identify activities that can be modified in the psychiatry out-patient clinic in order to improve the quality of services rendered. Consulting doctors obtained information on the reason for consultation and time spent by each patient over a one-month period.

Half of all the patients (50.5%) came for a repeat prescription, and 19.3% came for a repeat prescription and counselling. The mean times spent on these two activities were 5.13 (s.d.=2.5) and 7.81 (s.d.=7.51) minutes, respectively. The time spent on these activities by doctors was 47% of the total clinic time.

Clinic services should be reorganised so that doctors can use their skills in more efficient and creative ways.

Between 1998 and 2000, a surprisingly high number of positive results was noticed in our regional medium secure unit when testing for D-lysergic acid diethylamide (LSD). This led to an investigation of possible factors involved. It was felt that the testing protocol, particularly the use of a single, non-isotopic homogeneous immunoassay without routine further confirmatory testing, was largely to blame for what seemed to be a high incidence of false positives. On two different occasions, samples from each patient were sent, on the same day, to two different laboratories. At the first laboratory, only one test method was used and at the second one test plus two confirmatory tests were carried out.

Out of a total of 23 patients tested on two separate occasions, the first laboratory gave three positive results the first time and three positive results the second, while the second laboratory gave only one positive result on the second occasion that samples were sent and none on the first. This reinforces the belief that, without adequate confirmatory analysis, many psychiatric and non-psychiatric prescribed drugs can give false positives.

Positive LSD results should be confirmed by at least one, preferably chromatographic, alternative method. A protocol for testing and reporting LSD in psychiatric patients should be considered in order to minimise the risk of obtaining false-positive results which have negative clinical, legal and psychological repercussions.

To assess the impact of Carers' & Users' Expectations of Services –User version (CUES–U) upon clinical care planning in working age adults with mental health problems. Eighty-six individuals who were receiving input from the community mental health team gave their views.

Life and service satisfaction ratings ranged from 49% to 88%. The CUES–U discussion led to a change in clinical care for 49% of respondents. Care coordinators rated CUES–U as a good use of their time in 64% of cases. Women and those with a shorter duration of mental disorder were rated as more engaged in the consultation process.

CUES–U appears to be a useful tool for supporting individual clinical care and the evaluation of community mental health services.

To determine psychological morbidity among staff following actual or threatened violence from patients on acute psychiatric wards. A retrospective survey of all 156 clinical staff on Exeter's acute psychiatric wards was conducted by means of an anonymous questionnaire using standardised measures.

The response rate was 81%, and 72% of respondents had experienced one or more distressing incidents of actual or threatened violence within the previous year. The 12-item General Health Questionnaire and Impact of Events Scale scores were significantly higher in those who reported exposure to ‘frequent’ violent incidents.

Some National Health Service staff may be harmed psychologically when they are at work. This consequently may have implications for patient care, employer liability and recruitment.

To ascertain employers' attitudes to interviewing and hiring job applicants with a history of mental illness and, in particular, to assess the potential effect on job prospects for applicants with a history of admission under the Mental Health Act 1983. A postal tick-box questionnaire was sent to 174 companies; there was a 32% response rate.

The main factors influencing employers' hiring decisions were medical opinion regarding an applicant's fitness to work and their employment and sickness records. In about three-quarters of small companies and half of large companies, questions about mental illness are simply never asked.

Approved social workers have no reason to caution people assessed under the Mental Health Act 1983 that being detained could harm their job prospects.

Individuals with autism often have complex needs. In this paper, we attempt to establish the prevalence rates of other major psychiatric illnesses in learning disabled adults diagnosed with autism and analyse the use of medication in these individuals. A total of 571 clients with learning disability were screened for autistic spectrum disorder, identifying 164 individuals for study. Psychiatric and medical diagnoses were also reviewed.

Of the individuals with autism, 35% had another comorbid psychiatric disorder. An overall prevalence rate of 10% for hypothyroidism was also identified and 35% of people with autism and no other psychiatric diagnosis were on neuroleptics.

Planning of services for autism will have to take into account the high comorbidity of autism and other psychiatric conditions. Individuals with autism will also benefit from close monitoring of mental state and the development of hypothyroidism.

The perceptions and expectations by referrers of assessments performed by a medium secure unit were examined in order to ascertain areas for possible improvement. All referrals to two teams at the North West Thames Regional Secure Unit were monitored over a 6-month period. A self-report questionnaire was sent to each referrer, in cases where an assessment and forensic report had been completed.

Assessments and forensic reports were completed (and questionnaires sent to referrers) in 63% of total referrals (32 out of 51). The response rate to the questionnaire was 81% (26 out of 32). Many referrers wanted the assessments and report to be completed in 2 weeks. Most referrers were satisfied with the quality of the report received and the majority were happy with the risk assessment.

Referrers want forensic assessments to be of a high quality and to be performed quickly. Recommendations for service development are suggested.

Ward staff were asked to rate whether in-patients with a diagnosis of functional psychotic illness also met criteria for a diagnosis of alcohol or drug misuse or dependence during the preceding 6 months. Those who demonstrated such evidence were then asked to report the nature and extent of their substance use and whether they continued to use as in-patients.

264 in-patients with psychotic illness were screened for evidence of recent or current alcohol or drug misuse. According to staff reports, 127 (48.9%) met the criteria for substance misuse or dependence. The mean age of those with ‘dual diagnosis' was 34.7 years and 72% were male. Eighty-three (83%) of those with a history of current or recent alcohol or drug misuse reported that they had continued to use alcohol and/or illicit drugs in the in-patient wards during their current admission.

It appears difficult to prevent in-patients with drug or alcohol misuse problems from continuing to use substances in hospital. Further consideration and investigation of how best to manage this group is therefore required.

We surveyed all psychiatric services in the six northeast strategic health authorities to determine how the provision of liaison psychiatry services related to College recommendations and the size of the general hospital trusts served.

Thirty-six (100%) services provided usable data, 8% of general hospital trusts had no liaison psychiatry service, 41% of teams were not multidisciplinary with their only staff being nurses, only 38% of services had dedicated consultant psychiatry time and only a quarter met the recommended minimum standard of 0.5 whole-time equivalents. No teams contained clinical psychologists. Disorder-specific out-patient clinic provision was idiosyncratic.

There is a lack of rational planning of liaison psychiatry services and as a result, many services are not needs-based and do not comply with College recommendations. One indication of this is the lack of multidisciplinary teams.

To compare the assessment by community psychiatric nurses and junior psychiatric doctors of individuals following deliberate self-harm (DSH) and, in particular, to elicit differences in referral practices and perceptions of mental illness. The health professionals involved completed questionnaires after carrying out DSH assessment.

There was a significant difference in referral patterns between doctors and nurses after DSH assessment. Doctors were significantly more likely to refer individuals for psychiatric follow-up which involved direct contact with other doctors (51 of 72 (71%) compared with 60 of 175 (34%)). Doctors were also significantly more likely than nurses to perceive individuals as having a mental illness (57 of 72 (79%) compared with 86 of 175 (49%)).

Further research is warranted to establish the precise reasons for these differences, and to determine whether the widespread introduction of nurse-led services is an effective and efficient use of resources.

We conducted a questionnaire study to establish the incidence, specialist staff availability, treatment provision and socio-demographic profile of patients with first-episode psychosis referred to all adult and child and adolescent community mental health teams in south and west London.

All 39 teams completed the questionnaire, identifying 295 cases of first-episode psychosis (annual incidence 21/100 000/year) referred in the year 2000. Teams manage to engage most patients with first-episode psychosis. A total of 73% of cases of first-episode psychosis were on some form of Care Programme Approach. However, many teams did not have adequately trained staff to provide psychosocial interventions. Even where such staff were available, care was focused mainly on monitoring medication and risk assessment, with only half the teams providing psycho-educational programmes and only a quarter offering individual cognitive–behavioural therapy to those with first-episode psychosis.

Establishing early intervention services nationwide will require significant new resources, including specialist trained staff, which could prove difficult to provide in inner-city areas. Rather than a single, uniform service model, several models of early intervention services based on locally determined need might be more realistic and appropriate, and also allow research into their relative efficacy.

A postal survey of consultants in liaison psychiatry was carried out in the spring of 2002 to document the current state of liaison psychiatry in the UK and the Republic of Ireland. Information was collected on post specifications, clinical organisation and plans for further local development.

Ninety-three liaison consultants were identified. Seventy-seven posts were full-time or half-time, compared with 43 such posts in 1996. During the same time period, specialist registrar training posts have doubled from 30 to 61. A third of respondents anticipated further consultant posts in their region.

Despite the increase in the number of liaison consultants since 1996, the numbers still fall below that recommended by the Royal College of Psychiatrists. Liaison consultants need to improve links with primary care and continue to develop specialised services to demonstrate the qualitative and financial benefits that liaison psychiatry has to offer to a wide range of patients.

A postal questionnaire was circulated to all psychiatrists who had completed their basic specialist training on the Royal London Hospital training scheme within the last 7.5 years. The aim of the questionnaire was to explore their psychotherapy experience while on the rotation.

The response rate was 95%. The respondents had a broad experience of both didactic and case work that they valued highly. Over half of them wished for an even greater exposure to psychotherapy during their basic training.

The results of our survey suggest that with the dedication of both the trainees and trainers, it is possible to have a comprehensive psychotherapy experience while working on a busy inner-city rotation.

The aim of the study was to assess the practicality of extracting past risk-related information from case records and to assess how this process might be cost-effectively incorporated in routine practice. Case records of 43 patients referred to the Care Programme Approach in Dundee were examined.

Our study yielded relevant information – 39% of patients had a history of violence, 58% of self-harm or suicide, 58% of severe self-neglect and 72% of non-compliance with medication. However, it took an average of 5 hours to conduct a thorough review of each case because the notes were bulky and poorly organised.

Retrospective review of conventional case records in routine practice is likely to be incomplete and misleading. Prospective recording should be practicable if used selectively, but requires a standardised approach to clinical recording and case note maintenance. The risk recording system we developed, incorporating a dated index of incidents by risk category, followed by brief summaries of each incident, provides key clinical information not available from a simple check list while not sacrificing brevity.

The aim of this survey was to look at current practice in monitoring weight and glucose control in in-patients being prescribed antipsychotic medications. Records for 51 patients admitted with psychotic illnesses to a large teaching hospital during a 3-month interval were surveyed.

Fifty-five per cent of patients had no record of weight taken on admission to hospital. Only one patient had their weight repeated during the admission. Forty-nine per cent of patients had random blood glucose checked on admission. No fasting levels were performed.

Weight gain and hyperglycaemia associated with antipsychotic prescription are well-recognised side-effects. These results suggest that standardisation of weight measurement and blood glucose monitoring is required.

With an absence of appropriate residential services, people with learning disabilities are often placed outside their local areas and there is regularly no dialogue between the relevant health authorities prior to a placement being made. This survey from Leicestershire explored this issue by focusing on the catchment area covered by one consultant psychiatrist. Practice standards were formulated and compliance with these was examined.

A total of 29 patients were identified as ‘out-of-area’ placements. They had high psychiatric morbidity, exhibited significant degrees of aggression and needed a high level of professional input. The suggested practice standards were met by less than 10%.

In parts of the country where a large number of ‘specialist’ residential homes have opened, there has been an unplanned increase in the workload of local learning disability/ mental health services. This can compromise patient care and there is an urgent need for health authorities to address this issue.

A postal survey was sent to all consultant child and adolescent psychiatrists in the UK and Eire examining recruitment, retention, job satisfaction and job stress.

A response was received from 333 (60%) child and adolescent psychiatrists. Sixty-one per cent indicated their service was inadequately resourced and 89% reported that their service failed to meet the College's minimum staffing requirements. Safe access to in-patient beds was not available to 71%. One hundred and thirty vacant posts were identified. Rates of psychological distress and burnout were high. Adequate services and the presence of a close, supportive colleague were associated with higher rates of satisfaction and lower rates of psychological distress and emotional exhaustion.

A multi-faceted approach is suggested and recommendations are described under the headings of self-management, training, recruitment and commissioning.