This paper describes the establishment of a team of four nurses to provide a service in old age psychiatry along the lines of “Hospital At Home”. Its aim was to treat and nurse patients at home who otherwise would have to be admitted to hospital. An integral part of this initiative is the use of a problem orientated approach with integrated records. The work of the team over six years is reviewed and how it has evolved to provide a rapid response to difficult and fraught situations.

This prospective study assessed the importance off baseline clinical, socio-demographic and diagnostic variables on patient outcome at six weeks, and their relationship to total length of stay. It included all patients admitted to an acute day hospital in inner London over a one-year period, and used standardised rating scales. All scales improved after six weeks, but only improvement on the Global Assessment Scale (GAS) predicted the length off stay in those patients who were depressed. There was an increased length off stay in patients with a diagnosis off personality disorder and those admitted with a lower score on the GAS.

A retrospective survey was undertaken to evaluate the prescribing practices of medical staff in a District General Hospital in light of the Consensus Statement by the Royal College of Psychiatrists on the use of high dose antipsychotics (1993). Two per cent of 247 patients were prescribed a higher than recommended dose of antipsychotic. None of these cases had been prescribed ‘supra-BNF doses of antipsychotic on a regular basis, but with the addition of ‘as required’ (PRN) medication the recommended dose was exceeded. In only one patient was the high dosage administered. A further analysis of these patients is made.

In a study of a population over 13 months, ratings were made from medical records of adults who were admitted to short-stay, non-secure (acute) psychiatric beds. Of 197 patients, 126 fulfilled DSM-IV criteria for specified psychoses; 57 of the 71 remaining non-psychotic patients had a history of repeated self-harm, or threats of self-harm, and/or a substance-related disorder. Both these behaviours can be a manifestation of, and be associated with, personality disorder. It was considered that personality disorder made an important contribution to the psychopathology in the non-psychotic patients. The findings suggest a need to evaluate the alternative to in-patient care in a standard acute unit for such patients.

Direct access residents in an inner London homeless women's hostel were interviewed and asked to provide information on medical, personal and social history. For each a DSM–III–R diagnosis, General Health Questionnaire, CAGE and Global Assessment Scale score was assigned, and their views on future housing were sought. The effect of severe mental illness (SMI) and age on dependent variables was examined. A third of the sample (n=14) suffered from SMI, and a further quarter from other mental illness (n=10). A quarter had a DSM–III–R substance misuse disorder. The prevalence of SMI was similar across age groups. Younger women had a different pattern of service needs, with greater levels of psychological distress, substance misuse and residential instability, than older residents.

Following consultation in 1994, changes were proposed to mental health legislation. In Scotland these included the limitation of Leave of Absence (LOA) to 12 months and the introduction of Community Care Orders (CCOs). All consultants in general psychiatry in Scotland were surveyed regarding their views on LOA and CCOs. The results of our survey showed that the majority of consultants use LOA and extended LOA, giving lack of insight and threat of stopping medication as the main reasons. Consultants reject both CCOs and the limitations on LOA. Those who have been consultants for more than 16 years are significantly more likely to agree with restriction of LOA than others.

There has been increasing concern in recent years that trainee psychiatrists are not receiving adequate training and are not fully competent in the administration of electroconvulsive therapy (ECT). This has led to the publication of guidelines by the Royal College of Psychiatrists recommending measures to improve supervision and tuition. This study compares the results of two surveys, five years apart, exploring levels of supervision, satisfaction with training and confidence in the procedure among trainee psychiatrists on the Royal Free Hospital scheme. The findings are discussed in the light of Improvements to teaching of ECT in the interim. Continuing problems with supervision are highlighted, and the need for organised training is emphasised.

With the recent establishment by the College of ‘Affiliate’ status for non-member psychiatrists and continuing professional development (CPD) for ‘non-training’ grades, we though it timely to open a debate on the role, status and needs of staff grade doctors in psychiatry. Many of the issues that need to be addressed are common to staff doctors in all specialities. Following a brief description of the grade and how it is being used at present we will focus on education needs and career progression, drawing on recent debate in the medical literature and our own experience as staff grade psychiatrists in the West of Scotland.

The Caiman report (Caiman, 1993) aimed to reduce the period of postgraduate specialist training to about seven years, introduce the Certificate of Completion of Specialist Training (CCST), reduce the number of training grades to two, and introduce more structured training. Caiman also recommended four themes which should guide postgraduate training: flexibility, choice, competency and assessment on merit.

Previous audit of electroconvulsive therapy (ECT) standards has identified deficiencies in service provision. Little national information was available on ECT services in Scotland. Survey questionnaires were sent to all consultants in charge of ECT clinics in Scotland. There was a 100% response rate. The service provision varied across Scotland, and in some cases fell below Royal College of Psychiatrists' recommendations. There now exists a base of information on services available and an ongoing national audit system should be considered. Several recommendations have been made for the future of ECT services in Scotland and these have been distributed to consultants in charge of clinics.

As part of the academic programme for senior registrars in forensic psychiatry working in the North Thames Region, a series of visits to outside institutions of special relevance was organised. These visits form part of a larger academic programme which includes consultant tutorials, journal clubs and case conferences. Between May 1995 and October 1996 the author was the senior registrar in charge of organising the programme and this report is intended to share the experiences gained in visiting these other institutions.

We describe how a support group was set up and run over a ten-month period for members of a community paediatric nursing team. The views of the trainee who facilitated the group and of the nurse manager are offered.

There is currently concern that junior psychiatrists lack adequate skill in cardiopulmonary resuscitation. However, little attention has been given to the equally important issues of nurse training, organisation and the provision of equipment and drugs which are appropriate to psychiatric wards. This paper describes the work of the Leicestershire Mental Health Services Resuscitation Committee and makes suggestions as to how these problems may be approached.

Over the six years since the introduction of clozapine to the UK, the number of people prescribed this medication and living in the community has steadily increased. Coordination of blood monitoring and dispensing of clozapine to people dispersed throughout a district can be problematic. In Newcastle-upon-Tyne a steering group of healthcare professionals was established to address this situation. The outcome was the establishment of the Newcastle Clozapine Clinic. This paper describes the development of this service, which has improved administrative efficiency and given the opportunity to develop associated new services for people in the city with enduring mental health problems.

Carbamazepine and valproate are now well established treatments for bipolar affective disorder (BAD). Both drugs are used in the acute treatment of mania and, more frequently, as longer-term mood stabilisers. The British National Formulary (BNF, Vol. 32, 1996) provides information on the use of carbamazepine in the ‘prophylaxis of manic depressive illness' and suggests that the ‘usual range’ of doses is between 400 mg and 600 mg daily. No guidance on the use of valproate in BAD is given in the BNF because the drug is not licensed for this indication in the UK.

The clinical observation that some psychotic patients were attempting to register their ideas as patents prompted a survey of published patents. The hypothesis was that, given supposed links between creativity and mental illness, the Patent Office might be a repository of psychotic ideas. Searches were made on specific topics suggested by our patients' applications. A survey was undertaken of unusual patents in the collection as a whole, and of authors with unusual track records. Bizarre and eccentric patents were identified, but patents of the sort that our patients attempted to register were absent. Possible explanations for this result are discussed.

Good communication between general practitioners (GPs) and psychiatrists is important. An audit of new patient referral letters from GPs and the first assessment letter in reply from psychiatrists found that GP letters were short (mean 106 words) with limited information which increased with letter length. Psychiatrist's letters were longer (mean 849 words), of a high quality but with a negative relationship between length and information score. Use of the ‘preferred’ format derived from previous research was associated with shorter letters of higher quality. Communication between GPs and psychiatrists might be improved if GPs wrote more and psychiatrists wrote less.

Trainees in psychiatry frequently employ rapid tranquillisation (RT) measures. In this study we surveyed trainees as to RT regimes used. We found that a variety of drugs were chosen. On 45 (46%) occasions one drug was used, on 53 (54%) a combination. Drugs were administered in intramuscular form in 88 (90%) incidents. Zuclopenthixol acetate was prescribed on a total of 45 (46%) occasions. In 38 (39%) incidents the trainee used a high-dose regime. The literature regarding RT indicates inconsistency in practice. We address the reasons for this and make suggestions as to possible improvement in practice.

All British mental health professionals will be aware of several highly publicised deaths at the hands of mentally ill people and will have seen the conclusions of inquiries and government reactions. To reduce the risk of future tragedies effective methods of risk assessment and prediction are needed.

At the Council meeting of the Royal Medico-Psychological Association in November 1963 the Treasurer reported that “a handsome legacy of about £20,000 in shares had been made to the association by the late Dr Blake Marsh and arrangements are being made to take over these shares”. The actual amount was in fact a little over £23,500 – a considerable sum by today's standards. Numerous suggestions were made as to how this generous gift might be honoured including naming the Association's Bronze Medal after Blake Marsh but Council finally accepted a recommendation of the Education Committee “to found an annual lecture of a standing equal to the Maudsley Lecture on a subject connected with Mental Deficiency to be known by his (Dr Blake Marsh's) name” and this was ratified at the Annual Meeting in 1965.