Up to a third of clients referred to National Health Service (NHS) mental health services will miss their first appointment. Opt-in systems are widely used to reduce non-attendance but there has been little published research examining the effects of such methods on clients. A cohort study with non-randomised historical controls was used to examine the introduction of an opt-in letter as the route to a first appointment in an NHS psychotherapy service.

The introduction of the opt-in letter slightly reduced non-attendance rates for first appointments, but this was at the expense of overall access to the service for the highest prevalence disorders.

It appears that although an opt-in system can reduce non-attendance at first appointments, it may have an unintended consequence of denying access to clients with the most common mental health problems such as anxiety disorders and depression.

Dispensing of methadone to individuals with opioid dependence is a discretionary service and many independent pharmacies remain unwilling to do this. We aimed to determine whether there was any correlation between negative stigmatised attitude towards these individuals and the likelihood of methadone dispensing. The 20-point Attitude to Mental Illness Questionnaire (AMIQ) was used to assess stigmatised attitudes in a cluster randomised sample of managers of community pharmacies in England.

The response rate was 66%. The AMIQ stigma scores had a median difference of 1 and effect size of 0.42 in favour of those pharmacies which dispensed methadone (mean = 0.53; n = 138) compared with those who did not (mean = 0.93; n = 69; P <0.001).

The results show a clear behavioural distinction (discrimination) based on stigmatised attitudes towards individuals with opioid dependence. This may arise because managers with stigmatised attitudes refuse to dispense methadone to this group. Conversely, familiarity with these individuals may have a de-stigmatising effect.

Non-attendance rates in a psychiatric out-patient clinic and the effectiveness of telephone or postal reminders in reducing non-attendance were evaluated. All patients who did not attend the clinic for their second appointment within 2 weeks were contacted by telephone or letter. Patients who failed to attend the clinic 6 weeks after the reminder were classified as non-attendees.

Rate of non-attendance before the intervention was 31.3% (n = 61/195). After the intervention this was reduced to 23.1%, a relative risk reduction of 26.2%. Being male, not being prescribed medicines, having a diagnosis of psychoactive substance use or dementia were risk factors for non-attendance (odds ratio, OR>1). Risk of non-attendance was low for bipolar disorder, schizophrenia and depressive disorder (OR <1).

A simple low-cost intervention in the form of a reminder reduced non-attendance rates. Routine implementation of this intervention should be considered in all psychiatry out-patient services in low- and middle-income countries.

We have audited the impact of a dedicated dental clinic on the oral health needs of an inner-city in-patient psychiatric population. A questionnaire assessing patient perception of oral health was undertaken on in-patient wards before opening a dental clinic on the hospital site and 5 months after.

The audit suggested improvements in patients' perception of oral health, behaviour directed at oral hygiene and knowledge of accessing services after initiation of a dedicated in-patient dental clinic.

Psychiatric in-patient settings may provide important opportunities for oral health promotion and intervention. This is a neglected component of in-patient care.

We examined the local impact of introducing a home treatment team on the use of in-patient psychiatric resources and rates of detention under the Mental Health (Care and Treatment) (Scotland) Act 2003.

Rates of admission to hospital and duration of hospital stay were unchanged. However, there was an increase in episodes of detention in the year following the team's introduction.

Offering home treatment as an alternative to in-patient care may be associated with an increase in compulsory treatment. If true, this is incompatible with the ‘least restrictive alternative’ principle of the recently revised mental health legislation.

There is a lack of current data regarding attitudes of doctors towards psychiatry. General practitioners (GPs) are increasingly involved in teaching psychiatry, and their attitudes towards psychiatry may affect their ability to promote psychiatry. The main aim of the study is to inform on current attitudes of GPs towards psychiatry as a discipline. The Attitudes Towards Psychiatry (ATP-30) questionnaire was administered to all GPs within Shropshire.

The response rate was 61% (n = 145 from N = 239). The mean score for the ATP-30 was 113.9. An association was found between GP trainer status and higher ATP-30 scores. Positive associations were found between demographic data (age, length of career, postgraduate experience of psychiatry, involvement in undergraduate teaching, GP trainer status) and individual response items on the ATP-30 scale.

General practitioners in Shropshire have a positive attitude towards psychiatry. Associations between demographic data and ATP-30 scores indicate that GPs with more experience of psychiatry and those involved in training may have more positive attitudes. The main limitation of the study is the lack of proven validity of the scale for use in this population. The positive attitude towards psychiatry is consistent with GPs providing the role models needed if they are to be involved to a greater degree with teaching and promoting psychiatry as a career. The need for the development of a more specific tool or an update to the existing tool is discussed.

The evidence of the efficacy of cognitive-behavioural interventions is well established. Despite this, clinicians often face a consistent number of not attended appointments or early treatment discontinuation rates. This paper reviews the literature to date regarding the possible causes of early termination of cognitive-behavioural interventions. A literature search was done using Medline, PsycINFO, Embase and the Cochrane Library.

We reviewed 14 articles. Out of these, two were randomised controlled trials, one was a controlled trial and the rest were cohort studies. Drop-out was defined differently across papers. There are many factors that may affect early treatment discontinuation rates and they are described individually.

There does not appear to be a single strong predictor of early treatment discontinuation. Specific literature relating to cognitive-behavioural therapy is scarce. However, some factors such as young age, education level and psychopathology appear to be more strongly associated with early treatment discontinuation than others.