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.

To capture psychiatrists' reasons for ‘significant impaired decision-making ability’ (SIDMA) as there is no definition of SIDMA in the Mental Health (Care and Treatment) (Scotland) Act 2003. One hundred consecutive mental health reports from January to February 2008 were examined using a questionnaire.

More than half the mental health reports noted lack of insight as the main cause of SIDMA. Other reasons for SIDMA included limited cognitive function and presence of psychotic symptoms.

Five reasons for SIDMA were identified: lack of insight, cognitive impairment, presence of psychosis, severe depressive symptoms and learning disability. We recommend psychiatrists working in Scotland give full descriptions of SIDMA, indicating how this has an impact on the patient's ability to make decisions.

To ascertain whether patients with proximal femoral fractures were being correctly assessed in line with the Mental Capacity Act 2005. Fifty people admitted with proximal femoral fractures were audited to assess whether they had given consent to treatment in accordance with the Act. A Mental Capacity Act 2005 guidance and assessment form was then introduced accompanied by staff training. A re-audit was undertaken to assess the impact.

The initial audit showed that only one person (2%) had been properly assessed. The re-audit demonstrated that the use of the Mental Capacity Act 2005 assessment form ensured correct assessment.

Our findings suggest the form is a useful tool in the documentation and assessment of an individual's capacity under the Mental Capacity Act.

We examined peaks and troughs in demand for out-of-hours consultations and assessments in child and adolescent psychiatry and whether these have implications for service development. All out-of-hours referrals in three teaching hospitals providing services to a large and diverse inner-city population were prospectively registered from 1 January 2002 to 31 December 2005.

In total, 323 individuals under 18 years were referred; 21.6 (95% CI 19.3-24.0) per 100 000 general population per year. Bedside assessments were required in 37%, the remainder were dealt with by telephone. The work took more than 4 h for 22%; 46% of individuals presenting were aged 16-18 years. Significant diurnal variation was observed with a peak in referrals between 17.00 h and 00.59 h. More referrals were made when daytime liaison services were closed (odds ratio (OR) = 2.46, 95% CI 1.15-1.87), after referral pathways had been clarified (OR = 2.33, 95% CI 1.92-3.23) and during spring (OR = 1.50, 95% CI 1.14-1.98). Other factors analysed showed no association with referral activity.

Cyclic variations in the demand for out-of-hours services in child and adolescent psychiatry should be considered for service planning. Although paediatric psychiatric emergencies are relatively rare, they can take up considerable clinician time.

To assess the individual needs for psychiatric services of a representative sample of homeless men living in hostels. A standardised procedure was used to assess the needs of 101 randomly selected homeless men.

The main mental health needs of the study sample were for psychiatric and social assessments and for alcohol and drug services. Men with psychotic problems had a high level of needs for psychiatric services and a higher proportion of unmet needs.

Our findings support the need for community-based multidisciplinary services that work specifically with homeless people to meet their needs. These services should incorporate psychiatric, social and substance misuse services.

To determine which terms receivers of mental health services wish to be known by (service user, patient, client, user, survivor) according to the professional consulted (psychiatrist, nurse, psychologist, social worker, occupational therapist). We conducted a questionnaire study to assess terms by like or dislike and by rank order. There were 336 participants from local catchment area secondary care community and in-patient settings in east Hertfordshire.

Patient is the preferred term when consulted by psychiatrists and nurses, but it is equally preferable to client for social workers and occupational therapists. Service user is disliked more than liked overall, particularly by those who consulted a health professional, but not by those who consulted a social worker. A significant minority wish to be regarded as a survivor or user.

National and local mental health services should adopt evidence-based terminology in referring to ‘patient’ or, in some groups, ‘patient or client’ in preference to ‘service user’.

The level of reading ability required to understand written information about key mental health issues designed for service users is examined. Information was taken from four reputable internet sources and analysed for readability. The relevant literature in relation to psychiatric patients and literacy is reviewed and potential solutions are proposed.

A considerable proportion of the available information has a reading age at or above 14 years. Some organisations appear better than others in providing information at a more appropriate level of reading ability.

Written information aimed at users of psychiatric services may not take into account that they are more likely to have impaired reading ability, even though they might not have an identified intellectual disability. Professionals who develop written materials can use tools in word processing software to assist with the appropriate development of these materials. Information technology could in the future provide information directed at users of psychiatric services that does not rely so heavily on written material.

To develop a standardised clinical information form which helps health professionals provide clear and relevant information about individuals who believe mental disorders affect their ability to repay debt and have consented to creditor organisations or money advisors approaching professionals for evidence. The six-question form was evaluated by three stakeholder groups.

Overall, 35 responses were received from creditors/money advisors, 28 from mental health professionals and 29 from service users/carers. All questions scored acceptable levels of clarity and three questions scored acceptable relevance levels. Qualitative data were used to revise questions on the basis of concerns expressed by stakeholders about sharing diagnostic data, providing prognoses, and the risk of creditor misunderstanding.

The form is likely to be an acceptable standardised means by which health professionals can elicit information on debt from individuals with mental health problems, for use by creditor organisations or money advisors. The results of a pilot study are awaited.

Concerns have been raised that catatonia is underdiagnosed. Prevalence varies (1.3-32%) depending on diagnostic criteria. We used the Modified Rogers Scale to rate catatonic signs in patients consecutively admitted to three psychiatric wards over a 10-month period.

The prevalence of patients demonstrating any catatonic signs was at least 7.9-19.1%. The most common catatonic signs were marked underactivity (not sedated), echolalia/palilalia, marked overactivity (not restlessness) and gegenhalten. In those with catatonic signs, the most common diagnoses were schizophrenia, schizoaffective disorder and dementia.

Most of the most common catatonic signs in our sample were motor signs. Antipsychotic-induced motor signs reflect interaction between drug and disease. Catatonic signs are not anchored in any one diagnosis and are on a spectrum of severity and quantity. Prevalence of these signs is higher than often presumed.

To consider the link between responsible commissioner and delayed prison transfers. All hospital transfers from one London prison in 2006 were audited and reviewed by the prisoner's borough of origin.

Overall, 80 prisoners were transferred from the audited prison to a National Health Service (NHS) facility in 2006: 26% had to wait for more than 1 month for assessment by the receiving hospital unit and 24% had to wait longer than 3 months to be transferred. These 80 individuals were the responsibility of 16 different primary care trusts. Of the delayed transfer cases (n=19), the services commissioned by three primary care trusts were responsible for the delays.

There are significant differences in performance between different primary care trusts related to hospital transfers of prisoners, with most hospitals able to admit urgent cases within 3 months. This suggests that a postcode lottery operates for prisoners requiring hospital transfer. Data from prison services may be useful in monitoring and improving the performance of local NHS services.

The patient's experience of the clinician is an increasingly important area in time of ‘consumer choice’ and appraisal of the individual practitioner. Validated, easy-to-use scales are scarce. The aim was to validate a user-friendly, brief scale measuring patient satisfaction (PatSat scale). Over three phases, patients were involved in developing and validating the scale against the Verona satisfaction subscale.

A highly significant correlation was found between the two scales (Spearman's correlation coefficient 0.97, two-tailed P <0.001).

The PatSat is a new patient satisfaction scale validated in a psychiatric out-patient population. It appeared popular with patients and took less than 1 minute to fill in. The use of validated scales measuring patient satisfaction is a pivotal part of mental health delivery and advancing overall quality of care.

To assess the contents and the theoretical and empirical base of community mental healthcare (CMHC) for people with severe personality disorder. Medline and PsycINFO databases and handbooks were searched from 1980, as well as a recent meta-analysis and systematic review of trials in which CMHC served as the control condition.

Community mental healthcare is a long-term community-based treatment within a supportive atmosphere, aimed at stability rather than change. Mostly offered by community psychiatric nurses, occupational therapists and social workers, it lacks a formal structure, as well as theoretical underpinnings that guide interventions.

Community mental healthcare might profit from a more systematic application of effective ingredients from other treatments.

To determine the security needs of patients in medium secure services in Northern Ireland and to identify those requiring long-term secure care. Patients were rated on the Security Needs Assessment Profile.

Fifteen patients (45%) could be managed in conditions of low security. Twelve patients (36%) require over 5 years' further treatment in secure care. Particular security needs include relational nursing skills, restricted access to alcohol and drugs, and robust physical security.

This study should be replicated across the UK to determine whether forensic services are responding to patients' needs. Pathways out of medium security need to be better developed, with regional expansion of low secure services.

A postal survey of forensic psychiatric facilities in England and Wales was undertaken to obtain information about the services provided for carers of in-patients within these services.

Forensic psychiatric services vary in the support and facilities provided for carers. Many do not comply with current legislation for carers. Most units informed carers of their rights to have an assessment, but only a minority provided facilities for carers from Black and minority ethnic backgrounds.

Forensic psychiatric services should meet standards for the involvement and support of carers in mental health settings, and comply with legislation for carers.

The collection of results of a specific outcome measure, the Health of the Nation Outcome Scales (HoNOS), is mandatory for mental healthcare providers in the National Health Service in England. Not all providers collect HoNOS data and coverage varies widely. This paper explores, by means of interviews with clinicians and policy makers and econometric analysis of HoNOS data, the barriers and incentives to the uptake of HoNOS and outcomes more generally, and the key characteristics associated with providers who do undertake HoNOS.

The main barriers to the collection of outcomes involve a lack of adequate feedback mechanisms, a lack of perceived clinical relevance and poor information technology infrastructure. Econometric results show HoNOS collection is associated with providers who produce high-quality data.

Initiatives should focus on putting systems in place to encourage feedback mechanisms for clinicians.

A Trust-wide smoke-free policy was introduced in March 2007. This service evaluation retrospectively reviewed the outcome by focusing on recorded changes in behaviour, incidents and prescribing.

The majority of patients (89%) smoked before the smoke-free policy. There was no significant change in the rate of clinical incidents or the use of tranquillising medication at 3 months and 12 months post-implementation. Clozapine serum levels were raised significantly, necessitating dose reduction in 17% of patients. Fifty-four per cent of patients used nicotine replacement therapy and a small minority continued this treatment for 12 months.

Despite initial concerns there were no significant problems in implementation of the smoke-free policy. This was assisted by extensive preparation, education, patient advocacy and access to treatment beforehand.