Modern mental healthcare providers must demonstrate service-level clinical effectiveness to key stakeholders. We introduced two performance indicators of clinical effectiveness based on outcome data from routinely collected Health of the Nation Outcome Scales (HoNOS) and HoNOS–secure assessments across St Andrew's Healthcare, a charity providing in-patient services in Northampton and Essex. We present outcome data from the period 2004–2007.

The indicators showed consistent 90-day improvement rates and increasing stability over time. the validity of results is supported by levels of change along predicted lines among different patient cohorts.

It is possible and beneficial to use routine outcome measures to demonstrate clinical effectiveness at service level. the future of managing mental health outcomes will be in electronic health records systems.

There is insufficient research into the relationship between ethnicity and appeals against detention under mental health legislation. We sought to identify rates and success of appeals in different ethnic groups through a retrospective analysis of all detentions under the Mental Health Act 1983 over 1 year.

We found high rates of appeals overall, with substantial differences between ethnic groups (36 (39%) White British compared with 71 (63%) Black Caribbean (P = 0.0001) and 21 (68%) White Irish (P = 0.01) individuals (Yates corrected chi-squared)). Success rates on appeal were very low in all groups.

There are significant ethnic differences in appeals against detention under the Mental Health Act.

To explore clinical indications for, and results of, brain imaging in general adult psychiatry. We reviewed the 100 most recent uses of brain imaging on in-patients at the Department of General Adult Psychiatry, Mater Misericordiae University Hospital, Dublin.

Patients were of a mean age of 55.3 years. the most common indications for brain scans were cognitive impairment (33%) and other neurological concerns (e.g. seizures; 30%). Overall, 47% of scans were abnormal, with ischaemia (17%) and atrophy (10%) being the most common abnormalities. Patients with abnormal scans were older than those with normal scans (mean age 61.9 and 48.7 years respectively; P<0.001).

A high proportion of brain scans demonstrate abnormalities in general adult psychiatry patients, especially among older patients.

Pharmaceutical advertising material can confuse clinical and statistical significance. We used a brief questionnaire (five questions) to evaluate psychiatrists' appreciation of this difference. This approximated to the level of critical appraisal competence of the MRCPsych part 3 examination.

Of the 113 questionnaires distributed 93 were returned complete (response rate 82%). Senior trainees were significantly better than junior trainees at correctly interpreting data (mean score (maximum 5) 2.61v.2.08; P = 0.04). Consultants did less well than senior trainees, although our sample of consultant respondents was too small for significance testing.

Learning critical appraisal for the MRCPsych examination may provide psychiatrists with valuable transferable skills and prevent gaps in our knowledge being exploited by misleading study data. Psychiatrists of all grades need to maintain their research appraisal skills and should not regard the MRCPsych examination as the end of their learning.

A questionnaire was distributed to patients in a psychiatric hospital in Birmingham, UK, to identify the factors that affect their satisfaction with the ward round.

The questionnaire was completed by 42 patients (53% response rate). Waiting time was the only variable to be significantly correlated with total score of patient satisfaction. Regression analysis also identified diagnosis and patients meeting their consultant before the first ward round as significant predictors of patient satisfaction.

Reducing waiting time and ensuring that the consultant meets the patient before the first ward round would make a significant improvement to the in-patient experience, without causing much disruption to standard clinical practice.

We sought to gain an impression of how the Psychiatric Bulletin has changed over time. We took a ‘snapshot’ of the journal in two time periods, comparing characteristics of articles published early in its development (1988–1992) with those published more recently in its current format (2002–2006).

The Bulletin has become more scientific, with the proportion of articles categorised as ‘original’ increasing from 31% (217/700) in the early period to 47% (263/565) in the later period. There is less emphasis on history of psychiatry and the arts.

Changes in the Bulletin are in line with psychiatry and medicine in general, placing more emphasis and value on research with systematic methodology.