Although financial incentives to improve treatment adherence have been found effective in various medical specialties, there are few systematic data on their use, ethical background and effectiveness in psychiatry. We explored the practice of and possible ethical problems associated with direct financial incentives to improve adherence in assertive outreach teams in England. We also report clinical observations of a money for medication scheme with five assertive outreach patients in East London.

None of the assertive outreach teams that responded to the survey (response rate 47%) uses financial incentives. Attitudes of team managers towards the practice were mostly negative, often regarding it as unethical. Specific concerns were related to possible coercion and a negative impact on the therapeutic relationship. Out of five patients studied, four accepted the offer of money and had improved adherence; three remained without hospital admission since entering the scheme.

Money for medication might be a non-coercive and effective option to achieve medication adherence in otherwise non-adherent assertive outreach patients. However, ethical issues need further exploration and controlled trials are required to establish the effectiveness.

This study provides an overview of the development of early intervention services for psychosis across England in February 2005. A bespoke self-report audit tool was completed by key informants across the eight regional development centres of the National Institute for Mental Health in England.

Out of 117 teams identified, 86 have funding, of which 63 are operational with case-managed patients (as of February 2005). Only 3 teams meet all 10 audited early intervention fidelity requirements and there are variations in service model, delivery setting and resources across teams.

Current inequity of access and the early, fragile nature of service development means that early intervention in England has reached a critical phase requiring consolidation.

A cross-sectional survey was conducted to investigate the safety of rooms used by medical staff to interview patients in out-patient and in-patient settings of a mental health trust. An assessment tool was designed, and examined the features of an interview room that were likely to promote safety.

The survey included 112 rooms and demonstrated shortcomings that compromised interview room safety. Rooms were frequently overcrowded with furniture (n=30), cluttered with loose objects (n=101, 90%) and used for multiple purposes (n=82, 73%). Room layout often compromised either access to alarm systems (n=51, 46%) or exit from rooms (n=99, 88%). Necessary facilities for summoning assistance were found to be lacking.

The safety of interview rooms has not been emphasised sufficiently within everyday working practice and should be revisited.

A study was undertaken to investigate the views of professional staff and paid and informal carers' views of a new integrated mental health service for people with learning disabilities.

Twenty semi-structured interviews were conducted and transcribed. Most staff and carers were generally satisfied with the in-patient facility. However, information exchange, ward rounds and the ward environment were identified as areas requiring improvement.

Many of the participants had no previous experience of supporting a person with learning disabilities and mental health problems in an in-patient setting. However, over time they became supportive of the mental health service and provided valuable input in improving the service provision for people with learning disabilities.

We describe two patients, both diagnosed with psychotic illnesses, who developed stuttering while being treated with clozapine.

In both patients the stuttering was severe and significantly impaired progress towards recovery. Deviant speech dimensions and voice quality were consistent with dysarthria and dystonia.

Patients who develop abnormal electroencephalogram activity and those who have a family or personal history of stuttering might be at increased risk of developing speech problems with clozapine. Speech dysfluency might be a consequence of clozapine's action in lowering the seizure threshold. Potential management strategies include the use of sodium valproate and changing the type of antipsychotic.

Psychiatric senior house officers currently receive little formal training in how to give testimony at mental health review tribunals. The development of a simulated tribunal workshop for trainees, which is group-based, interactive and experiential in nature, with meaningful user and carer input is described.

We have incorporated simulated mental health review tribunal workshops into our academic programme and these have been successfully evaluated. Feedback has shown a marked increase in the confidence levels of trainees regarding tribunals.

The new Mental Health Act (England and Wales) is likely to place increasing demands on psychiatrists, in terms of giving testimony at mental health review tribunals. Simulated training for senior house officers, incorporating user and carer perspectives, can improve their skills and confidence in presenting at actual tribunals.