The study aimed to identify the correlates of aggressive behaviour in an adult acute psychiatric ward. Over a period of 9 months, all incidents of verbal and physical aggressive behaviour exhibited by in-patients were routinely assessed using the Overt Aggression Scale.

Of the 535 patients admitted during the study period, 80 (15%) were involved in a total of 124 aggressive incidents. Of these 80, 44 (55%) had a history of previous violence and 54 (68%) had a history of substance misuse. The majority of events occurred early in the hospital stay and in most cases aggression was against staff. There were significant differences between aggressive and non-aggressive patients in terms of gender and ethnicity, with the lowest rate occurring in European females.

These results reinforce clinical impressions, and empirical evidence, and allow risk assessment to be performed with greater confidence. The relevance of ethnicity (or more likely culture) highlights the difficulties of a ‘one size fits all’ approach to risk assessment.

To audit whether the introduction of a self-harm pathway and protocol increases the number of psychosocial assessments. All episodes of self-harm in a defined period during 2002 (n=335) and 2004 (n=390) were reviewed before and after the introduction of a self-harm pathway and protocol. Adherence to the protocol was also investigated.

After the introduction of the self-harm pathway and protocol, the proportion of psychosocial assessments requested had risen from 57% (2002) to 85% (2004). The proportion of psychosocial assessments completed had risen from 47% to 70%. Over the 2 years, the overall number of self-harm presentations was reduced by 27%.

The introduction of a self-harm pathway and protocol through a self-harm steering group is feasible, was well accepted and increased the number of psychosocial assessments after self-harm. It may also contribute to a reduction in the number of overall presentations with self-harm to the accident and emergency department.

To explore current practice in offering patients copies of correspondence, we audited the documentation of 422 patients of a community mental health team.

Discussion about copying letters was documented in 194 case notes (46%); older patients and those with medically unexplained physical symptoms were less likely to be offered copies. There were 159 patients (82%) that wanted to receive copies of letters; male gender was associated with declining this option. In 167 (87%) instances the professional completing the form was a psychiatrist.

Older patients need to be offered the opportunity to receive correspondence. Clinicians should record and substantiate their decision not to offer copies of letters to some patients. Professionals other than psychiatrists should be encouraged to discuss copying letters with patients.

Ru-ok.com is a recently developed website that includes a self-assessment questionnaire. The aim of this study was to evaluate the website and compare the self-assessment questionnaire with established screening questionnaires. A total of 105 teenagers from schools completed three paper-based questionnaires and the online ru-ok.com questionnaire.

The website receives 730 visits a week. Visits to the advice section and stories about mental health and relationships account for 35% of activity. Of the returned questionnaires, 80% were positive about the website. There were modest and expected correlations between the website questionnaire (RU–OK) and the Mood and Feelings (MFQ) and Strength and Difficulties (SDQ) questionnaires.

Internet-based self-assessment is feasible and acceptable to teenagers. Self-assessment of perceived need by teenagers may be a useful tool for tier one professionals, including teachers, general practitioners, school nurses, social workers and learning mentors.

We conducted an anonymous survey of support workers to examine attitudes to people with different types of mental illness. Scores were based on a previously demonstrated stigmatisation score.

A total of 133 questionnaires were returned, representing 27% of all possible recipients. Fewer than 20% of respondents considered people with schizophrenia to be dangerous, although nearly half thought that they would never fully recover. More stigmatising responses were demonstrated to alcohol and drug addiction than to other disorders.

Support workers who spend large amounts of time with people with mental illness, in particular schizophrenia, have a low perception of their dangerousness. This may have implications for planning further measures to reduce stigmatisation.

Referrals to a specialist psychotherapy service were audited to measure the average waiting time for a first appointment and the proportion of patients waiting longer than 13 weeks. Recommendations for improving service delivery were made, an action plan implemented and the audit repeated.

In 2003, an initial audit of 355 referrals was completed using data from 2002. This found a mean waiting time to first appointment of 11.5 weeks with 30% of patients waiting longer than 13 weeks. In 2004, following implementation of the action plan, a re-audit of 200 patients found that the mean waiting time from receipt of referral to first appointment had reduced to 6.7 weeks with only 2.3% waiting more than 13 weeks.

Audit can improve the efficiency of service delivery in a specialist psychotherapy service. However, this may require that psychotherapists review traditional ways of working. Also, it is important that they feel personally involved in the audit process.