A questionnaire survey of psychiatrists and mental health nurses was conducted to look at their awareness of nurse supplementary prescribing and its impact on patient care.

Response rate was 49.5% for psychiatrists and 23% for nurses. Most nurses (96.2%) and psychiatrists (91%) were aware of nurse supplementary prescribing, but more nurses than psychiatrists felt that it will provide patients quicker access to medication (P=0.023) and improve patient care (P=0.0003). Although two-thirds of the nurses felt confident to be a nurse prescriber, only 13% had actually approached a psychiatrist to be their supervisor. Most psychiatrists (54.4%) did not feel confident to act as supervisors.

Unlike nurses, psychiatrists were cautious about potential benefits of nurse supplementary prescribing on patient care. Both nurses and psychiatrists expressed concerns. As the expansion of nurse prescribing occurs, it is important for trusts to work actively with nurses and psychiatrists to address these concerns.

A postal survey of consultant psychiatrists was carried out to assess their level of knowledge about the role of the person representing the responsible authority at a mental health review tribunal (MHRT).

Consultants generally had a low level of knowledge and understanding of their responsibilities as representatives, which increased since appointment and with experience of MHRTs. They thought it appropriate that they continue representing the detaining authority in most cases, but recognised training needs.

Postgraduate training and continuing professional development should address the competencies required for the representative role. Trusts should review their practice in respect of legal representation at MHRTs.

Recent National Health Service (NHS) policy and guidelines support the increased provision of psychological therapies. As secondary care providers of psychological therapies, we carried out a questionnaire study of how our services were perceived by local general practitioners (GPs). All GPs in the borough of Southwark were included.

General practitioners value secondary care psychotherapeutic input across a spectrum of complex diagnostic groups and are interested in further training/education. They also consistently complain about long waiting times and confusion about accessing the various services.

With increasing interest in and willingness to fund the delivery of psychological therapies, there is the potential for working more effectively across the primary–secondary care divide. However, improved communication between primary and secondary care is essential if the increased commitment at government level is to be translated into a locally effective service.

To describe implementation of crisis resolution/home treatment (CRHT) teams in England, examine obstacles to implementation and priorities for development. We conducted an online survey followed by a telephone or face-to-face interview among 243 teams.

Considerable progress has been made in implementation with a subset of teams demonstrating strong fidelity to the Department of Health's guidance, particularly in urban settings. However, only 40% of teams described themselves as fully established. Many teams reported a high assessment load, understaffing, limited multidisciplinary input and patchy fulfilment of their gate-keeping role.

Successful implementation of the CRHT teams as alternatives to hospital admission requires resources for home treatment out of hours, effective systems working among local services, stronger local understanding and advocacy of the teams' role.

The working relationship between consultant psychiatrists and crisis resolution/home treatment (CRHT) teams varies quite widely. Data from the national survey have been used to investigate the effects of consultant psychiatrist intput upon functions of the CRHT team. Logistic regression was employed to consider the effects of team size, team maturity and consultant input upon gate-keeping and fidelity to model (how many of six criteria teams' activities included).

There were statistically significant effects of size and maturity upon fidelity, and of maturity and consultant input upon gate-keeping.

The relationship between the consultant psychiatrist and other elements of the acute care pathway is an important determinant of how it functions. Depending upon how they relate to them, consultants can assist or hinder a team's capacity to fulfill their intended purposes.

To describe the profile of patients staying on acute wards for longer than 6 months and to compare staff appraisals of accommodation needs with patients' placements at 2 years.

Long-stay patients consistently occupied around a fifth of all acute beds. the nursing and medical staff recommendations and patients' placements at 2 years showed only moderate agreement. Aside from remaining in hospital, patients were most likely to be living in a residential or nursing home at follow-up.

There is a need to sharpen the focus of mental health strategy on non-acute hospital provision and 24-h-staffed community facilities. In particular, it is important to recognise the contribution of clinical expertise to the assessment and placement of long-stay in-patients.

To investigate implementation of National Institute for Health and Clinical Excellence (NICE) guidelines in mental health, focusing on the schizophrenia guideline. Data analyses centred on implementation of the guideline, as well as looking at a set of markers mapped to the NICE principles of implementation and other identified clinical prerequisites. A self-report questionnaire tool was sent to senior executives at mental health trusts containing questions linked to the markers of implementation and clinical prerequisites; responses were analysed with data from the Healthcare Commission audit of implementation of the guideline to show key relationships.

Information from both data-sets (senior executive data collection and the audit) showed that implementation is patchy, with pockets of good implementation. Findings indicate that higher levels of implementation are linked to corporate commitment and leadership, as well as support from commissioners.

Implementation might be improved by corporate commitment and leadership and better support from commissioners.

To compare local practice with national guidelines, examine the areas of divergence, and establish complication rates for methadone and diamorphine. Fifty-one patients from Cornwall treated with injectable methadone or diamorphine were interviewed using a standard questionnaire.

Fewer problems were reported by individuals using injectable diamorphine, though for both drugs intramuscular injection was more problematic than intravenous injection. Injections into the groin were common, as was problem drinking.

Intramuscular administration of medications may be more likely to cause abcesses or cellulitis. Ongoing groin injecting and alcohol misuse is common, but should probably be tolerated if other harm reduction benefits accrue. It may be prohibitively expensive to set up injecting rooms in rural parts of the UK and future policy should reflect this.

This study examines the prevalence of vitamin D deficiency in a group of male psychiatric in-patients and follows 16 of them prospectively during treatment with calcium and ergocalciferol tablets.

Of 17 male patients, 15 had vitamin D deficiency and two had borderline deficiency. Vitamin D deficiency was associated with Black and minority ethnic background. Improvement in vitamin D status was observed following replacement therapy.

Vitamin D deficiency may be widespread in the psychiatric population particularly in Black and minority ethnic but also in White European in-patients. Vitamin D level should be routinely monitored in psychiatric in-patients. for those with vitamin D deficiency, replacement therapy can be commenced with calcium and ergocalciferol tablets (containing 10 μg of ergocalciferol), which is safe and well tolerated. All psychiatric in-patients should have adequate exposure to sunlight and attention to diet to ensure that they receive their recommended daily allowance of vitamins and minerals.