The roles of community mental health professionals may overlap and need clarifying. A survey is described of 95 occupational therapists (OT) and 200 community psychiatric nurses (CPN), of their views on their respective roles, and information on current practices. Administering medication and crisis intervention were regarded as specifically CPN roles, yet 26% of CPNs did not regularly administer medication. Half of the CPNs' clients were not chronically mentally ill, and over two-thirds of the nurses regularly carried out counselling and anxiety management. Assessing activities of daily living and work skills were seen specifically as OT tasks, yet 60% of the OTs did not usually assess work skills in practice. Roles overlapped considerably, suggesting that a more efficient approach might be to develop a generic core training for community mental health workers.

Mental health services have been criticised for failing to respond to the needs of the rising number of homeless mentally ill. We report on the first year of referrals to a community mental health team established to meet the needs of the severely mentally ill homeless in Birmingham. Most users had a psychotic disorder and a lengthy history of unstable housing, and experienced a range of other disadvantages. Although the team is successfully reaching its priority group, examination of other characteristics of users has highlighted a number of issues which should inform the future planning and development of the service.

A postal questionnaire survey of intensive care units/ locked wards in Scottish psychiatric hospitals revealed a lack of structural security features (other than a locked door) and an absence of personal alarm systems for staff in a substantial minority of units. The main reasons for transfer to locked units were physical violence to others and absconding risk, and the commonest diagnosis was schizophrenia. Transfer of in-patients not detained under mental health legislation was not uncommon. Differences in practice with regard to the transfer process were evident. In Scotland local locked facilities play an important role in secure provision and further evaluative research is required.

Violence in the workplace is of great concern to trainee psychiatrists. A questionnaire was devised to assess knowledge of safety Issues, and precautions available, among junior doctors. The results, which revealed gaps in provision of safety training and facilities in this area, have been forwarded to the relevant directorates with a view to setting standards suitable for audit review.

This article describes the principles and structure, staffing and training of an integrated psychotherapy service for the people of West Berkshire and South Oxfordshire (Reading, Henley, Wokingham, Newbury and Didcot) a population of 530 000.

The service is integrated internally as a joint outpatient and therapeutic community service that can provide psychodynamic psychotherapy across a wide range of length, intensity and styles. Externally it is integrated with the general adult psychiatry service, referrers, social services and community mental health teams.

This paper reports the results of a postal survey conducted to ascertain the views of general practitioners on the service provided by a newly established community mental health team for the elderly. The possible implications of GP fundholding for specialist provision of mental health services are discussed.

Following consultation in 1994, changes were proposed to mental health legislation. In Scotland these included the limitation of Leave of Absence (LOA) to 12 months and the introduction of Community Care Orders (CCOs). All consultants in general psychiatry in Scotland were surveyed regarding their views on LOA and CCOs. The results of our survey showed that the majority of consultants use LOA and extended LOA, giving lack of insight and threat of stopping medication as the main reasons. Consultants reject both CCOs and the limitations on LOA. Those who have been consultants for more than 16 years are significantly more likely to agree with restriction of LOA than others.

Professionals and consumers have joined psychiatric support groups on the Internet. This paper reports on a survey of members of an obsessive-compulsive disorder (OCD) mailing list (OCD-L). Members, who were primarily patients with OCD, but included family members and professionals, were generally positive about the benefits of the list, finding it a useful source of information about treatment, and a helpful source of support. It is concluded that a useful component of the management of OCD may include Joining OCD–L or a similar Internet support group, as benefits seem to outweigh possible problems. Further study of other Internet psychiatric support groups, which may differ significantly from OCD–L, seems warranted.

The case notes of 100 consecutive admissions to a general adult psychiatry service revealed that no sexual history was recorded in 73 cases. Only one patient had a detailed sexual history taken. In 22 cases the sex history was limited to a single mention of ‘reduced libido’ and in another four cases a brief explanation was done. Sexual side-effects of medication were not explored in any case. Sex history was more likely to be recorded when the doctor and patient were of the same sex; in cases with a history of sexual abuse or relationship problems; and where psychopathology had a sexual content.

Some recent criticisms of Mental Health Review Tribunal practices are reviewed against the background of concerns about public protection.

The report indicates that a psychosurgery service can be established on a regional basis. The outcome study of the Yorkshire Regional Psychosurgery Service indicates that the treatment should retain a place in the treatment of patients who have failed to respond to other available approaches. For such patients (and their carers) life is a state of persisting torment. Some psychiatrists consider psychosurgery as a procedure not to be countenanced, or outmoded, but patients have a right to know what may be achieved by the treatment and at what cost in terms of possible failure to improve and adverse effects. An audit of the Regional Psychosurgery Service indicates a favourable result of the Intervention. All patients improved to some extent, some very remarkably, and no adverse effects were encountered.

The Criminal Procedure (Scotland) Act 1995 came into force on 1 April 1996. It contains major new provisions in respect of defendants found insane, together with changes concerning other mentally disordered offenders.