We aimed to examine reasons for initiating and continuing the prescription of combined antipsychotics. A structured interview was carried out with the responsible medical officers for 40 ‘difficult-to-manage’ tertiary referral patients with schizophrenia who were regularly treated with two or more antipsychotics.

Lack of efficacy of monotherapy was the main reason for initiating and continuing combined antipsychotics. Other reasons for continuing combined antipsychotics included not wishing to change medication as the patient was reasonably well, and safety considerations. Perceived benefits of combined antipsychotics included fewer positive symptoms and less disturbed behaviour.

‘Difficult-to-manage’ and forensic treatment-resistant patients with schizophrenia pose a particular therapeutic challenge. Use of combined antipsychotics, although not evidence-based, is perceived by some psychiatrists as beneficial when other options have failed.

All mental health services are expected to aim for equality of access to people from minority ethnic groups. Psychotherapy services typically have a low proportion of ethnic minority clients. Specialist services such as therapeutic communities are no exception. It is also possible that ethnic minority residents are more likely to leave group treatments early if they are clearly in the minority. The study examined records between 1996–2000 to ascertain whether ethnic minorities show a different pattern of exit from the process than people from other backgrounds.

Just over 9% of referrals to Henderson Hospital were from ethnic minorities. Ethnic minority referrals were less likely to be invited to a selection interview. However, there was no difference in length of stay in treatment. There was a trend towards ethnic minority referrals having more severe symptomatology and histories than those from White backgrounds.

Ethnic background should be taken into account when considering referral for specialist psychotherapy. Routine monitoring of the processing of ethnic minority referrals should be conducted in all psychotherapy services.

We surveyed all psychiatric services in the six northeast strategic health authorities to determine how the provision of liaison psychiatry services related to College recommendations and the size of the general hospital trusts served.

Thirty-six (100%) services provided usable data, 8% of general hospital trusts had no liaison psychiatry service, 41% of teams were not multidisciplinary with their only staff being nurses, only 38% of services had dedicated consultant psychiatry time and only a quarter met the recommended minimum standard of 0.5 whole-time equivalents. No teams contained clinical psychologists. Disorder-specific out-patient clinic provision was idiosyncratic.

There is a lack of rational planning of liaison psychiatry services and as a result, many services are not needs-based and do not comply with College recommendations. One indication of this is the lack of multidisciplinary teams.