Locating psychiatric wards in general hospitals has long been seen in many countries as a key element in the reform of services to promote community integration of the mentally ill. In the UK, however, this is no longer a policy priority, and the recent trend has been towards small freestanding inpatient units, located either within the communities they serve, or on general hospital sites, but separate from the main building. Whether locating the psychiatric wards in the general hospital is essential to psychiatric reform has been little discussed, and we can find no relevant evidence.

Perceived strengths of general hospital psychiatric wards are in normalisation of mental health problems, accessibility to local communities, better availability of physical health care resources, and integration of psychiatry with the rest of the medical profession, which may faclilitate recruitment. However, difficulties seem to have been encountered in establishing well-designed psychiatric wards with access to open space in general hospitals. Also, physical proximity may not be enough to achieve the desired reduction in stigma, and complaints from the general hospital may sometimes result in undue restrictions on psychiatric ward patients. There are strong arguments both for and against locating psychiatric wards in general hospitals: an empirical evidence base would be helpful to inform important decisions about the best setting for wards.

Declaration of Interest: None.

Over the past ten years, the National Health Service in England has introduced home treatment teams throughout the country. Despite this, and the fact that England now has the fourth lowest number of beds per capita in Europe, no mental health service has been able to dispense with acute admission beds altogether. One unintended consequence of new investment in community alternatives to inpatient care is that the threshold for admission has risen and acute wards now accommodate a patient group that is more severe with regard to levels of disturbance and social disadvantage. This has compounded the challenge of providing high quality inpatient care and repeated national surveys suggest that acute admission wards are the weakest link in the English mental healthcare system. In response to this, the Royal College of Psychiatrists has established an accreditation scheme for acute admission wards. Only 22 of the first 132 wards to have completed the review process so far are considered to be excellent. Although 59 wards (45% of the total) failed to meet one or more essential standard, 43 of these were able to rectify the problem.

Declaration of Interest: None.

The author makes the case for the necessity of inpatient psychiatric services in a comprehensive, community based, system of care. The editorial begins with an historical perspective on mental hospitals. It then discusses acute and intermediate psychiatric inpatient units. A section also covers forensic units, also indispensable for a region or population of any size. The editorial concludes with a call for recognizing the purpose and value of inpatient services and thus using them most effectively.

Declaration of Interest: None.

Even though randomised controlled trials are the design of choice for evaluating the efficacy of health care interventions, they are not immune to bias that may affect research process and validity of results. In the present paper we discussed how trial quality may be appraised considering both whether a clinical trial is reported in a comprehensive and complete way (consistently with what had been declared in the study protocol), and whether the characteristics of the trial itself are associated with risk of bias.

Here we briefly summarize the most consistent structural MRI studies on hippocampus in major depression and debate the effects of clinical variables on hippocampal morphology.

Aims — This study had two objectives: 1) to design and develop a computer-based tool, called Multi-Objective Evolutionary Algorithm/Hot-Spots (MOEA/HS), to identify and geographically locate highly autocorrelated zones or hot-spots and which merges different methods, and 2) to carry out a demonstration study in a geographical area where previous information about the distribution of schizophrenia prevalence is available and which can therefore be compared. Methods — Local Indicators of Spatial Aggregation (LISA) models as well as the Bayesian Conditional Autoregressive Model (CAR) were used as objectives in a multicriteria framework when highly autocorrelated zones (hot-spots) need to be identified and geographically located. A Multi-Objective Evolutionary Algorithm (MOEA) model was designed and used to identify highly autocorrelated areas of the prevalence of schizophrenia in Andalusia. Hot-spots were statistically identified using exponential-based QQ-Plots (statistics of extremes). Results — Efficient solutions (Pareto set) from MOEA/HS were analysed statistically and one main hot-spot was identified and spatially located. Our model can be used to identify and locate geographical hot-spots of schizophrenia prevalence in a large and complicated region. Conclusions — MOEA/HS enables a compromise to be achieved between different econometric methods by highlighting very special zones in complex areas where schizophrenia shows a high autocorrelation.

Declaration of Interest: This study was partly supported by the Andalusian Government, P05-TIC-00531, PAI:P06-CTS-01765, CTS-587, PI-338/2008]; the Ministry of Education and Science [TIN2005–08386-C05–02] and the Ministry of Health [PI08/90752]. No additional financial sources have been received. No involvements are in conflict with this paper.

Aims — To describe patterns of experienced andanticipated discrimination in a sample of schizophrenic patients recruited in Italy in the context of the International Study of Discrimination and Stigma Outcomes (INDIGO). Methods — Cross-sectional survey on a sample of 50 people with clinical diagnosis of schizophrenia recruited in the Italian INDIGO sites of Verona and Brescia. The 41-item interview-based Discrimination and Stigma Scale (DISC-10), which assesses how experienced and anticipated discrimination affects the life of people with schizophrenia, was used. Results — The most frequently occurring areas of experienced discrimination were discrimination by family members (44%), making and keeping friends (33%), keeping (36%) and finding a job (34%), getting or keeping a driving licence (32%). Anticipated discrimination was common in applying for work, training or education (58%), lookingfor close relationships (50%) and doing something important (48%); 68% felt the need to conceal their diagnosis. Positive experiences were rare, and getting welfare benefits/disability pensions was the only area where participants reported being treated with advantage (34%) more commonly than with disadvantage (8%). Overall, experienced discrimination reported by Italian patients was in the intermediate position of the score range of all INDIGO sites, whereas anticipated discrimination was lower than that reported in the other countries. Conclusions — Interventions to reduce discrimination against people with schizophrenia may need to address both actual and anticipated discrimination. Targeted therapeutic strategies aiming to improve self-esteem of people with schizophrenia may be usefulto facilitate their social participation and full inclusion in the community.

Declaration of Interest: The authors declare they have not competing interests.

Aim – To investigate whether employers who have experience of hiring people with mental health problems differ significantly from those without such experience in terms of knowledge, attitudes and behaviours regarding mental health in the workplace, and the concerns which they report about employing people with mental health problems. We also examine whether non-workplace social contact is associated with the above variables. Methods – A telephone survey was conducted with a randomly selected sample of British employers. The sample included a similar number of human resource managers and managers/executive employees in other roles. Results – 502 employers took part. Having employed someone with a mental health problem was associated with closer non-workplace social contact. Those with experience of employing applicants with mental health problems had significant differences in knowledge (regarding the law), and behaviour (having a policy on hiring applicants with disabilities) but not in attitudes. Conclusions – Non-workplace social contact may be useful to consider in understanding hiring practices. The nature of social contact at work and possible lack of impact of this contact on employer attitudes and concerns warrants further study. Greater support is needed for employers to understand the law regarding mental health problems in the workplace.

Declaration of Interest: The study was part funded by Big Lottery and Comic Relief through their funding of the Time to Change programme. The study was also supported by the National Institute for Health Research (NIHR) applied programme grant awarded to the South London and Maudsley NHS Foundation Trust. The authors report no conflict of interest in the preparation of this manuscript.

Aim – To review the literature on the efficacy of electroconvulsive therapy [ECT], with a particular focus on depression, its primary target group. Methods – PsycINFO, Medline, previous reviews and meta-analyses were searched in an attempt to identify all studies comparing ECT with simulated-ECT [SECT]. Results – These placebo controlled studies show minimal support for effectiveness with either depression or ‘schizophrenia’ during the course of treatment (i.e. only for some patients, on some measures, sometimes perceived only by psychiatrists but not by other raters), and no evidence, for either diagnostic group, of any benefits beyond the treatment period. There are no placebo-controlled studies evaluating the hypothesis that ECT prevents suicide, and no robust evidence from other kinds of studies to support the hypothesis. Conclusions – Given the strong evidence (summarised here) of persistent and, for some, permanent brain dysfunction, primarily evidenced in the form of retrograde and anterograde amnesia, and the evidence of a slight but significant increased risk of death, the cost-benefit analysis for ECT is so poor that its use cannot be scientifically justified.

Declaration of Interest: Neither author has any financial conflicts of interest in relation to this paper.