Objectives: To describe the characteristics of the patient groups with severe and enduring mental illness residing in high support community residences in Dublin North East Mental Health Service and the impact of a rehabilitation and recovery service on their outcomes since the instigation of that service.

Method: Data was collected retrospectively on current and past residents from case notes and staff interviews. Data included demographics, psychiatric history and results of rehabilitation interventions. The results were compiled and analysed using descriptive statistics.

Results: Fifty patients were identified. The majority were male (62%) with a diagnosis of paranoid schizophrenia (66%).The levels of co-morbid alcohol and drug misuse were 48% and 36% respectively. Histories of verbal/physical aggression were found in 70% and noncompliance in 60%. Two thirds of patients had a past history of being detained under the Mental Treatment Act (1945). Ninety-four per cent were unemployed at admission to the residence and following rehabilitation intervention 60% were linked with vocational training programmes and 10% with community employment schemes. ‘New long-stay’ and ‘old long-stay’ patients showed a trend towards poorer outcomes, whereas patients who had previously lived in the community showed a trend towards progressing to lower levels of support.

Conclusions: Positive outcomes were achieved following active rehabilitation interventions, but there remained a cohort of patients whose needs could not be met in a supported community rehabilitation residential programme. This highlights the need to ensure that a range of rehabilitation services from inpatient to supported community placement are provided to meet the needs of patients with severe and enduring mental illness with complex needs.

Objectives: This study examines (1) what are the minimum accepted baseline investigations recommended in the literature prior to prescribing in child psychiatry and (2) whether these investigations are routinely performed.

Method: Medical literature on prescribing in child and adolescent psychiatry was reviewed, and a list of minimum baseline investigations recommended in the literature was established. A postal survey was performed to establish what current clinical practice is among child and adolescent psychiatrists. Current practice was compared with the recommendations in the literature.

Results: There are nine minimum accepted baseline investigations which are consistently recommended in the literature on child psychiatry. Six investigations are routinely performed by over 75% of respondents. However only 30% (n = 16) reported that they ‘always’ carried out eight or more of the nine recommended minimum investigations.

Conclusions: A consensus statement is necessary, providing a list of recommended investigations prior to prescribing in child and adolescent psychiatry. Continuing medical education can then highlight the importance of these investigations.

Objectives: We set out to review all admissions from the criminal justice system to the Central Mental Hospital from January 1997 to December 2003, with particular attention to patient diagnoses, offences, source of admission, length of stay, and patterns of discharge. This study was undertaken to assist with future service planning and determination of resource needs.

Methods: The service maintains a combination of electronic and handwritten records of all admissions. Information was extracted concerning all admissions from January 1, 1997 to December 30, 2003. The data was analysed using a statistical package, SPSS 11.0 for Windows.

Results: Nine hundred and eighty-six admissions of 780 individuals from the criminal justice system were recorded from January 1997 to December 2003. There has been an increase in the proportion of patients admitted suffering with severe mental illness. There has also been a significant shift in the pattern of discharges, with a higher proportion of patients leaving to return to their local hospital. The proportion of admissions returned to prison has fallen from 91.1 % in 1999 to 64.7% in 2003, while 3.3% of individuals admitted became new long-stay cases.

Conclusions: A shift in the profile of patients admitted in recent years reflects changes within the National Forensic Mental Health Service. An increased provision of regular and structured psychiatric input to the prisons has facilitated the identification of prisoners with mental illness. The shift from prison liaison to diversion from the Criminal Justice System to mental health services is however in its early stages.

Objective: There is a paucity of literature on the content of referral letters to psychiatric services and few relating specifically to referrals to a department of old age psychiatry. There has been a significant increase in referrals over the last five years to this service, which may reflect the ageing population and a greater awareness of the service. Our objective was to evaluate the quality and legibility of information received, clarity of reason for referral and details of pre-referral management.

Methodology: The clinical records of the first 100 referrals in 2002 to this department were analysed. The referral letters were examined for the documentation of a number of demographic variables, reason for referral, interventions to date and level of urgency.

Results: The clinical records of nine patients did not have an identifiable referral letter at the time of this analysis. Of the remaining 91 analysed, 59% were referred by their GP, 33% were inpatient liaison referrals and 8% from outpatient departments. In the majority, patients' details were given, however, only 30% included a phone number. Next-of-kin was mentioned in 29%. GP's name was included in 71% of referrals from OPD and 7% of liaison referrals. The level of urgency was stated in 19%. Whether a domiciliary or OPD visit would be more appropriate was stated in 22%. The reason for referral was clear in 75%, with 43% including some aspect of Mental State Examination, 7% had included a MMSE score, 1% mentioned level of suicide risk.

Thirty-one per cent had pre-referral investigations and 45% had pre-referral treatment documented. The letters were clearly legible in 73%.

Conclusion: The information in the referral letter in many cases was insufficient to prioritise and expedite appropriate assessment. It is planned to introduce a proforma referral form, specific to old age psychiatry, which would include the information which is required and which would, hopefully, lead to a more efficient service.

There is a strong link between childhood adversity and subsequent substance misuse. We describe a case of childhood adversity consisting of physical and sexual abuse, experience of homelessness in childhood and adulthood, intimate partner violence and polysubstance misuse in a 32 year old woman currently attending the methadone maintenance programme in the Drug Treatment Centre Board, Trinity Court, Dublin. The relevant literature to the case is reviewed in relation to the aetiology and symptoms of this complex case.

We report a case of a male asylum seeker, protesting politically, who stitched his lips together, presenting to a psychiatric service for assessment. We review the literature in this area. Funding of psychiatric services to meet the complex needs of immigrants should be an integral part of service development.