To provide a composite view of the impact of indefinite detention under the Anti-Terrorism Crime and Security Act 2001. Until recently, a number of detainees had been detained under this legislation since December 2001. The impact of this on eight detainees and three of their spouses is examined through qualitative analysis of 48 reports and documents compiled by 11 psychiatrists and 1 psychologist.

Detention has had a severe adverse impact on the mental health of all detainees and the spouses interviewed. All were clinically depressed and a number had post-traumatic stress disorder. The indefinite nature of detention was a major factor in their deterioration.

The use of indefinite detention without trial has severe adverse consequences that may pose insurmountable problems for the prison healthcare system.

In 2001 the National Institute for Clinical Excellence (NICE) produced guidance for the treatment of Alzheimer's disease. NICE encourages the withdrawal of medication when the Mini-Mental State Examination (MMSE) score reaches 12 and advises against the treatment of patients with cholinesterase inhibitors if the MMSE score is below 12. Most health authorities have rigorously enforced these guidelines, which has put old age psychiatrists in a difficult position. Our prospective 12 week audit of consecutive patients examines the response to treatment of patients treated both in accordance with and outside of NICE criteria. We also investigated the effect of stopping the medication according to NICE's recommendation.

Our results suggest that patients outside the NICE criteria respond better than those within the criteria. More disturbingly, when the medication was stopped owing to the MMSE score falling below 12, we found a very high mortality rate (5 out of 25, 20%) or acute deterioration (12 out of 25, 48%). This suggests that the medication is beneficial in the later stages and should not be stopped purely because of the stage of dementia.

If we are to prevent unnecessary suffering, greater freedom is needed by old age psychiatrists in the use of these antidementia drugs. Patients with severe dementia may benefit from acute treatment. The withdrawal of medication in line with NICE guidance is poor clinical practice and likely to have adverse outcomes in a large proportion of cases.

A new fast-track assessment (FTA) clinic was established by a community mental health team (CHMT) in SouthEast London. Previously, those who responded to an opt-in letter were offered an appointment with a duty worker or at an out-patient clinic. In the new system, all routine referrals are booked into a single fortnightly clinic staffed by two doctors and two to three other CMHT staff with post-clinic discussion of all cases (2–6 min per case). A total of 100 consecutive referrals before the introduction of the FTA clinic were compared with 100 following the introduction.

The interval between receipt of referral to first appointment offered was reduced from 55 to 18 days and to actual assessment from 71 to 26 days. Eighty-four referrals to the FTA were offered a first appointment date that was within 21 days of receipt of a referral, compared with four before the introduction of the FTA. These differences were highly significant. There was a trend for more patients to attend for assessment after the FTA clinic was introduced (79 compared with 68).

This simple re-engineering of the assessment process within a CMHT has achieved its objective of reducing waiting times to first assessment appointment. It also appears to have reduced the number of referrals that do not result in an assessment.

The aim of the survey was to establish the organisational structure and practice of specialised services for post-traumatic stress in the UK. Questionnaires were collected from 17 specialised trauma services across the UK.

Specialised trauma services use similar therapeutic programmes, but differ with respect to the characteristics of the treated clientele and organisational features. Although almost all services routinely measure outcome, some of the instruments used vary. There is no clear association between staff resources and number of patients treated.

Specialised traumatic stress services in the UK employ evidence-based treatment methods. A uniform protocol to measure outcome may help to establish a common UK-wide database on outcome of specialised treatment, and facilitate a reliable comparison between different service organisations and programmes. Organisational features should be considered to increase the efficiency of services.

There is interest in how outcome measures routinely used in mental health settings compare with each other in assessing risk and emotional disturbance. The relation between the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE–OM), a client-completed measure, and the Health of the Nation Outcome Scale (HoNOS), a clinician-completed measure, was explored using data from 297 clients referred to secondary services by a primary care mental health liaison team.

The correlation between CORE–OM and HoNOS was 0.50, with cluster and factor analyses revealing overlap between the measures in assessing risk to self and others and general emotional issues.

Although the measures are typically used in different settings, the overlap suggests that both might be useful in any setting where assessment for mental health problems and risk is needed.