Among the proposed changes in the current review of mental health legislation in England and Wales is the abolition of the right of the nearest relative to discharge patients from assessment and treatment orders (Sections 2 and 3 of the Mental Health Act 1983). We aimed to determine the clinical outcome of patients whose nearest relative applies for discharge. A retrospective case–control cohort study in a south London NHS Trust of 51 patients successfully discharged by their nearest relative and 33 patients whose nearest-relative applications were blocked by the treating psychiatrist on the grounds of ‘dangerousness'.

Patients discharged from section by their nearest relative did not differ significantly from controls in all the measures of clinical outcome examined.

This study suggests that discharges by the nearest relative against psychiatric advice are not associated with a poor clinical outcome.

To estimate specific time and resource implications for professionals, if proposed changes to the Mental Health Act 1983 (England & Wales) in the Government's white paper were to be implemented unchanged. An audit of time spent on current procedures was extrapolated.

The amount of time required to comply with the Act will rise substantially (by 27% overall). Social workers and independent doctors will spend 30% and 207% more time respectively, complying with the Act, but psychiatrists providing clinical care to forensic patients should be largely unaffected.

If the Government presses ahead with its plans for mental health law reform as currently proposed, extra resources will be required to provide additional social work and independent medical time – or other services for patients will suffer.

To compare the assessment by community psychiatric nurses and junior psychiatric doctors of individuals following deliberate self-harm (DSH) and, in particular, to elicit differences in referral practices and perceptions of mental illness. The health professionals involved completed questionnaires after carrying out DSH assessment.

There was a significant difference in referral patterns between doctors and nurses after DSH assessment. Doctors were significantly more likely to refer individuals for psychiatric follow-up which involved direct contact with other doctors (51 of 72 (71%) compared with 60 of 175 (34%)). Doctors were also significantly more likely than nurses to perceive individuals as having a mental illness (57 of 72 (79%) compared with 86 of 175 (49%)).

Further research is warranted to establish the precise reasons for these differences, and to determine whether the widespread introduction of nurse-led services is an effective and efficient use of resources.

A postal survey was sent to all consultant child and adolescent psychiatrists in the UK and Eire examining recruitment, retention, job satisfaction and job stress.

A response was received from 333 (60%) child and adolescent psychiatrists. Sixty-one per cent indicated their service was inadequately resourced and 89% reported that their service failed to meet the College's minimum staffing requirements. Safe access to in-patient beds was not available to 71%. One hundred and thirty vacant posts were identified. Rates of psychological distress and burnout were high. Adequate services and the presence of a close, supportive colleague were associated with higher rates of satisfaction and lower rates of psychological distress and emotional exhaustion.

A multi-faceted approach is suggested and recommendations are described under the headings of self-management, training, recruitment and commissioning.

A number of relevant professional bodies were invited to state their views on the responsibilities of consultant child psychiatrists within multi-disciplinary teams in order to ascertain whether there was any consensus on the issue.

Little consensus or clarity emerged, save for agreement on child psychiatrists' expertise with medical matters. Only medical organisations believed in a notion of the consultant holding ultimate responsibility, although definition of this remained elusive.

Consultants may need to seek clarity about their clinical and legal responsibilities from their employing Trust. However, there are many other dimensions to responsibility which have relevance for the training of child psychiatrists.

The need for training to prepare mental health professionals to assess and manage risks is now well established. This paper reports on the development, delivery and evaluation of interprofessional clinical risk training in Salford and Manchester since 1998. A training-needs analysis was carried out, followed by post-training evaluation and an impact-monitoring questionnaire.

The training was very well received by participants, with over 90% of them meeting the objectives and 100% of respondents reporting that the training had a positive impact on their clinical practice more than 12 months afterwards.

The evaluation of the training demonstrates that a properly planned and delivered 2-day clinical risk assessment course can have a positive impact on the practice of clinicians in mental health services. However, this should be seen only as an introductory course, as more advanced risk training is required. This is currently being delivered and planned.