This study reports on how 139 nursing and 42 medical staff in trauma units viewed psychiatric aspects of trauma, their training and the impact of their work upon them. Insufficient attention was paid in their units to the psychiatric aspects of trauma. There were important gaps in staff knowledge relating to the diagnosis and prevalence of post-traumatic stress disorder, and to the use of night sedation. Nearly all staff favoured providing information regarding post-traumatic psychiatric reactions for relatives, but nearly half had reservations about giving such information to patients. Job satisfaction was reported by most, but their emotional and training needs were generally not met.

Dissatisfaction with current psychiatric services provided for women in secure health environments is described. Mention is made of recent improvements in the special hospitals. A set of key criteria is suggested to judge the effectiveness of services wherever provided.

This prospective, sequential study compared the costs of using haloperidol or zuclopenthixol acetate for rapid tranquillisation. In the first phase, all 16 patients admitted to our psychiatric intensive care unit requiring rapid tranquillisation received haloperidol; in the second phase, all 26 such patients received zuclopenthixol acetate. Mean overall costs per patient were substantially lower in the zuclopenthixol acetate group than the haloperidol group, mainly because special nursing was used much less in the zuclopenthixol acetate group. All nursing staff preferred to use zuclopenthixol acetate rather than haloperidol. Zuclopenthixol acetate could potentially reduce the need for special nursing and produce valuable cost savings.

This paper describes the process of involving mental health service users in the planning and running of a community service. PACT (Psychiatric Assertive Outreach and Continuing Care Team) is based in south London and provides care for people who have severe and enduring mental health problems. We present an approach based on three years of intensive collaboration with service users. Community services will only become effective if they respond to need and develop new partnerships with people in contact with them. People require the opportunity to experience new ways of becoming involved at all levels of service provision and, therefore, efforts need to be made to develop a variety of opportunities for people to put forward their views. This takes time and determination by all involved.

An earlier survey of general practitioners in Grampian established their priorities for information they wished to learn from early discharge summaries on psychiatric patients. This survey resulted in changes to the format of the early discharge summary. An audit of information provided before and after these changes found significant improvement in 7 out of 10 items regarded by general practitioners as being of greatest importance.

Records were obtained of all suicide and open verdicts in York (n=127) between 1990–1994 inclusive. Those with no past or current contact with psychiatric services were identified (n=67). The extent and nature of this group's general (i.e. non-psychiatric) hospital contact in the months prior to death was established. Thirteen per cent (9/67) of these received general hospital input in the month before death with eight out of the nine aged over 65. Five of the 67 suicides showed evidence of depression. General hospital practitioners are in a position to make a small but important contribution in reducing the suicide rate.

Thirteen per cent of referrals of ex-servicemen to a military psychiatric centre for the treatment of combat-related post-traumatic stress disorder (PTSD) in a 12-month period have proved to be factitious. A simple classification of factitious combat-related PTSD into those with no military service and those with military service but with false claims of combat is described. The possible causes of this behaviour are discussed and a guide to the detection of factitious claims for psychiatrists without military experience is given.

In recent years the psychiatric users' movement has become more prominent and powerful. In this article aspects of the movement and some of the resultant challenges to psychiatrists are described. Psychiatrists are often regarded by users as resistant to its development. The author argues that psychiatrists may benefit from a creative engagement with this process of change.

Ascribing human behaviour to the influence of genetic factors is a reductionist idea that inappropriately applies the explanations of physical science to the human social world. The result is that the designation of some behaviour as deviant is disguised as objective science. The high profile of genetic research means that we must be alert to the potential social consequences of this type of reasoning.

It is a commonplace of clinical practice that those with obsessional disorder, or with obsessional features to a psychotic illness, often develop concerns about cleanliness and contamination, some with a focus on everyday bodily processes. In a search of the Patent Office for psychotic ideas (James & Gilluley, 1997), it became apparent that patents reflecting concern about bodily functions were strongly represented in the patent collection. These stood out from patents concerning innovation in conventional medicine or medical appliances, and some of them had the flavour of the more bizarre ideas on the subject put forward by patients in our psychiatric practice. It was decided to explore the collection of the Patent Office further, with a view to surveying the range of such patents and examining their relation to the times in which they originated. The procedure used was the same as in our previous article.

A one-day audit in a learning disabilities hospital revealed 15 patients (9.4% of the hospital population) on hypnotic medication. Guidelines were then developed for the use of hypnotic drugs. An audit of hypnotic drug usage was repeated for the 12-month period of 1994 which revealed that five patients were started on hypnotics.

The integration of medical/‘biologial’ and psychological approaches to the human mind is unique to psychiatric training. There have been past tensions between the two views, but the ability to integrate them is increasingly recognised as an indispensable contribution of our profession to mental health care as a whole.

Palliative care is a growing speciality. The terminally ill suffer high levels of psychiatric morbidity. The involvement of one senior registrar in setting up a liaison psychiatry service to a Marie Curie Hospice in special interest sessions is described. A liaison-consultation model developed and 29 referrals are described over six months.

The Glasgow Media Group, through a combination of media watching and group interviews, has confirmed the importance of media representations of mental illness, with its finding that negative images can outweigh even an individual's direct experiences in this area (Philo, 1996). In one recent summary, Philo concludes: “the results show clearly that ill-informed beliefs on, for example, the association of schizophrenia with violence can be traced directly to media accounts” (Philo, 1997). The origins and strength of this association can be traced to cinema, where powerful images of violent ‘insanity’ endure today. In a questionnaire of 487 people who had a family member with severe mental illness, 85.6% identified “popular movies about mentally ill killers” as the largest single contributor to the stigma of that illness (Wahl & Harman, 1989).