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Perceived difficulty in obtaining hospital admission for acute psychiatric patients was investigated in one health region using a self-reporting method. Over 17 months both inner city and rural districts reported a total of 327 episodes of difficulty in finding a bed. One hundred and six (32%) of reported cases could not be admitted, the remainder being admitted to a ‘leave’ bed, a bed booked for another patient, or elsewhere, solutions likely to compromise care. Attempts to locate a vacant bed required numerous telephone calls and led to considerable delays. Thirty-nine (12%) of the patients were described as particularly ill, but five of them absconded during the prolonged search for a bed, and a further 17 had to remain in the community, pending a vacant bed, including two aggressive and eight suicidal patients. Considerable under-reporting was confirmed. Possible consequences of the situation are discussed.
A sample of 49 ‘elderly graduate’ residents of a hospital designated for closure were surveyed in 1987 and followed up five years later. Twenty-two patients (45%) had died: the mortality rate was much lower than that predicted by the regional health authority and approximated to that of the general population. All but one of the survivors was living in supported accommodation at the time of follow-up. The majority were satisfied with the move and were receiving an appropriate level of care. However there was significant unmet need for structured activities and companionship. During the follow-up period the survivors had declined in functioning.
When introduced into the NHS in 1991, the internal market world off purchasers and providers was greeted with considerable cynicism by many working in the mental health field. Three years on, this cynicism has to a large extent been supplemented by either support or hostility about the changes dependent upon individual experiences. However a more detached analysis suggests a more balanced picture of the impact off the internal market beginning to emerge.
Patients and their relatives sometimes make what to others appear to be unfortunate decisions. In this paper the ethical dilemmas raised by such decisions in the context of old age psychiatry are examined. The case also raises questions about financial responsibility for the care of the elderly and suggests that the health needs of patients can no longer be separated from their financial interests.
The Royal College of Psychiatrists (1991) has recommended that all local mental health services should include specialist psychotherapy departments. At present these are uncommon outside major teaching centres, although a considerable amount of simple psychotherapy is provided on an ad hoc basis by mental health professionals of various disciplines. This paper describes the structure, functioning and costs of a specialist department in a non-teaching district in the south west of England.
The Health of the Nation asserts that the suicide rate in England and Wales can be reduced by the provision of better health care services. In a sample of suicides in one district health authority, 61% had had contact with health services during the year prior to death, suggesting that improvements in these services could have an impact on the overall suicide rate. However, the proportion who had had prior contact varied between different age and sex groups and individuals in groups with the higher suicide rates tended to have the least contact. Therefore, the impact of health service improvements on the overall suicide rate may be limited.
As hospitals close and relocate, our patients are increasingly being moved between different sites and out into the community. A move back to a large institution, however, is rare. This article describes the move of an in-patient facility located in a general hospital to an old psychiatric hospital with which, historically, it did not have very strong links.
This paper examines the experience and motivation of junior doctors who successfully published in the Psychiatric Bulletin and The British Journal of Psychiatry, over a four month period. Most articles took over a year from first involvement to successful publication, although this varied according to the type of article. While having published is recognised to increase the likelihood of appointment to registrar and senior registrar posts, interest in the subject is frequently cited as a more important reason to publish among authors than enhancement of their curriculum vitae.
An audit was undertaken looking at the information covered and length off discharge summaries in a psychiatric day hospital. Initially data were gathered from 90 multidisciplinary summaries over 18 months. This showed that although some key headings were being covered, 20% of summaries tailed to include a diagnosis and 63% were longer than two sides. The strategy devised to improve practice was the presentation off these findings to an audit meeting involving all staff which led to a general agreement to improve weaker areas. Over the following six months data were gathered on 26 discharge summaries. Headings were covered more frequently, 92% included a diagnosis and 88% were two sides or less in length.
This paper summarises some of the key points raised at a workshop held in 1993 on the new undergraduate medical curriculum. At the workshop, the General Medical Council's recommendations were summarised, and examples were presented of current undergraduate courses which met them. There was widespread support among workshop participants for psychiatrists having an expanded role in the new curriculum, beyond a single clinical attachment, particularly in the teaching of communication skills and in collaborative teaching with other medical specialties.
I have spent all my professional life as a child psychiatrist working in hospitals and clinics. For many years I have been interested in helping bereaved children and conducted research on how best to help them. As the result of my interest I found myself being asked to see increasing numbers of children who were traumatically bereaved because of one parent killing the other, an event that the children often witnessed. I needed to familiarise myself with the effects of witnessing or being caught up in severe trauma, as well as the effects of bereavement. As I saw more and more of these traumatically bereaved children, I realised that child psychiatric services were not well organised to help these children who often needed emergency help. I decided, with the backing of the Royal Free Hospital, to retire from my post as head of a busy department and set up a clinic for children who had been acutely psychologically traumatised. This work is now supported by a grant through Cruse-Bereavement Care from the Department of Health. I wanted to see how others had organised services for such children so I applied for and was granted a Winston Churchill Travelling Fellowship to study trauma services for children in the USA. I spent a month visiting San Francisco, Los Angeles, Boston, New Haven and New York in September 1993.
Argentina, a country about the size of Europe, has a population of approximately 30 million people. Over 80% of the inhabitants occupy the few large cities. About 12 million people live in the neighbourhood of the capital, Buenos Aires. Unlike many other South American countries, it has a large middle-class population and a well developed social infrastructure and industry. However, the country has been the subject of considerable political instability with many recent changes in government including several revolutions. These have resulted in many changes of leaders of institutions including senior members of the medical profession. Psychiatry has been particularly vulnerable because of its social identity and social function. As a consequence most of the leaders of psychiatric institutions and services, including the Professor of Psychiatry, have been dismissed from office following changes in government. This has greatly impeded the development of psychiatric services and academic psychiatry. Despite many natural resources, the political upheavals have resulted in a considerable weakening in the economy with inevitable consequences on the funding of health care and the universities and the creation of a large poverty trap for the most vulnerable.
The vigorous public profile adopted by the College in the ‘Defeat Depression’ campaign (Psychiatric Bulletin, 1993, 17, 573–574) is to be welcomed, but the proposed educational programme is premature. The MORI poll is not an adequate basis for understanding how ‘depression’ is popularly conceived nor how people respond to it. The research report (Royal College of Psychiatrists, 1992) says little about the methods used in the qualitative part of the study: whether the researchers were properly trained in ethnographic field interviewing to elicit illness categorisations, and their ability to elicit the whole complex of ideas and actions, involving nomenclature, causation, agency, recognition and recourse to treatment.
Jadhav & Littlewood make some interesting and thoughtful points, but I cannot agree with some of their syllogisms. I certainly do not sympathise with the pejorative tone of their comments (“to mount a glossy [sic] campaign … is frankly disturbing”) nor accept what appears to be their principal conclusion that “the proposed educational programme is premature”.