Self-harm among adolescent in-patients exercises all who work with them. the UK has an exceptionally high prevalence of this behaviour compared with the rest of Europe. However, in one in-patient adolescent unit, in-patient self-harm was significantly reduced. Details of our rationale and intervention are presented, together with a retrospective data analysis.

Using a range of practical and psychological interventions, the alarmingly high level of self-harm was almost completely eliminated and this level has been maintained to the present.

Our results suggest that self-harm in in-patients can be managed and reduced without adverse effects on the patients. Our methods may be applicable to other settings, although some staff may initially feel uncomfortable with such policy.

We examined the prescribing practices concerning benzodiazepine and hypnotic medications at a university teaching hospital. Retrospective data from 74 consecutively admitted in-patients were analysed.

Benzodiazepines were prescribed to 51% of individuals on a routine basis and to 66% of individuals on an ‘as required’ basis. An indication was documented for 70% of individuals prescribed benzodiazepines routinely and for 29% of patients prescribed benzodiazepines ‘as required’. Hypnotic agents were administered to 24% of patients on a routine basis and 23% of individuals on an ‘as required’ basis. An indication was documented for 39% of patients prescribed hypnotic agents routinely and 12% of patients prescribed hypnotics ‘as required’.

Benzodiazepine and hypnotic agents are frequently prescribed without any clear reason provided in the patients' medical notes or prescription card.

To examine trends in appeals to mental health review tribunals and hospital managers' panels in a hospital covering two outer London boroughs from 1997 to 2007. Data were also used to explore associations between demographic variables, including ethnicity, and the results of appeal hearings.

The number of detentions under Mental Health Act Sections 2, 3 and 37 rose from 203 in 1996 to 279 in 2006. the percentage of these that went to appeal increased from 34% to 81% during the same period. However, there was no observed trend in the result of the appeals. the results were not associated with gender, ethnicity, marital status, age or the section involved; 12% of appeals were successful.

The study shows rising use of the Mental Health Act over the past 10 years and an increasing volume of appeals against its use. Since appeals are no more likely to result in discharge, the increased use of the Mental Health Act is not balanced by increased rates of discharge by review hearings. the study also demonstrates the rising workload for all involved in appeal hearings.

This paper assesses the economic impact of a crisis resolution team (CRT) in South London, using data from a prospective controlled trial. Two cohorts of patients were compared. After referral with a psychiatric crisis, the first cohort received existing services and the second cohort had access to input from a CRT. Baseline and follow-up 6-month costs were measured for 181 cases.

At follow-up, mean costs were £1681 less for the post-CRT patients, which was not statistically significant. However, a significant difference of £2189 was observed when patients with any CRT contact were compared with those with none.

The crisis resolution team resulted in lower costs. Such services can thus help to release funds for other forms of care.

Capacity legislation was implemented in Scotland in 2002 under the Adults with Incapacity (Scotland) Act 2000. This questionnaire study aimed to explore the knowledge, experience and opinions of the Act among consultant psychiatrists in Scotland (n=373; response rate 64%).

The majority of respondents had attended an induction programme: 74% were confident in their assessment of capacity and 54% felt confident in their use of the Act. Awareness of the principles and code of practice was good. the administration of the Act varied between areas.

Despite good knowledge of the Act, respondents reported they were largely self-taught and would welcome further training. Administration, uptake by other medical disciplines and discrepancies between principle and practice were raised; these concerns are relevant to amendments of this legislation and to other jurisdictions.

To provide multiple estimates of the numbers of Australian and Victorian families and children living in families where a parent has had a mental illness. We used the Australian Bureau of Statistics Victorian Mental Health Branch service usage and data collected from 701 community participants to triangulate prevalence information.

According to population estimates, 23.3% of all children in Australia have a parent with a non-substance mental illness, 20.4% of mental health service users have dependent children and 14.4% of the community study participants report having at least one parent with a mental illness.

The multiple prevalence estimates of the numbers of children in families with parental mental illness provide fundamental information for psychiatric policy, planning and programming.

Despite considerable knowledge of outcomes for patients who complete treatment for eating disorders, less is known about earlier stages in the treatment journey. This study aimed to map the efficiency of the anticipated patient journey along care pathways. Referrals to specialist eating disorder services (n=1887) were tracked through the process of referral, assessment, treatment and discharge.

The patient mortality rate was low. However, there were serious problems of attrition throughout the care pathways. of the original referrals where a meaningful conclusion could be reached, in approximately 35% the person was never seen, only half entered treatment and only a quarter reached the end of treatment.

This study demonstrates considerable inefficiency of resource utilisation. Suggestions are made for reducing this inefficiency, to allow more patients the opportunity of evidence-based care.