Multidisciplinary approaches to complex cases referred to child and adolescent mental health services (CAMHS) are both mandated and necessary. However, multidisciplinary working is time-consuming and resource-intensive, especially where processes are not functioning optimally. We describe a completed audit cycle: auditing the consultation and liaison service within a community CAMHS, introducing service modifications and repeating the audit 6 months later.

During the first audit over 80% of data were lost; in the re-audit only 30% were lost. Audit results were successfully used to stimulate, design and implement change, with service improvement.

Auditing the process of interdisciplinary consultations is challenging, but possible. Where staff seek service improvement, audit can result in positive change without alienating staff.

The aim of this study was to explore older users' and carers' views of attending out-patient clinics for older adults. A questionnaire was designed to be distributed to all patients attending out-patient clinics for a period of 1 month in January 2007.

The response rate for returning the completed questionnaire was 71%, and 95% of these respondents were satisfied with their overall experience of attending out-patient clinics. Although satisfaction levels were high with every aspect of out-patient clinics, 49% preferred the hypothetical option of being seen at home.

The role of psychiatric out-patient departments for older adults merits further research, comparing cost and user/carer acceptability with home or general practitioner surgery-based treatment.

We surveyed the usage and perceived utility of standardised risk measures in 29 forensic medium secure units (a 62% response rate).

The most common instruments were Historical Clinical Risk–20 (HCR–20) and Psychopathy Checklist – revised (PCL–R); both were rated highly for utility. the Risk Matrix 2000 (RM2000), Sex Offender Risk Appraisal Guide (SORAG) and Static-99 were the most common sex offender assessments, but the Sexual Violence Risks–20 (SVR–20) was rated more positively for its use of dynamic factors and relevance to treatment.

Most medium secure units use structured risk assessments and staff view them positively. As HCR–20 and PCL–R/PCL–SV (Psychopathy Checklist – Screening Version) are so widely used they should be the first choices considered by other services.

Continuity of care is an important aspect of service provision. We retrospectively examined the number of changes over a 2-year period in care coordinator for new patients on enhanced care in a London borough. Deprivation score, length of hospital stay, and health and social needs were examined for association with continuity of care.

Twenty-six patients met the inclusion criteria; ten patients (39%) had a change in care coordinator. Patients having one or more changes in care coordinator were found to live in significantly more deprived council wards (P=0.004), but their needs score (P=0.863) or length of hospital stay (P=0.368) were not significantly different than in those who did not have changes in care coordinator.

Social deprivation affects relational continuity of care in community teams but the mechanism requires evaluation.

The Rainbow programme was introduced in January 2004 as a structured in-patient treatment for anorexia. There were two strands to the programme evaluation: a notes review of a cohort of in-patients and a series of questionnaires to users, carers and staff.

There was an improvement in adherence to the National Institute for Health and Clinical Excellence guidelines and 94% of staff responders found the Rainbow programme framework useful.

The Rainbow programme improved the level of care provided. There is scope for improvement in the distribution of the programme manual.

Programme budgeting and marginal analysis (PBMA) is a recognised tool for commissioning healthcare. the objectives of this project were to test the acceptability, data availability and practical value of PBMA within the sphere of mental health. the PBMA methodology was applied to the consideration of Norfolk Primary Care Trust's National Health Service expenditure on mental health for the fiscal year 2006/7.

The project successfully attracted the interest of, and contribution from, important stakeholders with the exception of general practitioners. the process led to the identification of areas for disinvestment, releasing funds to be made available for the development of new services, or enhancement of existing services.

Programme budgeting and marginal analysis is a useful structured tool for the commissioning of mental health services. It is essential, however, that psychiatrists fully engage with the process in order to have an influence over the future direction of mental health services.