Patient records from the emergency clinic at the Maudsley Hospital were analysed from July 1999 to assess the standard of risk assessment for self-harm and for harm to others routinely recorded by junior doctors. The recorded risk factors for the consultation and the evidence that risk had been considered were noted. An intervention that comprised two seminars and two written reminders about the importance of risk assessment was made and the analysis of records in the emergency clinic repeated for July 2000.

Risk factors were recorded more frequently for harm to self than for harm to others. There was little recorded evidence that consideration had been given to the overall risk of harm to self, and there was no evidence of this for harm to others. Recording of risk did not change significantly between 1999 and 2000.

Assessment for risk of harm to others is not a part of the emergency consultation that is emphasised by the majority of junior psychiatrists. Changing practice will require a shift in the way that risk to others is presented in psychiatric teaching.

Patient-held records have been introduced in mental health over the past 2 decades. This follow-up study aimed to evaluate one pilot project 5 years after the records were introduced. All patients initially interviewed 4 years previously were approached and asked about their use and opinion of the record.

Of the 19 people interviewed, 12 were still using the record and had a positive opinion of its usefulness. Of all community mental health team contacts, 72% were recorded in the patient-held notes.

Patient-held records are sustainable in a naturalistic clinical setting over the period of 5 years.

This paper reports the findings of a 1999 survey of academic old age psychiatry staffing and teaching in UK and Irish medical schools.

Just over half had staff established at the level of senior lecturer or above. These schools devoted more time to undergraduate teaching, covered more topics and used a wider range of teaching methods.

There is a need for further academic development in old age psychiatry to drive the development of the speciality, and to ensure that all medical undergraduates receive an adequate training in this subject area.

To identify and evaluate the reliability and quality of educational materials provided to individuals with schizophrenia and their carers. Materials used by mental health professionals working in community and in-patient settings were collated. Two independent raters used the ‘Discern’ questionnaire to assess the publications.

Fifteen documents were identified, but only 11 were suitable for evaluation. Interrater reliability of ratings using the Discern tool was highly significant. No educational package scored maximum marks, but four scored in the good quality range. About a fifth of the materials in widespread use were assessed as of poor quality.

The use of a rating instrument to assess the quality of educational publications appears to be a reliable and acceptable way to identify the strengths and weaknesses of widely available materials. Staff can use these data to assess the quality of their preferred materials against other publications and make an informed selection.

We describe the neuropsychiatry outreach clinic in west Kent and review referrals to the clinic over a 4-year period. By comparing the referral pattern of west Kent with adjacent health authorities we show how an outreach clinic can influence the number of neuropsychiatric referrals.

Referrals from west Kent increased from 87 in the 4-year period prior to the outreach clinic to 255 in the 4-year period that the clinic has been in existence. Forty-nine of these patients were first assessed in the outreach clinic. The number of referrals from east Surrey and east Sussex remained low in the same period.

An outreach clinic provides access to specialist expertise and increases local awareness of specialist services. Similar outreach clinics in other areas may enhance the clinical care of patients who are currently not being referred to neuropsychiatry.

Competence in patients with mental illness is an issue of growing importance. We present a matrix that provides a new tool to separate the elements involved.

This matrix is compatible with, and makes explicit, the Richardson Committee's suggestions concerning the incorporation of a test of capacity in Mental Health Act assessments.

We suggest that use of this matrix may offer practical help to clinicians in arriving at a clear understanding of each clinical situation and guide good practice in the use of the Mental Health Act, particularly in problematic cases.