To examine knowledge among Scottish psychiatrists of the 1996 guidance on National Health Service (NHS) responsibility for continuing healthcare, a postal questionnaire was devised and sent to the 132 consultants and specialist registrars in the South-East Scotland Deanery in May 2007.

Two-thirds of the clinicians (67%, n= 88) responded, 88% of whom had in-patient responsibilities. Only 24% responded positively to an awareness of the current Scottish guidance. There was a strong association between awareness of the guidance and psychiatric speciality, and greater awareness among clinicians with previous experience of a relevant complaint or appeal.

Uncertainty about NHS continuing healthcare guidance among practising psychiatrists suggests a need for increased awareness of the issues, with training implications for the new guidance on NHS continuing healthcare in Scotland which became effective in February 2008.

To explore the impact of diagnosis on people who experience psychosis. Eight participants were interviewed about the impact that diagnosis had on them.

The research found that the impact of diagnosis can involve both positive and negative elements. It can be a ‘means of access’ as well as a ‘cause of disempowerment’. It can help by ‘naming the problem’ and hinder by ‘labelling the person’. It is a ‘cause of social exclusion’ for all, but despite this service users can be successful in ‘achieving social inclusion’.

The findings have implications for how diagnosis is imparted by psychiatrists if they are to help to facilitate recovery and social inclusion.

To explore why and how on-site urine drug testing is performed in in-patient settings. Data were collected by questionnaire in four acute psychiatric wards.

The most commonly cited reasons for testing were suspected drug use and as a routine part of the admission procedure. On-site testing was typically favoured over laboratory methods owing to the rapid turnaround of results and ease of use. In 81% of cases the result of the tests had no effect on immediate management. the majority of staff had not received formal training in their use.

Clinical use of on-site drug tests does not reflect their established limitations. Guidance is required to direct staff in the use of this commonly used assessment tool.

To describe services used by children with epilepsy seen by a liaison psychiatry team in Scotland and to examine existing guidance. Case notes of all patients with epilepsy were systematically reviewed to determine service involvement.

The majority of patients attended joint psychiatry and neurology clinics. Scottish Intercollegiate Guidelines Network (SIGN) recommendations for the psychosocial management of children with epilepsy were met. Most patients were assessed by a clinical psychologist and received educational psychology input, individual and family treatment approaches. Half had social work involvement.

A liaison model is presented for the management of children with more complex epilepsy and psychiatric disorders.

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.

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.

The epidemiology of self-harm in older people is poorly understood and a low incidence rate hampers research efforts. Regional surveillance for this may assist with research and improve clinical services accordingly. This study involved undertaking a scoping exercise to explore current management of self-harm in elderly people in selected North London hospitals, by interviewing healthcare professionals directly involved in their treatment.

The study showed varied methods of coding clinical information across trusts, with no consistent method of surveillance.

Implications of this exercise involve generation of a summary document that will educate stage two of the project, which is the convention of a working party to implement a surveillance system across the region.

To explore user perspectives on the content and delivery of the undergraduate curriculum in psychiatry. the study design was qualitative and used focus groups. Four focus groups were run with a total of 28 participants.

The key finding was that participants were clearer about the attitudes they felt students should convey than they were about the skills and knowledge required.

Service user perspectives on the content of the undergraduate psychiatry curriculum need to be considered as curricula are developed.

To investigate whether children are in contact with their forensic in-patient parents and whether they are offered support regarding their parent's mental health and offending issues. A questionnaire was completed on in-patients in two medium secure units.

Only 69 of the in-patients surveyed had children aged 18 or under, but only 25 had contact with their children. Support was offered in 14 cases and accepted in 10. Many patients had lost contact with their children.

Children of forensic in-patients appear to be a neglected group, with limited attempts made to support them. In the absence of specific difficulties of their own, the onus may be on forensic mental health services to initiate contact.

We sought to gain an impression of how the Psychiatric Bulletin has changed over time. We took a ‘snapshot’ of the journal in two time periods, comparing characteristics of articles published early in its development (1988–1992) with those published more recently in its current format (2002–2006).

The Bulletin has become more scientific, with the proportion of articles categorised as ‘original’ increasing from 31% (217/700) in the early period to 47% (263/565) in the later period. There is less emphasis on history of psychiatry and the arts.

Changes in the Bulletin are in line with psychiatry and medicine in general, placing more emphasis and value on research with systematic methodology.

Suicide in schizophrenia remains frequent. One of the best predictors of suicide, previous self-harm, is increasing in young people. the aim of this case-note review was to investigate the frequency of a history of self-harm for individuals presenting to psychiatric services with a first episode of psychosis in our local area and study their demographic characteristics.

A history of self-harm was found in 32% of the cohort. the predominant method of self-harm was self-laceration. In univariate analyses, age and gender were significant predictors of self-harming behaviour.

The rate of self-harm among those with first-episode psychosis is high. Efforts to reduce the rate of completed suicide in psychotic illness need to focus on this risk, which often predates contact with psychiatric services. This emphasises again the need for early detection and intervention in psychotic illness.

Postal questionnaires were sent out to 66 learning disability psychiatrists to assess their knowledge and experience of the Mental Capacity Act 2005.

A response rate of 55% (n = 36) was achieved; 22 (61%) respondents felt that patient care had improved; 16 (44%) felt workload had increased. Despite 79% (n = 23) of the respondents feeling that the training for the Act was adequate, only 19% (n = 7) were aware of the situations where patients had to be referred to the Independent Mental Capacity Advocate (IMCA) service and only 53% (n = 19) were aware that the Act currently does not cover patients who fall in the ‘Bournewood gap’.

Learning disability psychiatrists are still not conversant with significant parts of the Act and this raises questions about the adequacy of the training delivered. Implementing the Act should improve patient care but will have implications for the workload of professionals.