The aim was to review the assessment and management of the psychosocial risk (including substance misuse) of older children presenting to the accident and emergency department, with a view to making recommendations to improve services. The method used was to inspect casualty records of attendances over two weeks of 11-16-year-olds.

In no cases was any note made of whether substance misuse might have occurred. Cases of apparent psychosocial risk were, however, dealt with appropriately in the main.

Brief advisory guidelines were written for accident and emergency staff to promote consideration of the misuse of substances in older children, and an information leaflet was developed for young people and their parents.

Psychotherapy patients' views of treatment received from two senior registrars were obtained by questionnaire. The aim of the study was to give patients an opportunity to reflect on therapy and help trainees evaluate their therapeutic style and the therapy they provided.

The response rate was 86% (25/29). All patients recalled key issues covered in therapy, 96% (24/25) found therapy valuable. Seventy-two per cent (18/25) made comments about therapists' style and 20% (5/25) made suggestions for improvement of the service.

Clinical, service and training implications are discussed and it is suggested that this form of patient survey is a useful adjunct in outcome evaluation of treatments and of training.

To quantify perceived problems with psychiatric bed availability nationally using a questionnaire survey of all 210 UK mental health trusts.

One hundred and seventy-three (82%) trusts replied. Thirty (17%) are often over-occupied, 21 (15%) often have problems with bed availability. Ten (7%) often use extra-contractual referrals (ECRs). Frequent over-occupancy is associated with deprivation. Frequent use of ECRs is associated with relatively few beds.

Problems with bed availability are found nationwide, but outside southern England are relatively infrequent. Such problems are less pronounced than in Greater London.

This survey is the first UK study of trainee psychiatrists' experiences of patient suicide. One hundred and three senior and specialist registrars in psychiatry working in Scotland completed the questionnaire, representing an 81% response rate.

Almost half (47%) had experienced suicide of a patient in their care or otherwise known to them (e.g. through on-call experiences). Although only 28% recalled previous training on issues to consider following a suicide, all of these doctors found this to be of value. Many reported that patient suicide had a deleterious impact on their personal and professional lives. The most valuable supports were informal, and the trainees' consultants appeared particularly well placed to offer support and advice.

Many trainee psychiatrists experience the suicide of a patient. Such experiences have potential for adverse effects on doctors' professional practice and personal life. Greater availability of training in this area would allow trainees to be better prepared for such an event. Trainees' consultants have a pivotal role to play in providing appropriate advice and support after a patient suicide.

A postal questionnaire of all pre-membership psychiatric trainees in the West Midlands was used to investigate the role of the educational supervisor. The trainees were asked about their experience of educational supervision, and also asked to rank a number of possible roles for their supervisor in order of importance.

A response rate of 70% was achieved. Trainees rated regular appraisal and assessment of skills and deficits as the most important role of the educational supervisor, but had only experienced this in 55% of their training posts thus far. Less than half of the respondents had developed a written educational plan with their educational supervisors, and trainees rated this the least important task of good educational supervision.

The results of this survey inform the training agenda for trainers, and emphasise the need to equip consultants with the skills to appraise their trainee's educational development.

To evaluate prescribing and monitoring of carbamazepine and valproate to patients in secondary care psychiatric units. Review of prescription cards and medical case notes.

Prescribing details for 433 patients were recorded. Both carbamazepine and valproate were widely prescribed for indications not listed in their product licences. Plasma level monitoring was not frequently undertaken, particularly with valproate. Where plasma levels were measured, apparently sub-therapeutic prescribing was found to be common. For the majority of samples, it could not be established that a true trough level had been taken. Monitoring of blood function was highly variable. Overall, the quality of both prescribing and monitoring was poor.

Patients may receive sub-therapeutic treatment or experience unnecessary adverse effects. Prescribing and monitoring need to be more evidence-based in line with the ideals of clinical governance.

We surveyed 25 general practitioners (GPs) on their needs from their local child and adolescent mental health services (CAMHS) to improve liaison and inform service development.

Most GPs refer to specialist services. Only a quarter deal with problems themselves. The top priority was easy and quick access to services. The most popular topics for GP training were interactions between teenagers and their parents, child abuse and eating disorders. No GP had formal training in child and adolescent psychiatry and further training was a low priority.

Such a survey has helped to develop a closer partnership between GPs and their local CAMHS using a service–response model. It has raised concerns about the under-identification of child mental health problems. It has informed CAMHS of the service and training needs of local GPs.

Information concerning team staffing, keyworker case-loads, and keyworker diagnostic case-mix was collected from six community mental health teams caring for 1651 patients to establish the clinical burden across teams and professions.

Team case-loads varied from 427 to 121, an average of 275 patients. Over half the patients were female, and psychotic disorders constituted 44% of the sample. The most common diagnoses were schizophrenia (28.6%) and depression (23.6%). Keyworker case-loads varied across both teams and professions, averaging 30 patients per full-time equivalent. Psychiatrists' case-loads were the largest. Diagnostic case-mix varied with profession. Community psychiatric nurses had the largest proportion of patients with psychosis (73.8%).

Multi-disciplinary community mental health teams have a shared view of appropriate work distribution. Consultant psychiatrists may underestimate the resources required by patients with non-psychotic disorders even in inner city areas.

This is an audit of 10 359 calls made to the national mental health helpline SANELINE between January 1996 and June 1998 aiming at describing the profile of suicidal callers.

More calls were by, or about, women. The most common age group for suicidal callers was 25–34 years, while those under 25 were least likely to call the helpline. Fifty-five per cent of all calls related to people suffering from depression, and 31% were for people with psychosis. The majority of sufferers who were planning suicide or were in the act of suicide at the time of the call were in contact with services, and almost three-fifths of sufferers reported problems with services.

There is an urgent need for innovative interventions targeting males and those under 25 years of age.

In order to investigate cognitive aspects of the experience of delusions, including onset and recovery, autobiographical accounts of schizophrenia were reviewed.

The sample was self-selected and biased towards women and highly-educated patients. The delusions described were usually gradual in onset and often occurred in the context of an odd or fearful mood, which was accompanied by distorted reasoning. Recovery was also gradual with an intermediate stage of reality-testing or fluctuation between belief and disbelief. Many patients retained residual aspects of delusional thinking after recovery. Most attributed their recovery to a combination of medication, psychotherapy, social support and personal coping strategies; some felt that their illness had enhanced their self-awareness or spirituality.

Further exploration of spontaneous coping strategies in recovery from delusions through personal accounts of illness would be valuable.

To assess what medication information long-term mentally ill patients required and acceptability of an advice service. Confidential consultations were offered by a community pharmacist at two mental health resource centres. The service was evaluated by patients and staff by questionnaire.

Data were collected on 33 consultations (30 users; three attended twice). Mean duration of consultations was 14.9 minutes (range 5–45). Antipsychotics and antidepressants were most commonly prescribed and enquired about. Most drug enquiries concerned adverse drug reactions (n=24) and therapy choice (n=17). All patients and staff hoped the service would be fully implemented.

Community pharmacists represent an acceptable, but underutilised, information provision service. Such a service could be overseen by specialist psychiatric pharmacists. This study reflects patients' concerns about the use of antipsychotics and antidepressants and the need to address them. Further work is needed to determine the impact of the service on clinical outcome.

The Community Care Act came into effect in April 1993. In order to see what impact this would have on the discharge profile of dementia inpatients, prospective studies of inpatient discharges from a dementia assessment ward before the Act, and five and 41 months after the Act were conducted.

The proportion of patients discharged to their own homes and to residential/nursing homecare remained unaffected by the Act. Duration of hospital stay increased after the Act in 1993 and 1996 (P=O.02) largely due to delays in placement into care homes. Placement delay was increased both in 1993 and 1996, but by 1996 the difference was no longer statistically significant. Duration of hospital stay was unaffected by the Act for those patients discharged to their own homes.

The new care management process by social services was found to be associated with delayed discharges for people with dementia requiring residential/nursing home placements, thus causing pressures on beds and hig her in-patient costs.

Long waiting lists and failure to attend appointments are a common problem in child and adolescent psychiatry. We introduced a novel ‘triage’ stage waiting list initiative to decrease the long waiting time fora first appointment at our child mental health service.

The waiting time to first appointment was significantly reduced and increased satisfaction with this process was expressed by clinicians, the referred families and referrers.

The reduction in waiting time was sustained over time and the triage process has now been implemented as routine practice. Following this implementation, there is no longer a lengthy waiting list for treatment after initial assessment. We would recommend this initiative, which screened referrals more efficiently and accurately, as a successful model for other child and adolescent services with long waiting lists.

A questionnaire sent to trainees in three regions of the UK asked them which current issues they felt were most important in psychiatry. Comments were invited of ways to improve the UK practice of psychiatry.

Trainees from each of the regions were concerned about inadequate resourcing, public expectations, manpower and quality of training. Solutions to these problems were collated.

The opinion of trainees reflects the recent initiatives undertaken by the Royal College of Psychiatrists to improve recruitment and retention. Consultants and trainees have similar concerns, which need to be addressed and monitored at a local and national level.

A retrospective review of a random sample of written complaints made by, or on behalf of, users of psychiatric services to determine: (a) the number and nature of written complaints against clinical aspects of services in a mental health trust over a 1-year period; and (b) what information complaints provide about deficiencies in the quality of care.

Out of 325 recorded complaints in 1997, 192 concerned clinical aspects of services; 89% of complainants complained once. There was a roughly equal split between complaints about technical v. interpersonal aspects of care. Complaints were far higher from in-patient than from out-patient settings. Evidence that the complaints related to psychotic symptoms was rare. All complaints were resolved locally, but 28 responses by the team were judged unsatisfactory. In 39 cases further action was taken as a result of the complaint, but no disciplinary action was taken against medical staff.

Poor communication is likely to be at the root of many complaints. Room for improvement was found with respect to responses to complaints.

To improve liaison between local schools and child and adolescent mental health services (CAMHS) by exploring teachers' experiences and perceptions of CAMHS. Semi-structured interviews were carried out with 25 volunteer primary school teachers.

Teachers reported exhausting education-based resources before seeking external advice. Most had positive experiences of child mental health services and were keen to be more involved. They favoured a service that provided rapid advice and ongoing support. Many complained about problems in communication.

Child psychiatrists should collaborate more effectively with teachers to promote mental health and manage children with behavioural and psychological problems.

To examine antidepressant prescribing in a general medical hospital in the UK. The data used were extracted from a prescription database prospectively maintained by the hospital pharmacy. All prescriptions of antidepressants over a five-year period, both new and continuation, were recorded.

During the study period there were 2037 prescriptions of tricyclic antidepressants. Only 18% of these prescriptions were at conventional therapeutic doses. This compared with 773 prescriptions of selective serotonin reuptake inhibitors, 70% of which were at conventional therapeutic doses. It is shown that antidepressants were prescribed at a dose in accordance with the smallest tablet size available.

We suggest that reformulation of tablets to allow one tablet daily prescribing may lead to improved antidepressant prescribing.

A questionnaire survey of all general practices in one health authority plus an assessment of a random sample of referrals were used to evaluate the impact of counsellors in primary care on referrals to mental health services.

A total of 91.1% of practices responded to the survey. A counsellor was present in 20.3% of these practices. A random sample of 180 referrals to community mental health teams was reviewed. There was a significantly higher referral rate from practices that employed a counsellor (P = 0.003). There was no evidence of a difference in rates of caseness of referrals between practices that employed a counsellor and those that did not.

Practices employing counsellors had significantly higher referral rates to mental health services, with no difference in the level of caseness between the two groups of referrals.