Many psychiatric hospitals in the UK have closed. Factors influencing staff morale around the time of a hospital closure will affect the functioning of that institution. This study surveyed staff anxieties, attitudes and expectations in a major psychiatric hospital three weeks prior to its closure. We found evidence of widespread denial despite energetic dissemination of information. There were also significant differences between staff groups. Our findings will have implications for the management of future hospital closures.

“We have to get it into our heads that a hospital is like a shell, a framework to contain certain processes, and when the processes are superseded, the shell must, most probably, be scrapped and the framework dismantled” (Enoch Powell, 1961).

The administration and outcome of electroconvulsive therapy (ECT) were studied retrospectively over two successive periods of 12 months, before and after replacement of our Ectron Series 5 ECT machine by a Thymatron DGx. It was found that using the Thymatron enabled the same outcome of ECT to be achieved, while administering significantly fewer treatments per patient. Possible explanations for this finding are discussed.

Fifty-three female in-patients of a psychiatric hospital were interviewed to obtain their views on their own safety and security, and what improvements they would recommend. Most had experienced sexual harassment and a few had been victims of sexual assault. There was a reluctance to report incidents to staff. The majority felt that female-only wards would improve safety. Other recommendations included higher staffing levels, more staff awareness and vigilance, and single rooms with curtains on the doors.

The work of NEWPIN was pioneered in the London Borough of Southwark in 1982. It was influenced by the rising child abuse figures, which were higher than the national average, and the low take-up of ante- and postnatal services in the district. A study of mothers with young children in Camberwell (Brown & Harris, 1978) had revealed that there was a high incidence of maternal depression within the group. This also influenced the direction NEWPIN was to take.

Although the attribution of psychotic symptoms to the television is widespread, there is little literature on the subject and one might surmise that the issue is considered so mundane as not to merit further interest.

In so far as ‘reality’ is a critical problem in psychosis, television can constitute a particular source of confusion. ‘Reality’ can be fudged by this medium for us all, with editing, propaganda, and the spectrum of front line live reports, ‘real life’ re-enactments, and drama.

An in-patient psychotherapy group was started in an acute female psychiatric ward. Staff and patients were asked to fill in a questionnaire about the group. The response rate was 65% from patients and 58% from staff. The commonest diagnosis was depression. Most patients who attended the group found it helpful. They most frequently valued not feeling alone and being able to talk to others. Staff confidence was low and staff resistance could have contributed to the group being discontinued.

Little is known of the facilities available nationally to treat the most disturbed patients. A postal survey sent to all pharmacists in the UK known to have a special interest in psychiatry identified 110 psychiatric intensive care units. They varied in size from four to 30 beds, with the small units having low and the larger units very high occupancy levels. Many units accepted a mixture of informal patients directly from the community, detained patients and referrals from the prison service. Medical cover was variable, multidisciplinary team-working poor, and the existence of written policies unsatisfactory. Staff often felt undervalued with little control over admissions and discharges. There is currently no national or local support network for these units.

We reviewed, prospectively, all patients who presented themselves at the reception of a large psychiatric hospital, which had no casualty department, to assess the extent and value of a long standing ‘unofficial emergency service’ that has been provided for decades. We found no evidence that the service was abused or that it led to unwarranted admissions. The service could provide a useful point of entry to mental health services for certain patients. The ‘ad hoc’ emergency service described here is hoping to become a recognised ‘Emergency Clinic’ in the reprovided service, after the closure of this 100 year old psychiatric institution in the very near future.

Child abuse could be defined from predominantly legal, clinical and research perspectives, and attempts at an integrative enunciation are fraught with over-inclusiveness. Meadow (1989) proposed that a child is considered to be abused if he or she is treated by an adult in a way that is unacceptable in a given culture at a given time. This definition usefully incorporates the essential issues including secularity and diversity of socio-cultural norms which often create controversy in case detection and are particularly relevant to the debate.

Violence in the workplace is of great concern to trainee psychiatrists. A questionnaire was devised to assess knowledge of safety Issues, and precautions available, among junior doctors. The results, which revealed gaps in provision of safety training and facilities in this area, have been forwarded to the relevant directorates with a view to setting standards suitable for audit review.

A survey of 92 in-patient alcohol detoxification services revealed that they varied in their goals, organisation and treatment approaches. We argue that detoxification units and alcohol treatment units should increasingly take on the assessment and treatment role hitherto played by general psychiatric wards in the management of the problem drinker. However, we also suggest that the general psychiatric wards should work closely with community alcohol teams and more specialist services in order to provide a comprehensive service for these patients.

This paper is the second in a series explaining key concepts and techniques used in health economics in the context of mental health care. The paper describes the different types of economic analysis and the circumstances in which they should be used. It explains key aspects of the methods used in economic evaluation to measure costs and benefits. The purpose of the paper is not to enable clinicians to undertake economic analysis, but to familiarise them with the methods used in economic evaluation and to enable them to assess the rigour and results of published studies.

The strong recent public interest in attention deficit disorder and its drug treatment has led to the need for, and development of, guidelines for clinical practice. As a first step in this process our aim was to ascertain the current level of professional consensus on certain points regarding the use of medication in attention deficit disorder. Although a high level of consensus was found in relation to indications and prescribing issues, opinion was divided on details of how the treatment should be delivered – including the role of paediatricians, and the use of psychological treatments.

This study sought social workers' views on the mental health needs of a sample of foster children. Out of the sample 80% of the children were considered to require treatment from a child mental health professional but only 27% had received any input. The reasons given for not referring for treatment were placement instability, inadequate child mental health resources and insufficient local authority funding. The provision of consultation services to allocated social workers and the availability of child mental health professionals at local authority reviews should be considered.

This study investigated the knowledge and attitude of 100 patients about their depot neuroleptic medication. Patients were well informed about their medication, particularly those seen in depot clinics. Most patients were content with service delivery but 48% did not realise that they had a choice about receiving their treatment. This aspect of patients' rights should be addressed and demands sensitive management in the case of depot refusers, or when assertive outreach is planned. We suggest that such issues should be incorporated into an educational programme and discussed with patients when they are relatively well.

A volunteer project for elderly people with severe mental health problems and social isolation was developed with close links with a community mental health team. The functioning of this service is described from 1988–1995. The volunteers benefited from training and supervision from the professional community team, while the volunteers took over the role of monitoring, allowing the earlier discharge of these patients by the community team.

The landscape of training in child psychiatry is changing fast. In recent years the content of theory and practice within the discipline has evolved rapidly and the latest Royal College guidelines for higher training (Royal College of Psychiatrists, 1995) show a daunting array of training areas to be encompassed in four years or less. The Caiman proposals (Department of Health, 1993) will abbreviate and so inevitably further intensify postgraduate training in the speciality. We argue in this paper that the fact of entering such an intensive training at the level of senior registrar can, under certain circumstances, create barriers to learning. We describe the efforts of trainees, consultants/trainers and scheme coordinators to adapt to these difficulties as they arise.

We evaluated clinical Information gained directly from 10 English-speaking and from 10 non-English-speaking subjects both directly and through interpreter-mediated Interviews. High levels of agreement between raters, when assessing both cohorts, were found for all data with a non-significant tendency towards better agreement in the Asian than the English-speaking sample for family history data. Analysis of the interview contents showed a number of errors of interpretation which were similar to those noted in previous studies. The addition of quantitative data represents a significant advantage over previous studies, allowing the qualitative results to be placed into perspective. Recommendations are made for optimising and avoiding the pitfalls of interpreter-mediated interviews.

This study compared the mean change in the total Health of the Nation Outcome Scales (HoNOS) with the general practitioners' (GPs) assessment of clinical improvement and satisfaction, in a shifted psychiatric out-patient clinic. The total HoNOS fell significantly between the first and last appointment, suggesting that it was sensitive to change even in patients with a lower level of morbidity. There was a weak association between change in the total HoNOS and the GPs' assessment of clinical improvement (r=0.4; P=0.06), and a trend towards a greater HoNOS fall in patients that the GPs assessed as having improved clinically (5.3) compared with those the GP thought had not changed (2.5), but this difference was not significant (95% Cl, 6.6 to −1.1). There was no evidence of a relationship between change in HoNOS and GP satisfaction, and no trend towards a greater fall in the HoNOS in cases where the GP was satisfied, despite a lack of improvement being the commonest reason given by GPs for dissatisfaction. The results suggest that the fall in total HoNOS relates to some degree with GPs' own assessment of clinical improvement in their patients, and that the HoNOS may be regarded as useful by GP fundholders.

This exploratory study assessed staff perceptions to the reduction of maintenance neuroleptic medication in patients with chronic schizophrenia living in a long-stay hospital. Ten in-patients were assessed at regular times over six months. In addition to the Brief Psychiatric Rating Scale (BPRS), data were obtained from nursing staff on patients' ward behaviour (Ward Behaviour Interview Schedule, WBIS), clinical global opinion (CGI) and staff reaction (SR) to the reduction of medication plan. The average decrease of BPRS and WBIS was not related to keyworker's clinical global impression. The SR increased against the reduction of medication over the study period (P<0.05). Staff perceptions in the treatment of patients with chronic schizophrenia and their possible influence on prescribed closes should be taken into consideration in addition to psychopathology and clinical symptoms.