A national survey of consultants in child and adolescent psychiatry was conducted to explore their attitudes to copying correspondence to patients and their families and the impact of recent national guidelines on practice.

Of the 290 respondents, 261 (90%) agreed in principle with copying letters to patients but only two-thirds (n=186) were routinely doing so. Nearly half (n=139, 48%) had changed their practice as a consequence of the guidelines. The majority (n=160, 55%) felt that the guidelines lacked clarity with regard to the complexities of child psychiatry and a third (n=93, 32%) had experienced difficulties when copying letters to patients.

This survey highlights some of the benefits and risks involved in child and adolescent psychiatry when letters are routinely shared with families. Increased openness and transparency can enhance the therapeutic relationship; however, given the complexities and sensitivities implicit in child psychiatry, there is a risk of jeopardising engagement and alienating the family.

Prescribing in everyday practice frequently deviates from evidence-based guidelines. Previous work compared practice in a community mental health service with evidence-based guidelines and identified factors related to suboptimal prescribing. This study reports the impact of a multifaceted intervention on prescribing practice. A Prescribing Practice Quality (PPQ) score was generated from six key aspects of prescribing at initial assessment and again 1 year later after an intervention to reduce suboptimal prescribing practices.

A total of 264 patients were attending the service at both the initial and follow-up phase and were thus exposed to the prescribing intervention. In this population, PPQ scores were significantly lower at follow-up (0.96 v. 0.67, P<0.001). Improved prescribing practice was predicted by receipt of adjunctive supportive inputs, such as anxiety management (P=0.003).

Similarly, mean PPQ scores substantially decreased when the total patient population was considered at each time point (0.75 in 2001 and 0.52 in 2002). These results suggest a reduction in both the initiation and continuation of suboptimal practices.

Prescribing in real-world settings can be improved by interventions that target multiple aspects of service activity. The provision of supportive inputs is a key factor in improving practice.

The Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) were developed as a routine measure of outcomes in child and adolescent psychiatry. In a preliminary study we administered sub-scale 12 of HoNOSCA (Family Life and Relationships) to 20 families and compared the results with two well-established measures of family functioning and a measure of abnormal psychosocial situations associated with psychopathology.

Strong correlations were found between HoNOSCA sub-scale 12 and both self-assessed and clinician-assessed measures of family functioning. However, there was little relationship between HoNOSCA (12) and a measure of abnormal psychosocial situations.

HoNOSCA (12) appears to provide a quick and valid assessment of overall family dysfunction and can be used in a time-efficient manner as a means to assess where further more comprehensive family assessment or family therapy may be required.

The aim of this study was to seek the views of consultant psychiatrists on the legal framework they would use when considering treatment with electroconvulsive therapy (ECT). A questionnaire, consisting of three clinical vignettes, was sent to 70 consultants in the Wessex rotation (East Dorset/Hampshire region).

A total of 56 questionnaires were returned; a response rate of 80%. Most consultant psychiatrists agree when giving ECT to capacitated and non-consenting patients. However, there was a lack of consensus when dealing with seemingly incapacitated but compliant patients.

More clarification in this area is needed. Trusts can assist clinicians by devising their own policies based on nationally agreed standards of best practice. The treatment of mentally incapacitated but compliant patients is an area of practice where uncertainty exists. If proceeding under common law in such cases, it is good practice to discuss with relatives/carers and obtain a second opinion from a consultant colleague. The most recent Bournewood judgement and the new Mental Health Bill will have further implications for clinical practice.

Smoking and substance misuse adversely affect the outcome of pregnancy and psychiatric patients are known to smoke more than other patients. Data collected at the time of routine antenatal booking were analysed to investigate whether pregnant women with mental health problems smoke more than other pregnant women.

Data were collected from 156 women. Those with a psychiatric diagnosis (n=76) were significantly more likely to smoke (P<0.001). Associations were also found with illicit drug use and previous termination of pregnancy. The most common psychiatric diagnosis was depression (62%). A diagnosis of schizophrenia was not recorded for any of the women.

The strong association between smoking and psychiatric diagnosis results in an increased risk of obstetric complications in psychiatric patients. Anti-smoking interventions might be delivered by adequately trained midwives and opportunistically during contact with mental health professionals.

One of the steps to change stigmatised attitudes involves identifying the concerns of people whose attitude is to be changed. This paper presents the Attitudes to Mental Illness Questionnaire (AMIQ), a short instrument aimed at systematically obtaining this information, and examines the feasibility, test–retest reliability as well as face and construct validity of the AMIQ on the UK general public. A postal survey of a random sample of 1079 adults was conducted. A self-reported questionnaire with 5-point Likert scale responses was validated in response to short fictional vignettes. A second subsample of 256 was used for a reliability test.

The AMIQ is a short instrument with good psychometric properties. It shows good stability, test–retest reliability, alternative test reliability, face, construct and criterion validity. The self-selecting sample of 1079 UK adults showed highly stigmatised attitudes to people with addictive disorders but more positive attitudes to those with depression or self-harm. Results from a smaller follow-up sample showed that attitudes towards people with alcohol dependence and schizophrenia were intermediate.

The AMIQ can be used in various medical and mental health stigma research and intervention settings.

A satellite methadone prescribing service was set up in a hostel in London's West End. The aim was to investigate if it were feasible to engage and retain these hard-to-reach, chaotic, polydrug users in treatment. A basic needs assessment was undertaken with staff and clients at the hostel. Treatment outcomes were assessed at 16 weeks using the Maudsley Addiction Profile.

At 16 weeks 87% of the original cohort (26 out of 30) were still in treatment. There were also significant reductions in mean heroin use (from 29.7 to 14.5 out of the past 30 days, P<0.001) and in the frequency of injecting (from 25.9 to 15.9 days, P<0.001).

This outreach clinic offers a model for developing services to homeless people with substance misuse problems.

Ru-ok.com is a recently developed website that includes a self-assessment questionnaire. The aim of this study was to evaluate the website and compare the self-assessment questionnaire with established screening questionnaires. A total of 105 teenagers from schools completed three paper-based questionnaires and the online ru-ok.com questionnaire.

The website receives 730 visits a week. Visits to the advice section and stories about mental health and relationships account for 35% of activity. Of the returned questionnaires, 80% were positive about the website. There were modest and expected correlations between the website questionnaire (RU–OK) and the Mood and Feelings (MFQ) and Strength and Difficulties (SDQ) questionnaires.

Internet-based self-assessment is feasible and acceptable to teenagers. Self-assessment of perceived need by teenagers may be a useful tool for tier one professionals, including teachers, general practitioners, school nurses, social workers and learning mentors.

We undertook a postal questionnaire survey of drug action teams in England and Wales with the aim of clarifying the nature of statutory specialist drug services.

Of 159 drug action teams, 110 (69%) responded; 64 (58%) reported that mental health trusts exclusively provided their specialist drug services. Other providers were primary care and acute trusts, the non-statutory sector and social services. The majority of medical leads were psychiatrists (123 senior posts with 20% vacant/occupied by a locum), then general practitioners (GPs) (42) and other specialists (4).

Specialist drug services are offered by a range of treatment providers, with the medical lead being taken by GPs and other specialists in some areas. In view of the current difficulty in recruiting psychiatrists, we propose that alternative training pathways are considered for addiction specialists.

We evaluated the various aspects of ‘do not resuscitate’ (DNR) decisions taken for psychiatric continuing care patients within NHS Ayrshire and Arran. Records were reviewed and nursing staff were asked their opinions about DNR orders in general and the way these were implemented on their wards.

There were 35 DNR orders among 88 continuing care patients in mental health wards for older adults. There were no DNR orders for the 25 continuing care patients in general adult psychiatry wards. Quality of life was the main issue when taking a DNR decision. Medical and nursing staff were involved in all decisions and the family in most. Patients were involved in only two cases. The documentation of the DNR order itself was satisfactory but documentation of the reasons behind the decision was inadequate. Patients with DNR status were perceived by ward staff to have more physical debilitation and more dependence on others. Local guidelines were being followed in most aspects, but these needed to be reviewed, as suggested within the resuscitation policy itself.

Decisions not to resuscitate may often be difficult to reach in psychiatric patients. Wards follow heterogeneous policies despite a resuscitation policy existing within the trust. Documentation needs to be improved and medical and nursing staff must reach a consensus regarding what constitutes quality of life and the appropriate time for a DNR decision.

The aim of this study was to provide a name for a psychiatric service for older people in Dublin. A total of 296 individuals (167 doctors, 129 workshop attendees) were surveyed regarding their views on a name for the service.

‘Age-related psychiatry’ was a universally popular term. It was chosen by 43% of general practitioners, 56% of hospital doctors and 44% of the workshop attendees, as one of their top three choices. ‘Psychiatry of old age’, ‘geriatric psychiatry’ and ‘psychogeriatrics' were unpopular with all three groups.

Names can gradually become stigmatising over time. This applies to the terms for ‘old’ and ‘psychiatry’. In this survey all groups surveyed rejected some of the terms in widespread clinical use.

To investigate parental experience of children with learning disability being placed out of borough. The parents of 70 children were interviewed.

Parents would prefer in-borough provision but 90% were satisfied with the current school. The main problems experienced in-borough were poor advice, delays, lack of information and family stress. After out-of-borough placement there was a reported increase in the use of speech and language therapy, occupational therapy and sensory facilities and a decrease in the use of paediatric services, social services, and mental health services.

Specialist services should be helpful and reduce family burden by keeping children in-borough.

Annual audits of the enhanced care programme approach (CPA) were conducted from 2002 to 2005 to evaluate and improve the implementation of CPA in two inner-London community learning disability services. The CPA standards included those stipulated by the Department of Health. The notes of all patients on enhanced CPA were analysed using a structured data collection form.

There was a gradual improvement in the attainment of targets by both services. Areas of strength included allocating a date for the next CPA review, crisis plans and documentation of service users' comments. Areas of weakness included completion and review of risk assessments and the availability of a care plan for the previous 6 months.

Completing the audit cycle and reauditing improves attainment of targets and encourages service development, but further progress is required.

By use of a telephone survey, we aimed to investigate liaison psychiatry services of all 29 general hospitals in Greater London. We specifically enquired about services to accident and emergency (A&E) departments.

We identified wide variations in staffing, working hours and patient groups seen. Fourteen services (48%) worked over 24 h and 4 (14%) had specific A&E teams. Twelve services (41%) had established or planned working links with community crisis services.

Generally staff numbers fell below national recommendations and there were frequent gaps in service provision. The recent focus on emergency care has lead to an increase in A&E services, but there is a risk that liaison psychiatry services for other general hospital patients are being neglected.

The aim of the study was to elicit clients' satisfaction with the methadone maintenance service and their views regarding opiate users not in the service. A self-completion questionnaire with 40 questions covering various aspects of service delivery was given to clients on this programme.

Of a total of 52 questionnaires, 31 (60%) were returned. There was a high level of overall satisfaction (93%) with the service and staff, but there were significant problems related to prolonged waiting times and access to ancillary services. There were also practical difficulties related to prescriptions. Over half of the clients (54%) used additional illicit opiates.

It is likely that addressing identified problem areas may influence treatment outcome in this challenging group. Staff should maintain optimism in helping the clients who, as seen by this survey, value their advice.

Ten people with a diagnosis of schizophrenia were interviewed. The interviews were analysed qualitatively with the aim of examining the concept of patient satisfaction in the context of a recent in-patient admission.

The analysis identified two themes that influenced the expression of patient satisfaction: external factors and internal factors. The theme of external factors contained four categories: fear of violence, communication with staff, lack of autonomy and ward routines. The theme of internal factors comprised participants' conceptions and expectations.

This small study suggests the complexity of the concept of patient satisfaction should be respected in assessing experiences of people with a diagnosis of schizophrenia.

The aim of this study was to examine visual problems among patients admitted to an inner city acute mental health unit. We measured visual acuity using a Snellen chart. Patients were also asked about perceived eye problems and access to services.

Of 55 in-patients on five acute general adult wards at an inner city mental health unit over a 3-day period, 31 agreed to participate in the study. Twenty (65%) had impaired visual acuity and 19 (61%) had not been to an optician for 5 or more years. Seventeen patients (55%) reported experiencing difficulty with their eyesight. The main problems reported were blurring of vision and periorbital pain. Of these 17 patients, 15 (88%) had impaired visual acuity on Snellen testing. Half of those who had previously been prescribed glasses or contact lenses reported that they had been lost.

Visual impairment appears to be another area of physical health which is underrecognised and undertreated in people with severe mental health problems. Although there are numerous issues that must be addressed by mental health staff, patients should be asked about eye problems and supported in accessing opticians.

In order to examine the opportunities for senior house officers (SHOs) to undertake emergency psychiatric assessments we conducted a retrospective cohort study of such assessments in a district general hospital.

Senior house officers conducted few assessments for self-harm compared with psychiatric liaison nurses (P < 0.001), and were involved in only 40% of emergency referrals where psychiatric opinion was requested. Senior house officers continue to undertake more assessments out of hours than any other group (P < 0.01).

Although the introduction of psychiatric liaison nurses has improved capacity and reduced waiting times for emergency assessment, the opportunity for SHOs to undertake emergency assessments has been reduced, particularly with regard to assessment of suicidal risk following self-harm. These results suggest the need for better monitoring of SHO experience, particularly in the light of service developments that have an impact on psychiatric training.