To assess the extent to which psychiatric history, with specific regard to compulsory psychiatric admission, is questioned in visa, insurance and permit applications. Application forms for the top UK destinations for immigration, work and travel visas, six types of insurance, and driving, sporting and vocational permits were analysed.

Psychiatric history is questioned in some applications across all visa types. Hospital admission, but not compulsory psychiatric admission, is questioned in some immigration visas. Psychiatric history is not questioned in mortgage protection, car or pet insurance but it is questioned in some travel, life and health insurance applications, as is hospital admission. The majority of permit applications questioned psychiatric history and one vocational permit considered compulsory psychiatric admission.

The majority of visa, insurance and permit application forms enquire about past medical and psychiatric history. Information concerning detention under the Mental Health Act is very rarely questioned, indicating that a direct link between detention and access restriction is not evident.

To explore what young people who self-harm think about online self-harm discussion forums. SharpTalk was set up to facilitate shared learning between health professionals and young people who self-harm. We extracted themes and illustrative statements from the online discussion and asked participants to rate statements.

Of 77 young people who participated in the forum, 47 completed the questionnaire. They said they learned more about mental health issues from online discussion forums than from information sites, found it easier to talk about self-harm to strangers than to family or friends, and preferred to talk online than face-to-face or on the telephone. They valued the anonymity the forums provided and reported feeling more able to disclose and less likely to be judged online than in ‘real life’.

Mental health professionals should be aware of the value of anonymous online discussion forums for some young people who self-harm, so that they can talk about them and assess their use with their patients.

A comparative analysis of emotional intelligence between psychiatrists and surgeons using the Bar-On Emotional Quotient Inventory (Bar-On EQ-i) validated assessment tool. Applied to psychiatrists and surgeons with postgraduate membership in Greater London.

A total of 148 individuals were recruited. The median scores for Total EQ scores were average, with no difference in Total EQ between psychiatrists and surgeons (P = 0.872). Psychiatrists scored significantly higher in the subscales of emotional self-awareness (P = 0.002), empathy (P = 0.005), social responsibility (P = 0.04) and impulse control (P = 0.011). Surgeons scored significantly higher in the subscales of self-regard (P = 0.005), stress tolerance (P < 0.0001) and optimism (P = 0.009).

There are significant differences between psychiatrists and surgeons in the component factors that make up the Total EQ score. They seemingly correspond with widely held perceptions.

To evaluate the characteristics of individuals seeking gender reassignment, the frequency of subsequent referrals to a specialist centre, and funding approval. Cases were identified from a local referrals database and data were extracted from case notes.

Fifty-four individuals attended for assessment; 70% were biological males and 30% were biological females. Mean age at referral was significantly different between the two groups. Over half were taking hormone supplementation and three had already had surgery. Further, 24% had a current and 30% a past mental illness. The majority of individuals were referred to a specialist centre for gender reassignment but only two had funding for surgery approved. Paedophilia was a rare but concerning finding.

Psychiatric assessment plays an important role in confirming transsexualism and in identifying other relevant diagnoses.

To ascertain the views and experiences of psychiatrists in England and Wales regarding community treatment orders (CTOs). We mailed 1928 questionnaires to members of the Royal College of Psychiatrists.

In total, 566 usable surveys were returned, providing a 29% response rate. Respondents were generally positive about the introduction of the new powers, more so than in previous UK studies. They reported that their decision-making regarding compulsion was based largely on clinical grounds.

In the absence of research evidence or a professional consensus about the use of CTOs, multidisciplinary input in decision-making is essential. Further research and training are urgently needed.

To examine the clinical outcome and bed usage in patients with comorbid substance misuse and psychosis. The patients were randomised to ordinary assertive outreach team care or to enhanced assertive outreach with nidotherapy. Ratings of clinical symptoms, social function, engagement with services, bed usage (primary outcome after 1 year) and economic costs were assessed at baseline and at 6 and 12 months after randomisation.

Patients referred to nidotherapy had similar reduction in symptoms and engagement, with marginal superiority in social function (P = 0.045). There was a 110% reduction in hospital bed use after 1 year compared with control assertive care (P = 0.03). The mean cost savings for each patient allocated to nidotherapy was £14705 per year, mainly as a consequence of reduced psychiatric bed use.

Nidotherapy shows promise in the treatment of substance misuse and psychosis and may reduce hospital bed usage.

To investigate the complementarities of staff and service users' experiences of shame in psychiatric in-patient settings. Qualitative methods were used by means of focus group interviews in two compositions – staff and service users. Data were transcribed and thematically analysed.

Service user group transcripts revealed four prominent themes: ‘loss of value’, ‘loss of adulthood and autonomy’, ‘loss of subjectivity’ and ‘shaming or blaming of others’. Staff group transcripts also revealed two themes one of which overlapped with service users (‘shaming or blaming of others’) and one of which was distinct (‘entrapment’).

Shame processes may be elicited by caregiving and impede treatment. Staff find themselves in the predicament of provoking the problems they intend to address. Suggestions are made as to how to respond to this dilemma and practically improve aspects of the in-patient care process to reduce shame.

The home treatment service in central Manchester was established in 1997 to provide an alternative to in-patient care: referrals were only taken from secondary care services. In order to meet national crisis resolution and home treatment (CRHT) activity targets, referral routes were extended to primary care from 2008. To examine the impact of these changes, details of all referrals to the service were collected for a 6-month period in 2008/2009. Referral sources, demographic details and diagnosis were compared with similar data from 2005.

There was a marked increase in the number of individuals accepted by the service in 2008/2009 with a corresponding reduction in duration of contact. Primary care referrals were not accepted in 2005 but accounted for 20% of people treated in 2008/2009. This was mirrored by a change in diagnostic profile, with the proportion of individuals with mild to moderate illness increasing from 25 to 50%. In 2005, 70% of individuals treated had complex care needs compared with 39% in 2008/2009.

The strict imposition of numerical activity targets can have a significant impact on service delivery. Although more individuals have been treated under the new arrangements, the emphasis has shifted away from the intensive care of those with severe mental illness.

Post-traumatic stress disorder (PTSD) has been reported in 90% of chemical warfare victims in previous studies. An individual's traumatic experience(s) may affect the lives of other family members as well. This cross-sectional case–control study compared the prevalence of PTSD symptoms in the husbands, the secondary PTSD symptoms in the wives and also aimed to identify if there was an association between the PTSD symptoms of the couples in the case group. Cases were 150 husband–wife couples where husbands were civilians exposed to chemical warfare; the controls were 156 husband–wife couples where there was no such exposure. Both cases and controls were recruited from Sardasht in Iran; this Kurdish city was attacked by four 250 kg sulphur mustard warheads in June 1987.

Across three sets of cut-off points for the Mississippi Scale for Combat-Related PTSD symptomotology (<120 and ⩾121; <106 and ⩾107; and <65, 65–130 and > 130) wives in the case group demonstrated higher rates of PTSD symptoms than did those in the control group; the difference was statistically significant. Furthermore, husbands in the case group had a significantly higher overall mean score (123.0 (s.d. = 17.2)) than the husbands in the control group (112.3 (s.d. = 21.7); P<0.001, t = 4.80). There was no statistically significant association between the overall PTSD score of the husbands in the case group with that of their wives (P = 0.274, correlation coefficient 0.092).

Husbands who were exposed to the chemical agents reported higher PTSD symptoms and there were higher rates of PTSD symptoms among the wives of individuals who were exposed to chemical warfare. Study results suggest the need for coordinated treatments, policy efforts and interventions to improve the wellbeing of chemical warfare victims and their caregiver wives.

Prison mental health inreach teams (PMHITs) were introduced in response to policy from 2003. This provision comes under the responsibility of the National Health Service. Service development and structure was not defined in policy. A total of 97 prisons of an estimated 100 known to have a PMHIT were targeted by postal questionnaire and responses covered 62 prisons. Team structures were captured in the data with specific regard to the number of available professional sessions.

Findings determine there is generally no correlation between input and prison capacity, although there was some evidence of correlation in the high secure (category A) estate and that the female estate was generally better served.

It is evident from this study that PMHITs have evolved piecemeal, with no clear standards or equity across the estate. This is of concern.

Our aim was to follow-up on a cohort of self-referred doctors who attended MedNet. We used a two-point cross-sectional design. Measures included three standardised self-report questionnaires administered before and after consultation. Doctors were also asked to complete a service user questionnaire, and data regarding engagement and onward referrals were gathered through case-note review.

A statistically significant improvement in scores on all three questionnaires was found after intervention; however, scores on one subscale, the risk domain of the Clinical Outcomes in Routine Evaluation – Outcome Measure, did not change significantly. Of the doctors at no risk of suicide at intake, nearly two-thirds (n = 41/70, 59%) were sufficiently helped by the consultations provided to not need further treatment. Of the doctors at some risk of suicide at intake, two-thirds (n = 34/51, 67%) did need an onward referral. Only one doctor required hospital admission, an outcome that suggests the approach used is containing and clinically responsive.

This paper highlights the efficacy, need and importance of specialist services for doctors in difficulty. We found that the bespoke consultation model provided at MedNet is valued highly by the doctors as service users.

To assess how well psychiatric teams follow up abnormal results from physical health monitoring of patients in a secondary care clozapine clinic compared with follow-up in a specialist secondary care physical health clinic, using an audit/re-audit method of comparison. Prevalence data for cardiovascular risk factors within the clinic population were also obtained.

Substantial and statistically significant (P < 0.01) improvements in follow-up of abnormal results were made following the introduction of a specialist clinic compared with treatment as usual. Prevalence of all cardiovascular risk factors among the patients on clozapine was very high compared with the general population.

Patients on clozapine have significant and multiple cardiovascular risk factors, which may be best managed within a specialist secondary care physical health clinic that can follow up abnormal results and coordinate care across primary and secondary care.

To determine the extent of prescribed antipsychotic polypharmacy and high-dose antipsychotics at the time of discharge from an acute psychiatric ward. Copies of discharge summaries for patients between the ages of 18 and 65 were examined; only those that had antipsychotic medications at the time of discharge were included. Names and doses of antipsychotics and all other medications concurrently prescribed were recorded.

A total of 651 discharge summaries were included in the study. Nearly a quarter of individuals were discharged on one antipsychotic as the only medication to take home; only 6.8% were discharged on a high-dose antipsychotic and of those on combinations 59.6% were on depot medications. Combining antipsychotics significantly predicted the use of high dose.

Most patients were discharged on doses of antipsychotics within the British National Formulary limits; however, a small proportion is still sent home on high doses of antipsychotics. Combining antipsychotics remains the strongest predictor of high-dose antipsychotic use; clinicians need to be aware of this.

The study explored the impact of National Health Service changes on the working and personal lives of psychiatrists. A questionnaire survey was carried out with psychiatrists working in the South Eastern Division of the Royal College of Psychiatrists.

The response rate was 44.9%. Changes to services have reduced stress in some areas, but increased stress in others. Over the past decade early retirement has become less popular, but psychiatrists have been more likely to self-prescribe and have suicidal thoughts.

The increasing involvement of psychiatrists in leadership may be a way to reduce adverse impacts of future changes on their working lives.

To share evaluation findings of a new decentralised mental healthcare system addressing Axis I disorders, developed in four subdistricts of Aceh Besar in Indonesia following the 2004 Asian tsunami. Two complementary methodologies were employed: an adequacy survey that assessed whether agreed programme implementation tasks were completed, and an outcome study that utilised patient, caregiver and staff assessment of the programme to determine what changes, if any, resulted from participation in the programme.

The system is functional in 3 of 4 subdistricts, and 47 of 53 subdistrict clinics (puskesmas) have trained mental healthcare nurses. Both patients and caregivers reported statistically significant differences when ranking patient wellbeing and were able to qualitatively describe specific changes in patient symptomatology and social functioning.

Results indicate that (a) the creation of a decentralised system with outreach at multiple levels, (b) emphasis on staff capacity building within a wider household-to-hospital continuum of care, and (c) incorporation of community volunteers working with trained medical personnel led to effective treatment options for people with Axis I disorders in a resource-poor setting.

To systematically review the published literature with respect to formulating a dose-response curve for flupentixol decanoate. A systematic literature search using the Cochrane Database was performed for studies that published both dosage information and data on relapse rates.

The data showed modest effects of dose on survival rates. Increasing dose may be associated with increased survival rates up to around 50–60 mg of flupentixol decanoate every 4 weeks. There was no evidence of increased survival rates at higher doses and higher doses may be associated with lower rates of survival. There is considerable uncertainty as to the true effects of dose of flupentixol decanoate on relapse rates.

There is no evidence that survival rates improve for doses above 50–60 mg every 4 weeks. These doses are much lower than doses commonly prescribed. Clinicians may wish to consider these data when prescribing flupentixol decanoate.

To investigate whether women were being asked about their current and previous mental health, and where risk factors for perinatal mental health problems were identified, to determine whether appropriate referral occurred. Individual case-note review was performed on women where present or past mental health problems were indicated.

In two-thirds of women where a history of mental health problems was indicated at the booking clinic this was not addressed in their obstetric case notes. Of the women who reported being depressed, nearly a third had no reference to this in their obstetric case notes and only 40% were referred to the Mental Health Liaison Clinic (MHLC). Two-thirds of the women who indicated a history of postnatal depression had no further comments documented in their obstetric case notes. One case of bipolar affective disorder and one case of puerperal psychosis were identified on booking questionnaires and neither had any comments documented in the obstetric case notes. In total 16% of women who reported a history of mental health problems were referred to the MHLC.

More robust procedures for the identification and management of perinatal mental health risk need to be implemented.

To describe the process for reader feedback on the Royal College of Psychiatrists' online public information leaflets, to report the findings of a retrospective analysis of feedback received over a 14-month period, and to discuss the value of feedback, particularly in relation to the Information Standard quality mark introduced by the Department of Health.

We received 38 700 completed feedback forms during the period under analysis. We derived scores from the feedback forms, which enabled us to identify those that should be prioritised for review. Written comments from readers highlighted specific areas of the leaflets that required further work.

The development of our public mental health information can be guided using feedback from our readers.