In-patient psychiatric care needs urgent improvement and development. A new model of psychiatric care (triage) has been used for 6 months across an adult psychiatric service covering a London borough.

Preliminary results show that the new model has reduced bed occupancy, leading to more-efficient throughput, with positive feedback from patients and staff. Important factors contributing to these positive changes include a whole-systems approach, senior medical input 6 days a week, creative use of information technology and a highly skilled multidisciplinary team.

The introduction of the new model has resulted in a more-efficient use of beds. Further evaluation will enable us to assess the impact on other parts of the service. As with all innovations, the improvements must be sustained once the initial enthusiasm has passed.

Our aim was to determine the role of evidence and other factors in specialist service development in liaison psychiatry. We held two focus groups with liaison psychiatry practitioners working in different services throughout Europe. A topic schedule focused the discussions, which were taped and transcribed. We used content analysis to identify the role of evidence and other factors that had hindered or facilitated service development.

Our content analysis revealed two factors relating to evidence and 25 other barriers and facilitators of service development, which we grouped into national factors and factors related to local services.

Evidence appears to have some impact on service development but many other factors are influential. Clinical service development cannot be understood simply as emerging in response to research evidence.

This study aimed to assess how referrers to specialist child and adolescent mental health services (CAMHS) wanted priorities to be determined. Postal questionnaires were sent to practitioners referring to the service in the Bridgend district.

Nearly three-quarters of the questionnaires were returned (n=184). There was wide variation between professional groups in the priority attributed to different presenting problems, their modification by ‘contextual factors' and acceptable waiting times for the service. Mental disorder, self-harm, child abuse and complex cases require greatest priority.

Needs of referrers must be considered when deciding priorities for specialist CAMHS, however diverse these appear. If youth mental health needs are to be addressed, better communication between services, and clearer definition of the role of specialist CAMHS is imperative.