To develop and evaluate a novel teaching session on clinical assessment using role play simulation. Teaching and research sessions occurred sequentially in computer laboratories. Ten medical students were divided into two online small-group teaching sessions. Students role-played as clinician avatars and the teacher played a suicidal adolescent avatar. Questionnaire and focus-group methodology evaluated participants' attitudes to the learning experience. Quantitative data were analysed using SPSS, qualitative data through nominal-group and thematic analyses.

Participants reported improvements in psychiatric skills/knowledge, expressing less anxiety and more enjoyment than role-playing face to face. Data demonstrated a positive relationship between simulator fidelity and perceived utility. Some participants expressed concern about added value over other learning methods and non-verbal communication.

The study shows that virtual worlds can successfully host role play simulation, valued by students as a useful learning method. The potential for distance learning would allow delivery irrespective of geographical distance and boundaries.

We undertook a cross-sectional service evaluation of the reasons and extent of delay in the discharge process in an intellectual disability hospital over a 12-month period. Delays at each stage of the discharge process are also quantified in this study.

We found that discharge was delayed for 29% of patients during the study period. The majority (78.5%) was due to awaiting completion of assessment of future care needs and waiting for public funding.

Commissioners (health and social), provider trusts, regulators and community providers should consider the reasons for delay in the discharge process and adopt a whole systems approach to discharge planning. This is highly relevant in light of recommendations by the Department of Health following the Winterbourne View scandal, which has raised concern about patients staying in intellectual disability in-patient units too long and for the wrong reasons.

The study reports findings of an investigation into the presence of severe and enduring mental health problems within the four statutory and non-statutory teams of an established substance misuse treatment partnership.

Of a total of 772 clients in the four teams surveyed, 69 (8.9%) were identified as having severe and enduring mental health problems and problem substance use in the past 12 months. Alcohol was the most prevalent substance used by this predominantly male group. Different rates were found across the four teams, with higher numbers in the non-statutory teams. The clients displayed significant levels of self-harm and suicide risk and were responsible for 131 acute service contacts over the past 12 months.

Clients with severe and enduring mental health problems engaged with substance misuse services display high levels of complex need. It is important to identify the best and most effective service response to this group.

A community intensive treatment service for severe anorexia nervosa is described. The service is multidisciplinary but driven by a focus on psychological formulation. Psychological and dietetic interventions are grounded in a process of active risk management. Evaluations of safety, cost and acceptability of the service are described.

Patients are highly satisfied with their care. A relatively low mortality rate for such a high-risk population was observed. In-patient bed use and costs were substantially reduced.

There is a case for greater use of intensive community care for patients with severe anorexia nervosa, as it can be acceptable to patients, relatively safe and cost less than admission.

To investigate medical students' performance at and perceptions of the mental state examination (MSE) at a medical school with a modern integrated curriculum. We undertook an evaluative case study comprising a survey and analysis of performance data. The study is presented in two parts: part 1 discusses the students' perceptions of the MSE and the teaching, learning and practising of it.

Most students in the study group considered the MSE an important examination in medicine. Other perceptions grouped in themes are presented. Unsurprisingly, most students found psychiatric attachments the most useful part of the course for learning about the MSE. About a half of students had witnessed an MSE being undertaken in clinical practice.

Although students appear to recognise the importance of this examination in medicine, the teaching and learning of it possibly needs greater emphasis in the undergraduate curriculum, and teaching and learning opportunities improved throughout the course.

To investigate medical students' performance at and perceptions of the mental state examination (MSE) at a medical school with a modern integrated curriculum. We undertook an evaluative case study comprising a survey and analysis of performance data. The study is presented in two parts: part 2 reports the students' performance data as assessed by integrated structured clinical examination (ISCE).

About a third of students (32.7%) thought that the MSE ISCE was more difficult than the non-MSE ISCE from the questionnaire data. The evidence from the ISCE performance data indicates that there are no significant differences between the scores of students in the MSE station and the non-MSE stations.

Most studnets do not find the MSE ISCE station more difficult than other ISCE stations. Perhaps therefore students should be reassured that assessments in psychiatry are just like other assessments in medicine. For some students, however, performing at the MSE ISCE station is a more complex challenge.