This study sets out to make a meaningful and useful contribution to the discussion surrounding the treatment of heroin addiction in Ireland. The study took place in nine urban general practices in Dublin city. Twenty five service users were interviewed in-depth. A phenomenological approach drawing on the psychological research methods of Colazzi for data analysis informed this study. Four themes emerged from the data: Service users' the significance of methadone for the service user; service users' understanding of the Methadone Treatment Protocol and the experience of addiction and its effect on families.

This paper reports on the experiences of service users receiving methadone treatment in urban general practice in Dublin and in so doing highlights the influence of the GP in supporting recovery. It explores the theme - Service User's Experience of attending general practice for methadone treatment. These accounts provide insight into the harm reduction policy of methadone maintenance and highlight how - from the service users' experience - the implementation is falling short.

Objective: Recovery has become an increasingly significant concept within mental health literature. Despite this, few studies have investigated the measurement of recovery and its correlates using quantitative methods. The aim of the current study was to measure recovery in people with chronic psychiatric disabilities using a quantitative tool and to investigate what factors were correlated to recovery outcomes. It was hypothesised that measures that investigated the individual's subjective sense of well-being would have a stronger correlation to recovery than more traditional clinician-rated scales.

Method: Participants were 63 people with a chronic psychiatric disability. They were recruited as a convenience sample from community mental health rehabilitation teams in three locations. Using a cross-sectional design, participants completed measures of psychological well-being (Psychological Well-being Scale (PWB); hope (Adult State Hope Scale) and recovery (Recovery Assessment Scale (RAS). Health professionals rated participants' psychosocial functioning using the Multnomah Community Ability Scale (MCAS-R).

Results: Analyses found that there was no significant correlation between clinician-rated psychosocial functioning scores and participant-rated recovery outcomes. Psychological well-being variables rated by the participants themselves were found to significantly correlate with recovery outcomes. The variables hope, environmental mastery and relationships with others were found to emerge as independent predictors of recovery scores.

Conclusions: Results underscore the premise that recovery is a distinct construct that is unique to the individual and cannot be fully captured by objective measures of functioning. Implications for practice suggest that services for people with chronic psychiatric disability should utilise recovery focused tools in patient assessment and treatment in order for a comprehensive assessment to be achieved. Recovery interventions should also focus on the individual's hope, mastery and relationships with others in order to promote recovery.

Objective: High rates of alcohol-related harm have been reported in the European Union, including Ireland, for more than 20 years. This article's goal is to contextualise such rates by examining gender-based pathways to alcohol use disorders from the perspective of those self-identifying as in recovery using data collected midway through this 20-year trend.

Methods: Sixteen informants (nine men and seven women) were interviewed between 1998 and 1999 in Dublin, Ireland. Using qualitative methods, informants were asked to reflect upon their experiences of problem drinking and recovery.

Results: Drinking expectancies, pub-based socialising, social anxiety and perceived social expectations to drink were cited as common pathways to problem drinking by informants, highlighting contradictions in drinking practices and the symbolic functions of alcohol. Drinking contexts identified by informants were public pub-based drinking for men and home-based drinking for women. Primary barriers to problem acceptance centered on pub-based socialising norms and gender-based shame. Benefits of support group membership included establishing new social networks and learning alternative ways to cope with negative emotions.

Conclusion: Consideration of drinking expectancies, the social contexts in which problematic drinking occurs, gender ideologies, the cultural meanings of drinking behaviours, and attention to feelings of isolation or loneliness experienced by those exhibiting problematic consumption behaviours might further understandings of potentially harmful drinking, especially in periods of economic uncertainty.

We report on the case of a middle-aged woman with a complex psychiatric history in whom atypical intrusive imagery identified in the mental status examination appeared to represent an emergence of childhood dissociative phenomena. These new symptoms led to the reappraisal of her clinical presentation and a diagnostic re-evaluation that they represented a re-emergence of childhood post-traumatic stress disorder secondary to sexual abuse. We discuss the phenomenology identified in our patient with the aim of increasing awareness of unusual symptoms in adults with a history of childhood sexual abuse and the importance of the mental state examination in eliciting and classifying such phenomena.

Objectives: The hypothesis that burnout is predictive of performance deficits on a number of neuropsychological tests was examined among a group of psychiatric nurses. A possible relationship between burnout and state and trait anxiety levels was also investigated.

Methods: A sample of psychiatric nurses (n=45) completed the Maslach Burnout Inventory (MBI) and the State-Trait Anxiety Inventory (STAI). Their performance on a number of neurocognitive tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) was examined. The neurocognitive tests measured visual memory, verbal memory and attention.

Results: Multiple regression analyses were conducted between the burnout subscales and the results of the neuropsychological tests, and also between the burnout subscales and both state and trait anxiety levels. No overall significant relationship was found between neurocognitive performance and burnout. However, trait anxiety was significantly predictive of each of the burnout subscales of emotional exhaustion, depersonalisation and also of decreased personal accomplishment.

Conclusions: The levels of burnout were in the moderate range for all three subscales and so the population was suffering from burnout. The fact that the trait anxiety variable was predictive of all three of the burnout subscales suggests that predisposition towards anxiety may be a vulnerability factor among people who suffer from burnout.

Objectives: Initial examination of data held by the Mental Health Commission indicated a number of patients having repeated involuntary readmissions (defined as patients having three or more involuntary episodes in a calendar year). The Commission sought more empirical analysis of the data relating to these patients, to determine if there were any trends or commonality regarding their demographic characteristics, length of episode, and diagnoses.

Methods: From 1 November 2006 the Mental Health Commission has been notified of all involuntary admissions in Ireland under the Mental Health Act (2001). From this national database information on patients who have had three or more involuntary admissions per year was analysed.

Results: In the period studied there has been an overall reduction in the number of voluntary and involuntary admissions to Irish psychiatric hospitals and units. However, the use of involuntary admission remains constant at around 10% of all admissions. Seven percent (n=569) of involuntary admission orders in this four year period relate to two percent (n=121) of all involuntary patients. Patients who have experienced repeated involuntary admissions are predominantly male (59%), often have a diagnosis of schizophrenia, or schizotypal and delusional disorders (57%), or mania (20%), are in the age band 22-64 (80%) and more often live in rural counties.

Conclusions: Potential appears to exist to significantly reduce the number of involuntary admissions by focusing on the care given to patients who are repeatedly re-admitted. More analysis is needed of voluntary and involuntary re-admissions if inpatient facilities are to be effectively configured.

Background: Care planning is a multidisciplinary process used to develop an individualised recovery plan for each service user. The success of this process will depend on the extent to which members of mental health teams can work with one another, with service users, and with other service providers in developing a coordinated plan that meets service user needs across multiple domains.

Aims: This paper examined the teamworking challenges that Community Mental Health Teams (CMHTs) face during the care planning process and how such challenges may be managed.

Method: A narrative review of published articles and policy documents relevant to teamworking and recovery-focused care planning within mental health teams.

Findings: Teamworking challenges include the provision of integrated rather than fragmented care, the empowerment of the service user, and development of a distributed model of leadership, responsibility and decision making.

Conclusions: CMHTs face a range of substantial but manageable challenges in attempting to implement recovery-focused care planning. Recommendations include the need to integrate recovery-orientated skills and values into professional training, the need for greater multidisciplinary training opportunities, and the need to evaluate CMHTs based on recovery-orientated criteria.

To determine if a consultation/liaison mental health clinic in primary care as proposed for Vision for Change, The Primary Care Strategy and the Department of Health is an efficient model of delivering mental health care in Ireland.

Methods: The pattern of service use and the clinical characteristics of new patients attending a pilot consultation/liaison clinic in a local primary care centre were studied.

Results: During the first 16 months of this clinic 1.2% of patients did not attend the initial assessment in the liaison clinic versus 29.75% in the regular Outpatients Department (OPD). Less than one in five (17.1%) required a follow-up review with the clinician in the consultation/liaison clinic compared to almost all patients first seen in OPD secondary care (96.6%). A small minority of patients (6.1%) needed referral to secondary care due to the complexity of their presentation.

Conclusions: A consultation/liaison mental health clinic in primary care results in an efficient use of manpower resources due to the low Did Not Attend (DNA) rates and low proportion of formal referrals to secondary care. As patients seem to favour this type of setting, over traditional outpatient departments, a move towards consultation/liaison clinics in the primary care team should be considered.

Corticosteroids are commonly used in the treatment of a variety of medical conditions in children and adolescents. However, adverse psychiatric side effects can occur which pose challenges in treatment of medical conditions. This case highlights some of these challenges, in particular the treatment of steroid-induced psychiatric complications in Acute Lymphocytic Leukaemia (ALL). It also accentuates the importance of awareness among pediatricians of the potential adverse psychiatric effects when prescribing corticosteroids in this age group. Families need to be advised accordingly to ensure early recognition and treatment.