Data were collected on a six month sample of patients attending a psychiatric emergency walk-in clinic (n=378), based on the clinical impressions of the interviewing doctor. This information was then compared with a hypothetical model emergency service on the following five items: nature of patient problem, severity of problem, diagnosis, referring agent and current contact with psychiatric services. The severity of the perceived threat to the interviewer was recorded. Only 4.7% of referrals conformed to the hypothetical model on all five criteria. The majority of patients referred themselves, and the problems of self-referrals were significantly less severe than those of general practitioner referrals; 17.2% of consultations were perceived by the interviewing doctor as presenting a moderate or severe threat to his or her safety. The findings suggest that such an emergency facility operates as a form of primary care and is therefore inappropriately used. The level of perceived threat to interviewing doctors is unacceptably high.

The challenge facing services for people with learning disabilities is to create the environment in which clients have the best quality of life without preconception. The heterogenous nature of people with learning disabilities requires diversity of care provisions sensitive to their individual needs. The different demonstration and presentation of their mental health needs has influenced the development of services and different models of specialist services have emerged with local variations. There is still, however, a great deal of confusion on both ideological and service delivery level. Although services for people with learning disabilities have succeeded in resettling people in the community and supporting them in developing adaptive skills, unfortunately these successes are not matched by equally effective and efficient services to those with mental health needs.

This paper puts the case for accessible multidisciplinary mental health services for children and young people to managers, purchasers and GPs, in a framework of national and international statutes and guidance. The essential differences between the disciplines are explained, based on detailed advice from mental health colleagues in nursing, teaching, social work, psychology, child psychotherapy and child and adolescent psychiatry.

This paper describes the development of a simple computer-based care programme system. An important issue in its development was the attitude of professional staff. After one year of use staff recognised the system as a useful and practical aid in the management of their cases.

To maximise the effectiveness of psychiatric day hospitals it is important to establish which patients benefit most. We tested the hypothesis that day hospital therapists can predict responders. The consultant, key-workers, junior psychiatrist and secretary predicted outcome for 26 patients. These were measured blind using the Brief Psychiatric Rating Scale (BPRS), Global Assessment Scale (GAS), Becks Depression Inventory (BDI) and the Social Functioning Questionnaire (SFQ). There was poor correlation generally between staff predictions and patient progress as measured by the standardised instruments. The only significant correlation was the consultant's prediction with the BPRS. We suggest this is consistent with the consultant's experience and training in phenomenology. We conclude that consultants should be fully involved in day hospital assessments.

Resettlement of 15 long-stay psychiatric in-patients from a hospital rehabilitation unit to a new hostel was assessed by measuring symptoms, social behaviour and client satisfaction beforehand, then six and 12 weeks afterwards. Three residents experienced relapses with varying degrees of recovery. Overall, symptoms and social behaviour improved significantly. Change in satisfaction with the services offered proved difficult to measure accurately. A well resourced resettlement project can enhance long-stay patients' well-being.

Community mental health services have been criticised for seeing those with minor psychiatric disorders at the expense of those with severe and long-term illness. We report a cross-sectional evaluation of a UK service based entirely within the community. Most patients in contact with the service (66%) had a psychotic disorder or an affective disorder. Patients with greater impairment were likely to receive more intensive treatment. Only 20% of the community psychiatric nurse (CPN) case load focused on acute distress and neurotic disorders. Within this service careful operational planning and maintaining CPNs within the secondary care system appear to be critical factors in achieving the goal of giving priority to the severely mentally ill.

This paper charts the progress of a continuing audit cycle of prescribing of hypnotics in a psychiatric hospital. First we reviewed some possible standards from the literature, then educated the prescribing doctors, and fed back to them their own patterns of prescribing. We present the results of this exercise repeated over 18 months; these show a change and general improvement in prescribing patterns. Finally we discuss some of the motivations and possible mechanisms behind these changes, and the implications for the audit process in general.

The aftercare of psychiatric patients discharged from hospital is currently under debate among clinicians and in the media. Our study audited the planning of aftercare for detained patients discharged under section 117 of the 1983 Mental Health Act. Our completed audit cycle showed how discharge planning can be improved yet underlines the difficulties encountered in providing for this vulnerable patient group.

Experience of psychiatry in a developing country is not generally regarded as pertinent to the training of the British psychiatrist. In this article I draw on my own experience of a psychiatric attachment in India to argue that such experience can be useful and relevant for British psychiatry trainees, and that it should be encouraged.

Little has been published by junior trainees of their experience of part-time training. This paper discusses two different arrangements of flexible training at registrar level based on the personal experience of a married couple where both partners wished to combine psychiatric training with childcare. Job-share by working alternate periods of six months is compared with being in separate flexible training posts as super numerary registrars.

At present there is a somewhat damaging ‘splitting’ occurring within the NHS ‘reforms’ – assisted by the media. Consultant psychiatrists, who are regarded as intrusive and paternalistic, administer treatments (mostly medication and ECT) to patients who are not consulted, and are generally thought to know what is best for themselves. General management, which overtly sets out to ‘change the culture’, appears to sustain this irrational harmful and pseudo confrontation.

The Health and Safety Executive (1992) defines violence against staff as “any incident in which an employee is threatened or assaulted by a member of the public in circumstances arising out of the course of his or her employment”. Verbal abuse and threats are, as the Health and Safety Executive notes, the most common types of incidents, and staff have the common-law right to be protected from such incidents in the course of their work. While the literature on physical violence against mental health professionals is quite large and expanding (see, for example, Health and Safety Commission, 1987; Shepherd, 1994; Wykes, 1994), comparatively little emphasis has been placed on verbal assaults, although these may be extremely distressing.

The paper by Curran & Bingley (Psychiatric Bulletin, 1994, 18, 328–332) is most clear and helpful. While much is written in our Bulletin about the operation of the Act, little is written about the Commission itself. The Commission visits most of us far more frequently than does the College and makes much wider and more critical comments on our services. The account given, quite properly, gives little discussion to the role of the medical member. Many psychiatrists are or have been members of the Commission – currently 16 out of a total membership of 90. One year after completing a four year stint some very personal and subjective views may be of interest to colleagues about to be proposed, or propositioned, for membership of the Commission.

This is the kind of conference at which the Royal Society of Medicine excels – an international array of speakers, firm chairmanship, time and space to meet other delegates, abstracts published with the programme and a Consensus Overview published within a fortnight (by Professor Hugh Freeman as rapporteur).