Supervised discharge orders were introduced in April 1996. This paper describes two national surveys of their use in all mental health provider trusts in England. Data were collected from key informants in mental health provider trusts using a postal survey in 1997, and a follow-up telephone survey in 1998.

The total number of patients subject to supervised discharge in 1997 was 160, a mean of one per trust. In 1998, there were 378 cases, a mean of two cases per trust. The annual period prevalence in 1998 can be estimated as 510 cases, approximately one per 100000 total population per year. Seventeen applications of the ‘power to convey’ were identified.

Supervised discharge is regarded as suitable for very few patients, though its use is growing. The controversial power to convey is seldom used in practice and barriers to its use are described.

The implementation of the Health of the Nation Outcomes Scales for Old Age Psychiatry services (HoNOS66+) in a National Health Service trust is described. Some preliminary data are reported for illustrative purposes.

Lessons learnt from this process are identified, and further work needed both on the glossary for the scales and on systems for trapping data is suggested.

These remain uncertain. It may be that HoNOS65+ will remain a purely administrative tool.

To assess the degree of psychological morbidity and burnout in 138 psychiatrists in three Manchester teaching hospitals.

The results for senior house officers (SHOs), registrars, senior registrars and consultants were compared. The overall response rate was 76.8%. There was no significant difference in psychological morbidity between the three training grades, but SHOs and registrars reported significantly higher levels of burnout than either senior registrars or consultants. Dealing with violent patients was stressful for all psychiatrists, no matter what the grade.

Factors related to job stress in psychiatry need to be addressed. In particular, the provision of safer working environments needs to be considered for psychiatrists at all levels of training.

This study presents an evaluation of an education programme for families whose relative has experienced a first episode of psychosis. Participants attended a five-week programme and were asked to rate their level of knowledge and confidence in managing the illness before and after the education sessions.

Two consecutive groups of relatives (n=9; n=11) attended the programme. Comparison of knowledge and confidence ratings before and after the education sessions demonstrated significant levels of change at the final session for both groups.

Education for relatives of people experiencing psychosis for the first time is an important component in community management. Such education improves the knowledge and confidence of relatives in coping with the illness, possibly leading to a more accepting and less stressful family environment reducing the risk of relapse and promoting the psychological health of the patient.

Due to a concern over the low level of referrals of children to the child and adolescent psychiatry team, an audit was designed to investigate the possible causes. An audit was undertaken in which the case notes of 100 consecutive adult female admissions to acute wards in Goodmayes Hospital were screened. The case notes were screened for mention of children, any actions taken on their behalf, in addition to a number of demographic and social factors.

The findings of the audit indicate that children of psychiatrically ill mothers do not receive the attention they need, as indicated by the literature on the topic.

More detailed case history-taking by the parent's psychiatrist and closer cooperation between adult and child psychiatry departments are suggested as two methods of addressing this need.

A prospective audit of the 425 referrals made to a community child and adolescent mental health service over a three month period was undertaken. Standardised data were collected about the referrer, reason for referral problem chronicity and complexity, service response and first appointment attendance.

The service is currently seeing less than one in five of the children conservatively estimated to require specialist mental health services. The majority of those referred were appropriate, identifying multiple problems of longer than six months' duration presenting within a complex context.

The results have provided commissioning authorities with a clear specification of the current service. This can inform decisions about resource reallocation, prioritisation and future service development. Clinicians feel that the complexity of their work is now understood and various audit projects and initiatives have been established in order to explore alternative ways of responding to referrer demands.

The prevalence of errors in reference citations and use in the psychiatric literature has not been reported as it has in other scientific literature. Fifty references randomly selected from each of three psychiatric journals were examined for accuracy and appropriateness of use by validating them against the original sources.

A high prevalence of errors was found, the most common being minor errors in the accuracy of citations. Major citation errors, delayed access to two original articles and three could not be traced. Eight of the references had major errors with the appropriateness of use of their quotations.

Errors in accuracy of references impair the processes of research and evidence-based medicine, quotation errors could mislead clinicians into making wrong treatment decisions.

To describe physical sequelae of cylindrical battery ingestion and their management by description of recent cases and literature review.

X-rays should be performed to determine the position and integrity of the battery. In the absence of abdominal symptoms, immediate surgical opinion may not be indicated.

Conservative management of battery swallowing is frequently possible.

Surveys of career intention among medical students, Membership Examination results and manpower figures are used to examine trends in recruitment to psychiatry over the last 10 years.

Problems of recruitment to psychiatry have increased. Consultant expansion contrasts with a fall in the number of medical students. The increase in the number of career senior house officers and specialist registrars is insufficient to fill existing consultant vacancies notwithstanding new and replacement posts. The popularity of general psychiatry and psychotherapy have declined.

Proposals include an increase in the number of medical students, the introduction of psychiatry in the pre-registration year, increased specialisation and closer integration of general adult psychiatry with general medicine.

This study describes the effects of teaching medical students in a maximum security psychiatric setting. A questionnaire was distributed to students (n=210) at the beginning and end of their third year.

Following the visit to the State Hospital significantly more students understood that maximum security psychiatric facilities are part of the National Health Service; that some serious offenders may require hospitalisation rather than imprisonment; that not everyone detained in such surroundings is actively violent or dangerous, or permanently detained. Twenty-three students considered forensic psychiatry to be a possible career option.

This study demonstrates that early exposure, even to such a specialised area of practice, can enhance the prospects of future recruitment. Attracting motivated, able and interested doctors is important in improving patient care.