The establishment of mental health teams which take responsibility for small geographical catchment areas has been a fundamental element in the planning of community services in most Western European countries over the last decade. This idea is challenged in the companion paper in this issue of Psychiatric Bulletin which refers to catchment areas as a “relic of the past”. The case is put for catchment areas in terms of their planning, service delivery and quality advantages for the development of comprehensive inter-agency mental health services. In brief, it is argued that community mental health services are still in many areas poorly developed (Audit Commission, 1994; Faulkner et al, 1994), and that catchment areas are necessary but not sufficient for their fuller realisation.

With the emphasis on ‘care in the community’ there have been moves to provide psychiatric care away from the large psychiatric hospitals, which have resulted in the development of community mental health teams and the expansion of primary care and health centres to cater for people with psychiatric needs. The opinions of patients attending a hospital-based depot neuroleptic clinic are reported. A 17-item questionnaire was designed addressing the functioning of the clinic, including aspects of the medical and nursing care offered and the overall service provided. The majority of patients were in favour of attending this facility and expressed their wish for the service to continue.

The British benefit system provides for disabled people. However, disincentives within the existing system reduce uptake of benefit entitlements. The link between mental illness and poverty is now well known. If welfare benefits are essential for mentally ill people to function effectively in the community, then changes may be necessary to the current system. These changes include increasing the availability of accessible literature and information from both health and social services sources, further training for mental health staff, and the automatic evaluation of benefit entitlement by the Department of Social Security.

Results of a retrospective survey of the reasons for referral and admission to a specialist neuropsychiatric hospital are presented in an effort to address the uncertainties which exist regarding the nature of the conditions treated by this subspecialty. The results indicate that a wide range of both neurological and psychiatric conditions are treated, but the paper suggests that boundaries between these two specialities are largely conceptual and that the differentiating principle in the practice of neuropsychiatry is mainly philosophical.

There are good reasons for Improving liaison between child psychiatrists and general practitioners. This study examined whether characteristics of the GP, patient or service influenced the referral of patients from primary care to the local child psychiatry service. Data collected by semi-structured interview from two samples of general practitioners who had either referred frequently or not at all over a two year period failed to show many of the associations found in other studies. Referral behaviour appears to be a complex phenomenon which may be influenced by increasing personal contact between professionals.

Psychiatrists are becoming increasingly involved in the assessment of candidates for genetic testing for Huntington's disease (HD) in which their role ranges from diagnosing conventional psychiatric disorder to identifying ‘new odd behaviours'. They are also expected to predict dysfunctional response to test results (e.g. self-harm). This paper describes the psychiatric component of the Cambridge HD Clinic and its assessment protocols. Practical concepts, useful to the understanding of the clinical problems that may be encountered, are also discussed.

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.

Severn NHS Trust has recently commissioned a psychiatric intensive care unit (PICU) which became operational on 18 July 1994. Although the number of PICUs is increasing and their services are greatly valued, they are often fraught with problems. A model for the development of PICU services is described. It includes admission criteria, overall clinical organisation of the PICU, discharge criteria and a discussion. The model described is based on the hypothesis that the primary role of the PICU is to deal with clinical nursing problems rather than medical problems. The discussion points out some of the instrumental components necessary for the successful development of PICU services.

In a retrospective study at a medium secure unit, the incident reports where a degree of restraint was used in dealing with in-patient aggression were examined for management strategies used and their relationship to various factors. There was a decrease in the use of seclusion over the period of study, seclusion being more likely to be used when agression was aimed at staff and property, following staff-patient interaction (demands) and younger age of perpetrators.

The advantages and disadvantages of a mother and baby facility as part of a general hospital psychiatric admission unit were explored. A questionnaire was sent to 60 women who had been admitted to the unit with their babies over a ten-year period asking about their psychological health following discharge from hospital, the welfare of their family and their opinion of the facility. A 37% response rate was obtained. The patients' case-notes were studied for information on various items and the results for the response and nonresponse subgroups were compared.

‘Failed discharge’ was used as a measure of service efficacy on a psychogeriatric unit. Thirty-eight failed discharges from hospital were compared with 38 controls. Failed discharge was associated with a diagnosis of depression and a greater number of previous admissions. Possible underlying causes are discussed.

In the current NHS climate, it is increasingly important to measure the outcome of medical care. In psychiatry, the most appropriate methodology is not clear-cut (Garden & Oyebode, 1989). Tailed discharge’, or readmission to hospital within a short period of discharge, has been advocated as a possible outcome measure (Jones, 1991). This point prevalence study, of patients under 65 years, yielded a ‘failed discharge’ rate of 27%. Recurrence of original symptoms, poor treatment compliance and failure of follow-up arrangements emerged as important factors.

Formal teaching in ethics is neglected in psychiatric training. This paper takes a practical approach in outlining ethical issues relevant to different stages of a research project. It is suggested that whatever the scale of the research, it is important to examine the ethical issues which surround the development of a project, as well as those which are integral to the protocol.

Dose titration is the new colloquialism in ECT circles. The technique, as generally applied, assumes that current and the time for which it is passed, are equally important in the depolarisation of nerve cells. The units used to quantify its measurement, namely the milliCoulomb (mC) reflect this. We think this is misleading and suggest it ought not to be used as a parameter to describe a treatment regime. It is the aim of this communication to explain, in general terms, the physical parameters that control the current flowing in the patient's head, to suggest a more appropriate method to describe the treatment administered and outline the requirements of a good ECT machine.

The closure of large psychiatric hospitals and the opening of community-based mental health facilities is a central part of British health policy for the care of people with mental illness. The North East Thames Regional Health Authority's (NETRHA) psychiatric hospitals closure plan started in 1985. As part of this a programme was established to assess the closure process (Leff, 1993). This study was carried out between 1988 and 1992 and was designed to study the reactions of the public to the hospital closure decision (Reda, 1993).

We undertook a study on the staff group of an in-patient unit for deaf patients which is run on therapeutic community principles. The study addressed attendance patterns and attitudes of staff to the group, using a Questionnaire with open and closed Questions. About half of the staff found the group useful and attended with some regularity, while a minority expressed negative opinions and did not attend. There were conflicting views about the boundaries of the group and is purpose. The implications for setting up and running a staff group are discussed.

A postal questionnaire assessing key professionals' and managers' views about local services achieved an overall 72% response rate. The results demonstrated concerns about the range, quantity and quality of mental health and social care provision for adults with learning disabilities and mental health needs in all 15 districts. Only eight (14%) respondents provided specific local service utilisation data, and confusions about care co-ordination responsibilities were evident. Improving future service provision should involve utilising needs assessments and quality assurance data to better inform multi-agency commissioning and purchasing strategies.

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.

Patients seen in psychiatric settings may, for a variety of reasons, be incapable of informed consent. The Mental Health Act allows for their treatment, but research into their pathologies is practically impaired (while their consent is a criterion for inclusion). Is it ethically unacceptable to perform research upon these patients? If so, then the prospects for therapeutic and conceptual advance seem remote. In this paper the competing ethical claims are examined. An approach is proposed which is humane yet permissive of research in this heterogeneous group of patients.

In this article we give an alternative view of service provision for adolescents with emotional difficulties centred around four high schools. We believe that the service we offer differs in a number of ways and has a number of benefits for clients and other pupils and staff at the schools. We present this view of our service with some information about its historical context and as a snapshot of the current state of the service in the expectation that there will be further developments.

Patients often ask psychiatrists for advice on how to answer questions about their health, when seeking employment. They fear not being employed if they declare that they have suffered from a mental illness. The attitudes of personnel directors of 200 randomly chosen public limited companies were measured. This confirmed significant reluctance, stigma and ignorance about employing and believing the mentally ill. Employers decided whether to employ someone by considering the fob description, the standard of previous work, whether the applicant was receiving treatment, previous time off sick, and the particular illness suffered. Those with depression were more likely to be employed than those with schizophrenia or alcoholism. The largest companies were significantly more likely to employ patients and were less likely to seek dismissal than the smallest. Employers would welcome more information about mental ill health. Potential employees should approach large firms and seek treatment.