In successfully recruiting patients for drug trials in dementia the Therapeutic Research Unit for the Elderly (TRUE) had referrals from various sources. The local Memory Clinic (MC) provided 38 patients for screening of which 31 (81%) were recruited, 75% of the overall number recruited. This number was small (n=41) despite various efforts and does not reflect the time invested and amount of contact work with GPs, out-patient departments and other psychiatric services.

The memory clinic provides a source of recruitment of patients for drug trials as well as services for those who do not qualify for such trials. But recruiting without the aid of a memory clinic is difficult and time-consuming and new approaches must be found.

When I was at school the big IT everyone talked about, some explored avidly and others shunned nervously was sex. In psychiatry today, as in so many other fields IT is information technology. This article is a polemic. I believe IT (the new sort) is indispensable for modern mental health care. In the British National Health Service we have a window of opportunity to get IT right and if clinicians fail to act decisively and quickly, there isa risk that the chance will be lost.

In response to concerns raised by GPs and mental health professionals, a postal questionnaire was used to ascertain level of knowledge about and attitudes towards the care programme approach (CPA) among general practitioners in one sector of Nottingham. Less than one-third of GPs who replied had heard of the CPA. GPs did not rate the benefit of CPA reviews highly and did not feel that they would be able to spare sufficient time to attend all the reviews to which they would be invited. Other issues of practical concern such as car parking at the local teaching hospital and provision of expenses were raised. Methods of acquiring valuable information from GPs must be reconsidered.

A controlled study of community care in serious mental illness (SMI) was carried out. Patients with SMI were randomised to have hospital care or be looked after by a community psychiatric care team in a Daily Living Programme (DIP). The day-to-day work of a clinical team with the difficulties encountered in delivering community psychiatric care in an inner city is described. There were seven deaths from self-harm during the 45-month study. One DIP patient committed homicide. An ordeal by media following this and the suicides are described. Lessons learnt include the need for the community care team to be responsible for discharge from any in-patient phases and for attention to team morale, especially during adversity, and to time spent working under pressure.

A cross-sectional survey of all in-patients at a psychiatric hospital was performed to see to what extent College guidelines on neuroleptic prescribing were being adhered to. Thirteen (7.3%) patients were found to be on high doses and one (0.6%) on megadoses. Only 23% in the high-dose group had had an ECG at all, and Just 7.7% had had one in the previous three months. The single patient on megadose treatment had had an ECG but not In the previous three months. Prescribing habits that could potentially have led to 21.9% of patients receiving high doses and 9.0% megadoses were identified, and reasons for the low rate of ECGs discussed.

The introduction of supervision registers for mentally ill people according to the NHS Executive Guidelines in February 1994 aroused debate among psychiatrists. This paper highlights many of the issues and describes the development of the supervision register at one medium secure unit.

This paper reports on a survey of newly appointed consultants in old age psychiatry. The Questionnaire asked for opinions on the adequacy of higher training in a number of areas such as clinical, management, teaching, supervision and research. In addition views were sought on particularly valuable experiences in preparation for consultancy. The results show that overall clinical training was judged to be good, while training in some non-clinical areas, especially management, was found to be insufficient. The importance of management training Is emphasised and some valuable training experiences are highlighted.

This report describes the use of the needs for care assessment (NFCA) in measuring symptom and social function in patients with long-term mental Illness. The schedule recommends specific care interventions and these were implemented where appropriate. The problem status of the patients was reassessed using the needs for care schedule after the interventions had been offered and tried. The recommended care items were within the compass of our rehabilitation service, were rarely refused by the patients and there was an improvement in symptom and social function. These findings provide some validation for the concept of unmet need.

This study presents a comparison between the domiciliary consultation services in urban and suburban sectors of the Croydon Health District. Urban general practitioners requested less domiciliary visits (DV) and tended to be less satisfied with this service than their suburban counterparts. Sociodemographic factors such as population density and multi-ethnicity in the urban sector may be responsible for a smaller referral rate and the degree of satisfaction with the psychogeriatric DV service in Croydon.

Six yean ago, Edinburgh's community drug problem service established a model of shared care between drug specialists and general practitioners who were encouraged to prescribe oral methadone and other drug substitutes in an attempt to reduce drug injecting and the spread of HIV in a city with a high seroprevalence rate. Of Edinburgh's GPs, 70% now prescribe for around 1200 drug users who have altered their pattern of drug taking, with a marked shift away from injecting drug use, and towards oral pharmaceutical drugs. HIV rates among new referrals to the service have fallen from 21% to 8%.

In 1991 the Prison Service began to develop a programme of treatment for sex offenders in custody. HMP Risley was the first establishment to successfully establish and run the ‘Core Treatment Programme’. This paper examines some of the issues involved in setting up such a programme, which was designed to be implemented by relatively inexperienced staff.

The characteristics of clients admitted to a community support bed unit (SBU) serving an isolated, rural community were compared with those of clients from the same sector, admitted to a district general hospital (DGH) unit over the same period. There were few differences In the nature of the problems presenting to the two units, although there were more readmissions to the SBU, and more women tended to be admitted there. These results suggest that although the need for inpatient care remains for some patients, many who are currently admitted to such units can be managed in less institutional settings in the community. A support bed unit may play an important part in offering service users more choice about where and when they received help.

Referral rates to three groups of mental health professionals working In primary care were compared. All patients referred over an 18-month period at two health centres in an outer London borough were assessed by case-note review and data were collected on 181 consecutive referrals. In general, younger, more socially-stable patients were referred to the psychologist and older patients were seen by the CPN. The psychologist saw most new patients; patients previously seen by a psychiatrist were most likely to be referred again to a psychiatrist. Patients requesting referral to a mental health professional were most likely to be referred to the psychologist. Patients with a diagnosis of psychosis were seen mainly by the psychiatrist and the CPN; the psychiatrist saw most patients with a personality disorder. A high proportion of patients were seen for assessment only. In general, all interventions were brief. There was evidence of selection by GPs in the referral of patients to each mental health professional.

The use of mental health legislation in a Regional Adolescent Unit over a 10 year period was reviewed. There was a trend of increasing use over time. This was thought to reflect changes in attitude and professional practice subsequent to the introduction of the Children Act 1989. Conversion rates of Section 5(2) were high and practitioners with appropriate training were involved in the majority of sections, indicating good practice.

Evaluation studios of community mental health services require the research, often in the form of interviews, to be carried out in private homes which poses a particular set of issues relating to the interview environment and the organisation of the work. This paper describes the experiences of interviewing patients, staff and informal carers as part of an evaluation study of the mental health services in two psychiatric sectors in South London and makes recommendations for more effective community based research.

The Law Commission report on Mental Incapacity was published in 1995 and examines how decisions can be made on behalf of those who are unable to make decisions for themselves. It has far reaching implications for psychiatrists and recommends the introduction of new legislation. Research with those unable to consent, advance treatment directives, decisions about medical treatment and public law protection of vulnerable Incapable people are areas covered in the document. Although there are some concerns for psychiatrists, many of the proposals can be welcomed.

The study examines the knowledge and views among district social workers of a local child psychiatric service and determines whether their views influence decisions to refer to the service. The results are compared with similar studies of general practitioners (GPs) and paediatricians and discussed with reference to recent national reviews of child psychiatry in the UK.

A survey of 101 new attenders at a regional drug and alcohol service found that 46 adults had a total of 88 children at home. Twenty-three children were considered by their carers to show signs of emotional or behavioural disturbance. Difficulties had only been discussed with professionals in a minority of cases. Help for troubled children from primary care services was preferred to secondary services. Closer liaison between child psychiatry and primary health care workers should be considered.

The circumstances associated with high lithium concentrations detected by 23 district laboratories in the West Midlands during a 22 month period were investigated.

A survey of 100 completed Regional Secure Unit (RSU) in-patient episodes shows that most patients are young, male, short-stay and suffering from chronic psychotic disorders. Substance abuse is prevalent, and many currently face serious charges. A significant minority of patients had previously been admitted to the Unit, especially those admitted directly from the community. Nearly half of all discharges were directly into community placements, and nearly as many remained under the care of the forensic service. Despite the sampling frame, it is clear that a few ‘long-stay’ patients contribute disproportionately to overall bed occupancy, so that beds for acute admissions may be blocked. Further, ‘parallel care’ is operating to a significant degree in this service, with the inevitable accumulation of patients who will continue to require future in-patient care. These two factors in particular suggest that the ability of the RSU to fulfil its basic functions may become increasingly compromised, particularly with respect to emergency requirements for medium secure beds at the district level.