This study was designed to clarify the nature and extent of psychiatric provision that would be needed if a new health screening protocol were to be introduced into the prison system. The reception screening questionnaires for every inmate coming into the prison over a 15-week period were reviewed using the new protocol. A further mental health assessment was undertaken on those who had screened positive.

201 men (32.6%) were found to be positive for serious mental illness

Based on this analysis, large increases in psychiatric resources would not be needed if the proposed new reception health screening processes were in place, although a reorganisation of the way in which services are delivered may be required.

We conducted a questionnaire study to establish the incidence, specialist staff availability, treatment provision and socio-demographic profile of patients with first-episode psychosis referred to all adult and child and adolescent community mental health teams in south and west London.

All 39 teams completed the questionnaire, identifying 295 cases of first-episode psychosis (annual incidence 21/100 000/year) referred in the year 2000. Teams manage to engage most patients with first-episode psychosis. A total of 73% of cases of first-episode psychosis were on some form of Care Programme Approach. However, many teams did not have adequately trained staff to provide psychosocial interventions. Even where such staff were available, care was focused mainly on monitoring medication and risk assessment, with only half the teams providing psycho-educational programmes and only a quarter offering individual cognitive–behavioural therapy to those with first-episode psychosis.

Establishing early intervention services nationwide will require significant new resources, including specialist trained staff, which could prove difficult to provide in inner-city areas. Rather than a single, uniform service model, several models of early intervention services based on locally determined need might be more realistic and appropriate, and also allow research into their relative efficacy.

To study whether psychiatry received differing treatment in newspapers than the other medical specialities, and whether tabloids were more negative in their coverage of general medicine and psychiatry than broadsheets. We conducted a survey of all headlines in all daily newspapers in the Dutch-speaking part of Belgium over a one-month period and judged whether the content was essentially positive, neutral or negative.

There was no significant difference between articles on general medicine and psychiatry with respect to the tone of the article. Whereas negative articles about medicine focused on both doctor and patient to the same extent, negative articles on psychiatry tended more often to describe the patient. Broadsheets published more negative than positive articles, while tabloids published an equal proportion of negative and positive articles.

There appears to be no difference in tone with respect to articles on general medicine and psychiatry, respectively. Nevertheless, the fact that negative articles on psychiatry tend to focus more exclusively on the patient points towards continuing stigmatisation of the psychiatric patient. Finally, broadsheets tend to be more negative in covering both general medicine and psychiatry, which contrasts with earlier findings.

The National Service Framework sets standards to improve the treatment of mental health on a national level, and requires the development of localised shared care protocols. We aimed to develop a shared care protocol for use in local National Health Service (NHS) services, based on best practice guidelines and local consensus. A systematic literature search used three databases and the advice of a clinical expert. Articles satisfying the search inclusion criteria were retrieved and appraised. Clinical recommendations from well-designed regional and national documents relevant to all aspects of the management of psychotic illness in primary care were compared and contrasted by a facilitated group involving primary and secondary care clinicians who drafted the final recommendations. A multi-agency steering group guided the work.

Twenty-two articles were retrieved, of which nine reached the criteria for inclusion. The protocol provided a comprehensive range of recommendations regarding detection, assessment, management, referral and shared working with local mental health services.

Using local clinical consensus to resolve uncertainty about conflicting clinical recommendations from a series of well-designed guidelines was an effective method for adapting clinical guidelines to local circumstances.

To compare prescribing practice in a community mental health service with evidence-based guidelines and identify factors related to sub-optimal prescribing. All current patients (n=640) were assessed regarding six key aspects of prescribing (polypharmacy, high-dose treatment, use of thioridazine/maintenance benzodiazepine/maintenance hypnotic or routine anticholinergic treatment). The relationship of quality of prescribing practice to demographic, illness and service variables was examined by regression analysis.

Five-hundred and five (79%) patients were receiving psychotropic medication. Of these, 232 (46%) had evidence of sub-optimal prescribing practice. Mean prescribing practice quality score was 0.75 ± 0.99. Maintenance benzodiazepine/ hypnotic (31%) and anticholinergic (30%) use were particularly common. Prescribing practice quality score was higher in those receiving depot antipsychotic treatment (P < 0.01) and in older patients (P < 0.01). Scores were significantly lower in patients whose principal medical contacts were with a consultant rather than a junior doctor (P < 0.001).

Prescribing practices in real-world settings frequently deviate from evidence-based guidelines. The quality of prescribing is related to patient, illness and service variables. In particular, greater contact with consultant staff is linked to better practices. Patients receiving depot antipsychotics are especially liable to less judicious prescribing practice.