To dissect duration of untreated psychosis (DUP) into three components: help-seeking delay, referral delay and delay in mental health services, all mental health services in a defined geographical region were screened over a period of 1 year. All cases of first-episode psychosis without a primary mood disorder were identified (n=55).

The median delay within secondary services was over seven times the delay in the referral pathway. The mean delay in mental health services accounted for 35% of overall DUP.

Intervention is required in secondary as well as primary care services if DUP is to be reduced.

By use of a postal survey we sought to determine attitudes and beliefs about recruitment to psychiatry. Members of the Scottish Division of the Royal College of Psychiatrists were asked to complete a questionnaire asking their views on the importance of various factors in relation to recruitment (n=387).

Response rates were low from non-consultants and we focused on the views of the 212 consultants (55%) who responded. The perceived low status of psychiatry among other doctors and the belief that individuals with psychiatric disorders are difficult to deal with emerged as the two most important factors seen to affect recruitment. Improving undergraduate teaching in psychiatry was deemed important in enhancing recruitment.

Dealing with stigma, within and out with the profession, and improving undergraduate exposure to psychiatry may be important in recruiting doctors to psychiatry.

To examine patients' views on the quality of care they received before, during and after electroconvulsive therapy (ECT), a questionnaire was completed by 389 patients who had received ECT at ECT Accreditation Service (ECTAS) member clinics.

The nine key standards set by ECTAS relating to quality of patient care were rated as having been met by 65% or more respondents. Most patients found staff friendly and reassuring and often commented on how this had helped reduce their anxiety prior to ECT. Patients were less positive about standards relating to being introduced to staff prior to ECT, and the quality of the waiting and post-recovery areas.

Patient views are important indicators of quality of care and should be used to improve ECT practice. Anxiety about ECT is helped by supportive and caring staff. Improvements could be made to practices related to waiting for and recovering from ECT.

To assess the feasibility of using a structured risk assessment tool (Historical Clinical Risk 20-Item (HCR–20) Scale) in general adult psychiatry admissions and the characteristics of ‘high-risk’ patients. A notes review and interviews were used to conduct an HCR–20 assessment of 135 patients admitted to Murray Royal Hospital, Scotland.

Patients scoring higher on the HCR–20 were discharged earlier and more likely to have a diagnosis of personality disorder and a comorbid diagnosis.

It was possible to complete an HCR–20 assessment of over 80% of patients within 48 h of admission.

The recent Medical Training Application System (MTAS) has been fraught with problems. A survey of MTAS applicants from two London training schemes and a request for emails from trainees and trainers documenting problems with the system were undertaken with the aim of canvassing the views of candidates and shortlisters/interviewers about MTAS, and providing evidence of the system's failings.

A total of 101 candidates responded to the survey, and the first 92 emails sent to the Royal College of Psychiatrists were analysed. The majority of respondents (73%) were dissatisfied with MTAS and 63% thought the system unfair. UK and European Economic Area (EEA) applicants (71%) were more successful in being shortlisted than non-EEA candidates (48%). The majority of applicants (70%) planned to reapply in subsequent rounds if they failed to secure a training post.

Both surveys showed clearly that the system was not working well. The trainees and trainers both felt that the system was flawed and that the reasons for the failure included a centralised system without any piloting, and the question design. In addition a lack of resources added to the stress and burden on both trainees and trainers.