Inner London psychiatric services face particular pressures. One measure of this is over-occupancy of acute psychiatric beds. Seven census-based surveys were conducted between June 1994 and January 1999 to quantify and monitor problems of inner London acute psychiatric bed provision. The censuses involved 14 inner London mental health services with a combined catchment population of approximately three million. Measures included levels (and changes over time) of occupancy, detention under the Mental Health Act, prolonged hospital stays and ward violence.

‘Minimum’ occupancy levels for the combined services were above 100% at all census points. Occupancy level fell from 122% to 112% between the first and seventh census. This was associated with an increase in bed numbers of 2.5 per 100000. Levels of detention were consistently at around 50% and violent incidents were high at all census points.

Current provision of acute beds remains insufficient to meet service demand. To meet the 85% ward occupancy level recommended by the Royal College of Psychiatrists a further 14 beds or community alternatives per 100000 population would be required.

To describe the work of the ‘Vron’, a seven-bed active rehabilitation hostel which has operated in Gloucester for the last 15 years. Such units have been acknowledged as a successful alternative to hospital care for patients with severe mental illness, but nationally are grossly under-provided.

Demographic details, admission and discharge data were described for all 103 patients admitted over a 12–year period up to January 1996. Duration of hospital treatment fell from mean 105.8 days one year before and 138.0 days two years before admission to the Vron to: mean 28.6 days one year after and 57.1 days two years after discharge from the Vron. The change was highly significant for both one and two year analyses.

Residential rehabilitation, provided as part of a comprehensive rehabilitation service, was effective at reducing requirement for hospital care. Clinical approaches which contributed to this success were described. The results point to the value of a range of residential hostels, which can through skilled deployment effectively target individual needs for a wide ranging, heterogeneous population.

The use of electroconvulsive therapy (ECT) was surveyed over the first six months of 1996 in Wales. Data on the indications for ECT and clinical outcome were collected in the first three months.

The computed annual rate was 22 patients treated with ECT per 100 000 population. Women constituted 71% of those receiving ECT (236/321). Eighty-three per cent had an affective disorder, and 80% had failed to respond to previous treatments. Only 33% of patients had been prescribed more than one class of antidepressant and only 25% had received augmentation with lithium or an alternative drug before being given ECT.

ECT is mostly used after a failure of patients to respond adequately to a course of antidepressants.

The legal provisions concerning the admission to hospital, holding powers and compulsory treatment of the mentally ill in Germany are illustrated. The essential legal concepts are compared to the situation in Great Britain.

Whereas British law gives key powers to multi-professional decision-making and relatives, German law requests formal court decisions even in routine cases. This reflects a different understanding of individual rights and their protection. German mental health law is motivated by the experiences of the totalitarian national socialist regime. It tries to protect patients' rights by restricting physicians', hospitals' and family members' Influence. British law, on the other hand, assumes that experts as well as family members act benevolently in the patient's Interest, prefers less formal mechanisms and expresses more trust in professional ethics.

Further research is desirable to analyse the situations in other countries and to determine which of these approaches is the most adequate from the point of view of the mentally ill. This is even more important in view of further European integration which will undoubtedly touch these questions and accelerate a convergence in medico-legal issues.

This paper describes the characteristics and outcome of the first 20 patients seen by a newly appointed specialist registrar in cognitive therapy. The outcome of the first (cases 1–10) and second (cases 11–20) cohorts were evaluated to assess if training had any impact on clinical effectiveness.

Comorbidity was common, but more patients improved following the intervention (effect size=0.64–1.34). The 25% therapy drop-out rate was comparable with previously reported rates. Four out of five patients who dropped out had Cluster B personality disorders. The two cohorts showed similar baseline characteristics, but the second cohort showed improved outcome (effect size of training=0.89–1.04) and had a significantly shorter course of therapy (P=0.02).

Specialist registrar training in cognitive therapy provides experience in treating a wide variety of mental disorders. The routine collection and analysis of clinical and psychometric data helps identify training effectiveness and training needs. The data demonstrate that training was associated with improved patient outcomes.

Following concerns over recruitment into general adult psychiatry, this study was undertaken to determine which factors influence senior trainees in psychiatry with regard to whether or not they choose a career in general adult psychiatry. The method used was by postal survey of all senior and specialist registrars in the UK.

Of those responding, 32.6% had chosen a career in general adult psychiatry, while 38.9% had actively rejected such a career. Twenty-six per cent of respondents had chosen another speciality without actively rejecting general adult psychiatry. For those actively rejecting general adult psychiatry, the top three factors cited were poor resources (57.6%), high workload (43.2%) and poor working conditions (30.7%).

Through an awareness of why senior trainees reject general adult psychiatry as a possible career, resources can be targeted more specifically in the future at the factors responsible, and thereby improve recruitment into this speciality.

This survey was commissioned and funded by the Department of Health to examine perceptions of training by flexible trainees in higher psychiatric training. A total of 214 trainees were surveyed using a postal questionnaire.

One hundred and thirty-five questionnaires were returned (response rate 63%). In general, flexible trainees valued the opportunity to train part-time and perceived the quality of their training to be high. However, there were drawbacks such as: perceived lack of status, restricted training opportunities and a lack of part-time consultant posts at the end of training.

Flexible training plays a major role in maintaining doctors in the workforce. However, there is a need for part-time opportunities to extend beyond the training grades and into consultant posts.

To review the experience, examination success and career progress of trainees on the flexible scheme in psychiatry in the North and South Thames region. Trainees in psychiatry who enrolled on the flexible training scheme 1993–1997 were Included In the retrospective survey of flexible training records.

Trainees on the flexible training scheme had gained experience in a broad range of posts before entering psychiatry for a mean time of 14 months. Forty-nine per cent entered flexible training during basic specialist training and 41% during higher specialist training. This cohort of trainees performed better in the MRCPsych examinations than the national average. Forty-nine per cent of the trainees intended to become child and adolescent psychiatrists. Flexible trainees' progress to consultant status was slower.

The flexible training scheme attracts trainees of comparable quality to full-time trainees and encourages their retention in the workforce.