To develop a logic model that illustrates the steps needed to develop an effective intervention for diabetes management in a psychiatric inpatient setting, as the point of admission to a psychiatric inpatient unit may present as an opportune time for improving diabetes care.

We undertook (i) a survey of diabetes care among inpatients in a Mental Health Trust in England, comparing care to the National Health Service (NHS) Core National Diabetes Standards (ii) interviews with key clinical staff to understand challenges in delivering good diabetes care (iii) a review of current UK guidance on standards for diabetes care. On the basis of the findings we developed an initial logic model for service delivery.

Among 163 inpatients reviewed, 44 (27%) had a diagnosis of diabetes, and only 3 (7%) had all three National Institute for Health and Care Excellence (NICE) treatment targets within range. Staff identified needs for regular training, better understanding of roles in shared care, and good quality IT support. We developed a logic model that illustrates the steps needed to develop an effective intervention for diabetes management in a psychiatric inpatient setting.

Admission to a psychiatric inpatient setting provides an opportunity in which diabetes care may be optimised. The quality and understanding of diabetes care will need to be enhanced if this opportunity is to be exploited.

Recently the NHS has expanded the provision of liaison mental health services (LMHS) to ensure that every acute hospital with an emergency department in England has a liaison psychiatry service. Little work has been undertaken to explore first-hand experiences of these services. The aim of this study was to capture service users’ experiences of LMHS in both emergency departments and acute inpatient wards in the UK, with a view to adapt services to better meet the needs of its users.

This cross-sectional internet survey was initially advertised from May-July 2017 using the social media platform Facebook. Due to a paucity of male respondents, it was re-run from November 2017-February 2018, specifically targeting this demographic group. 184 people responded to the survey, of which 147 were service users and 37 were service users’ accompanying partners, friends or family members. The survey featured a structured questionnaire divided into three categories: the profile of the respondent, perceived professionalism of LMHS, and overall opinion of the service. Space was available for free-text comments in each section. Descriptive analysis of quantitative data was undertaken with R statistical software V.3.2.2. Qualitative data from free-text comments were transcribed and interpreted independently by three researchers using framework analysis; familiarisation with the data was followed by identification of a thematic framework, indexing, charting, mapping and interpretation.

Opinions of the service were mixed but predominantly negative. 31% of service users and 27% of their loved ones found their overall contact with LMHS useful. Features most frequently identified as important were the provision of a 24/7 service, assessment by a variety of healthcare professionals and national standardisation of services. Respondents indicated that the least important feature was the provision of a separate service for older people. They also expressed that a desirable LMHS would include faster assessments following referral from the parent team, clearer communication about next steps and greater knowledge of local services and third sector organisations.

Our survey identified mixed responses, however service users and their loved ones perceived LMHS more frequently as negative than positive. This may be attributed to the recent governmental drive to assess, treat and discharge 95% of all patients seen in emergency departments within four hours of initial attendance. Additionally, dissatisfied service users are more likely to volunteer their opinions. The evaluation and adaptation of LMHS should be prioritised to enhance their inherent therapeutic value and improve engagement with treatment and future psychiatric care.

There are a number of candidates as useful outcomes in self-harm research – repetition of self-harm; symptom states; quality of life, social participation. Repetition of self-harm has been the predominant choice of researchers, not least because of its status as a risk for eventual suicide. Use of alternatives would respond to the preferences of study participants, but there are substantial methodological constraints. Nonetheless more attention could be given to the use of outcomes other than repetition. Another option is to broaden the approach to evaluation design, incorporating advances in the use of observational data either alone or linked to data from trials.

This paper describes the process of setting up and the early results from a new liaison psychiatry service in primary care for people identified as frequent general practice attenders with long-term conditions or medically unexplained symptoms. Using a rapid evidence synthesis, we identified existing service models, mechanisms to identify and refer patients, and outcomes for the service. Considering this evidence, with local contingencies we defined options and resources. We agreed a model to set up a service in three diverse general practices. An evaluation explored the feasibility of the service and of collecting data for clinical, service and economic outcomes.

High levels of patient and staff satisfaction, and reductions in the utilisation of primary and secondary healthcare, with associated cost savings are reported.

A multidisciplinary liaison psychiatry service integrated in primary care is feasible and may be evaluated using routinely collected data.

The problem of people presenting to hospitals with self-harm is important because such presentations are common, there is a clear link to suicide and a high premature mortality. However, the best treatment for this population is unclear.

To see whether a package of measures, that included regular postcards and problem-solving therapy, improved outcomes at 1 year compared with usual care in people who presented to hospital with self-harm (the ACCESS study: trial registration Australian and New Zealand Clinical Trials Registry ACTRN12609000641291).

The design of the study was a Zelen randomised controlled trial. The primary outcome was re-presentation to hospital with self-harm within 12 months of the index episode.

There were no significant differences in the primary outcome and most of the secondary outcomes between the two groups. About half the people offered problem-solving therapy did not receive it, for various reasons.

The package as offered had little effect on the proportion of people re-presenting to hospital with self-harm. The dose of problem-solving therapy may have been too small to have an effect and there was a difficulty engaging participants in active treatment.