To review the literature to examine the factors that may be affecting recruitment into psychiatry in the UK. We systematically searched four databases to identify studies from 1974 to 2016 and identified 27 papers that met the specified inclusion criteria.

Most papers (n = 24) were based on questionnaire surveys. The population in all studies comprised of 1879 psychiatrists, 6733 students and 220746 trainees. About 4–7% of students opt for a career in psychiatry. Enrichment activities helped to attract students more towards psychiatry than just total time spent in the specialty. Job content in terms of the lack of scientific basis, poor prognosis and stigma towards psychiatry, work-related stress and problems with training jobs were common barriers highlighted among students and trainees, affecting recruitment. Job satisfaction and family-friendly status of psychiatry was rated highly by students, with lifestyle factors appearing to be important for trainees who tend to choose psychiatry.

Negative attitudes and stigma towards psychiatry continue to persist. Teaching and training in psychiatry needs rethinking to improve student experience and recruitment into the specialty.

To determine the annual rates of assaults and threats to psychiatrists, describing the situations and staff involved, using a retrospective postal questionnaire of 139 doctors working in South Wales.

Over the year, 17% of respondents reported one or more assaults (of these, 42% were assaulted more than once) and 32% reported one or more threats. The most junior senior house officers (SHOs) were significantly more likely to have experienced an incident, regardless of the individual's gender or attendance at a course in managing aggression. Most assaults (61%) were committed by patients from general adult psychiatry, and half occurred during urgent assessments. Eighteen (58%) of the assailants were known to have previously assaulted amember of staff, and this information was known to the doctor before the assault for 16 (88%). Five (16%) of the assailants had been drinking alcohol prior to the assault. Twenty-nine (78%) of the assaults were documented in the case notes and 6 (19%) were reported to management.

Some staff (in particular, inexperienced SHOs) are at greater risk, and efforts should be made to identify and help these individuals and/or grades to deal with aggression. All psychiatric staff should be trained to manage violence. Staff should be encouraged to report incidents to management, so that employers can identify and address problem areas.

A 1-day census provided an opportunity to examine the variation between 44 mental health services in the frequency of prescribing high doses and polypharmacy of antipsychotic drugs to in-patients on acute psychiatric wards.

The proportion of patients prescribed a high dose ranged 0–50% and simultaneous use of more than one antipsychotic drug ranged 12–71%. A number of case-mix variables explained 26% and 40%, respectively, of the variance between services on these two indicators of prescribing practice.

Services with high rates of prescription of high dose or polypharmacy might consider a review of clinical practice and of service-level factors that might affect prescribing.

To examine the quality of information concerning depression available on the internet, identify factors associated with ‘good’ quality, and develop a simple-to-use instrument for assessing websites on depression. The Depression-Website Content Checklist was developed and compared with a previously validated, yet too complex, scale. Websites were assessed using both instruments.

Good quality information is more likely to be found on websites provided by governmental, professional and charitable organisations. The differences we observed in the median scores for these websites using the Depression-Website Content Checklist are significant at the 0.05 level (Ctot; Mann–Whitney, U=24.00; P=0.013). The Depression-Website Content Checklist is a valid and reliable user-friendly tool.

Patients can be directed towards better quality information by diverting them to public and non-sponsored websites. Clinicians can use the Depression-Website Content Checklist to determine website quality.

To determine knowledge, skills and confidence of junior medical emergency department staff in managing mental health patients. Over a 2-year period new emergency department junior doctors were given a questionnaire to complete early on in their post and prior to any mental health training. The questionnaire asked about knowledge, confidence, concerns and skills in the management of mental health patients in accident and emergency services.

More than half of the 32 doctors surveyed said they lacked knowledge, skills and confidence when assessing mental health patients.

The survey has demonstrated a need for mental health training of new doctors working in the emergency department. Effective training for such doctors can be offered by a liaison psychiatry service. This should be embedded in their teaching programme and be continually responsive to their perceived training needs.

To examine non-attendance rates in patients seen by psychiatrists of different grades and a consultant clinical psychologist. Rates were obtained from the patient administration system over a 21-month period.

A planned linear contrast showed that the clinical psychologist's patients had the lowest rate of non-attendance (7.8%), followed in turn by those of consultant psychiatrists (18.6%), specialist registrars (34%) and senior house officers (37.5%).

Factors such as continuity of care, perceived clinical competence and the provision of non-medical interventions might have an impact on attendance rates. These results indicate the difficulty in reconciling the training needs of junior doctors with the provision of continuity and quality of care for patients. Reminder systems for people seeing training doctors might be an effective way of reducing non-attendance rates.

The Royal College of Psychiatrists' Consensus Statement on “The use of high-dose antipsychotic medication’ suggests only fully qualified psychiatrists (MRCPsych) should recommend the prescribing of high-dose antipsychotic treatment. We observed changes in anti-psychotic prescribing in two surveys of psychiatric in-patients conducted eight and 32 months after publication of the Consensus Statement.

Overall mean chlorpromazine equivalent doses of antipsychotic drugs reduced between the surveys. When p.r.n. (as required) prescribing (usually done by junior doctors) is included, mean potential doses and numbers of patients who might receive ‘high-doses' increases substantially, although the reduction between surveys in total mean dose and proportion of patients on high-dose antipsychotic medication is preserved, and the actual use of p.r.n. medication was low (4–5% of p.r.n. prescriptions).

We recommend the development of local guidelines for junior staff concerning antipsychotic drug prescribing, regular monitoring of p.r.n. medication by consultants, and pharmacists' involvement in reviews of patients prescribed high-dose antipsychotic medication.

We examined the impact of a crisis resolution and home treatment teams (CRHTT) on hospital admission rates, bed days and treatment satisfaction among older people with mental illness and their carers. We compared these factors in the 6 months before the service started and 6 months after its introduction.

The CRHTT significantly reduced admissions (P<0.001), but there was no significant difference in the length of hospital stay as compared before and after the introduction of this service. There was a trend towards carers, but not patients, being more satisfied with treatment after the introduction of the CRHTT.

The CRHTT reduced hospital admissions for older people by 31% and carers preferred the service. Further research on crisis teams in older people with mental illness is needed using randomised controlled methodology.

To assess the preferences of people attending a substance misuse facility towards the treatment options available for opiate dependency. Interviews were conducted using a card sorting technique.

The majority (60%) of the 101 participants believed that detoxification was superior to maintenance in preventing illicit heroin use. The preferred treatment options were oral methadone, buprenorphine, drug-free rehabilitation, in-patient detoxification and prescription of injectable drugs.

Both pharmacological and psychosocial options, including in-patient detoxification and rehabilitation, are among the treatments preferred by clients of substance misuse services. There is also a significant demand for both injectable drugs and dihydrocodeine.

The study aimed to identify the correlates of aggressive behaviour in an adult acute psychiatric ward. Over a period of 9 months, all incidents of verbal and physical aggressive behaviour exhibited by in-patients were routinely assessed using the Overt Aggression Scale.

Of the 535 patients admitted during the study period, 80 (15%) were involved in a total of 124 aggressive incidents. Of these 80, 44 (55%) had a history of previous violence and 54 (68%) had a history of substance misuse. The majority of events occurred early in the hospital stay and in most cases aggression was against staff. There were significant differences between aggressive and non-aggressive patients in terms of gender and ethnicity, with the lowest rate occurring in European females.

These results reinforce clinical impressions, and empirical evidence, and allow risk assessment to be performed with greater confidence. The relevance of ethnicity (or more likely culture) highlights the difficulties of a ‘one size fits all’ approach to risk assessment.

To assess the compliance of contemporary online media output with guidelines for the responsible reporting of suicidal acts. A search engine was used to identify online media reports of suicide from UK sources over the course of 1 month. Each article was assessed against guidelines for the responsible reporting of suicide produced by the Samaritans, a UK mental health charity.

We identified 229 articles, of which 199 failed to comply with at least one of the Samaritans' guidelines. Failure to mention support sources, excessive detail about the method used and undue speculation about the trigger for suicide were the most commonly breached guidelines. Significant differences were found between the quality of local and national media sources, with local media sources being broadly more compliant with guidelines.

This study highlights the urgent need for the implementation of responsible reporting guidelines in online media articles as a component of suicide prevention efforts.

To develop a service development plan supporting recovery-based practice through collaborative service user-led methodology, and contribute to the National Institute for Mental Health in England (NIMHE) pilot evaluation of recovery sensitive measures. Staff, residents and service user group representatives collaborated in implementing the Developing Recovery Enhancing Environments Measure (DREEM) in a residential rehabilitation service.

Staff and residents demonstrated a shared vision of recovery. Many areas were being addressed to a high level but others showed areas of deficiency, and illustrated discrepant views between staff and residents, which provided a focus for the development of a clinical service action plan.

As an experimental measure DREEM provides a user-led structure, which enables services to measure their commitment to, and effectiveness in, providing recovery-based care. It focuses service development and enhances collaborative work with service users, thus mirroring the principles of recovery it measures. It merits further evaluation and consolidation.