Mental health services have changed the way they operate during the COVID-19 pandemic. We investigated the challenges and innovations reported by staff working in services for people with intellectual disability and/or autism in National Health Service (NHS) and non-NHS sectors, and in in-patient and community settings.

Data were drawn from 648 staff who participated in a UK-wide online survey. Issues around infection risk and mitigation were more important to those working in the NHS and in-patient settings. Community staff were more likely to express concern about the practicalities of a rapid shift to remote working and engaging patients remotely. Qualitative data revealed support for maintaining remote staff working and remote service provision post-pandemic.

Given the current emphasis on community support for people with intellectual disability and/or autism, the focus of research and clinical practice should be the development of accessible and effective models of remote service provision.

The aim of the study was to obtain numbers of adult patients with attention-deficit hyperactivity disorder (ADHD) on consultant adult and adolescent psychiatrists' case-loads. A brief semi-structured confidential postal questionnaire was sent to 1947 consultant psychiatrists in England and Wales.

There were 1030 consultants who responded (52.9%), which clearly indicates that there is an increasing demand and need for a service, and the resources, to treat adult ADHD. Only 197 consultants offered a service for adults with ADHD. Adult ADHD is more commonly diagnosed in males (n=995, 73%), and the total number of patients with a diagnosis of adult ADHD was 1345. Most patients were aged 18–25 years (n=209, 54%). The most commonly prescribed stimulant medication was methylphenidate (n=251, 55%).

There is a clear need to improve services and funding for adults with ADHD. The study shows there are already services available for adult ADHD patients in some areas of the country. However, more research is needed to establish the prevalence of adult ADHD in England and Wales.

In-patient psychiatric care needs urgent improvement and development. A new model of psychiatric care (triage) has been used for 6 months across an adult psychiatric service covering a London borough.

Preliminary results show that the new model has reduced bed occupancy, leading to more-efficient throughput, with positive feedback from patients and staff. Important factors contributing to these positive changes include a whole-systems approach, senior medical input 6 days a week, creative use of information technology and a highly skilled multidisciplinary team.

The introduction of the new model has resulted in a more-efficient use of beds. Further evaluation will enable us to assess the impact on other parts of the service. As with all innovations, the improvements must be sustained once the initial enthusiasm has passed.

To develop and introduce an evidence-based drug treatment protocol for clozapine-induced hypersalivation, a review of published literature relating to clozapine-induced hypersalivation and its treatment was undertaken in March 2000. The databases searched were Medline, EMBASE and PsychLit, from 1966 to the present.

This paper reviews the evidence of the benefit of using antimuscarinic agents, adrenergic antagonists and adrenergic agonists. There is alack of good-quality controlled-trials, with most papers reporting aseries of uncontrolled cases dependent on subjective measures of improvement reported by the patients. However, the published literature suggests a benefit for all of the drug categories reviewed. The most effective treatment may be acombination of terazosin and benzhexol.

Clozapine-induced hypersalivation is not only an embarrassing problem, but can be difficult to treat. An evidence-based prescribing protocol will encourage the use of those drugs found to be the most effective in treating this problem. It will also offer alternatives if acertain treatment is ineffective or intolerable.

To examine the effects of implementing the individual placement and support (IPS) approach within four community mental health teams (CMHTs). Demographic, clinical and vocational data were collected through a repeated cross-sectional survey. Additionally, a service user experience survey was conducted.

The IPS approach appears to have a significant effect on the employment rates of service users; a higher proportion felt able to return to employment and a smaller proportion believed they were unable to work because of their mental health problems. Employment rates for service users appear to be independent of general employment rates.

Implementing IPS appears to increase the employment rates in CMHTs resulting in increased service user expectations of being able to return to work.

We sought to determine whether new procedures recommended by the UK Department of Health in partnership with the Home Office reduced delays in transferring mentally ill prisoners to hospital. Our main outcome measure was time taken from identification of a prisoner's need for transfer to actual transfer to hospital. Waiting times for transfers that took place during 6-month periods before and after introduction of the new procedures were assessed. We also assessed adherence to medication while awaiting transfer.

There was a reduction in mean waiting time from 77 days to 53 days (24 days; 95% CI –2 to 50). Approximately 50% of patients offered medication while awaiting transfer were non-adherent.

Despite the new procedures, many individuals with acute mental illness remain untreated in prison for several months while awaiting transfer to hospital. We recommend that time limits should be specified for hospital transfers from prison comparable to norms under civil sections.

To analyse clinical outcome indicator data from the Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS-LD) in adults with intellectual disability admitted to mental health wards during a 19-month period; and to identify clinically relevant domains of change associated with in-patient admission.

Significant improvements were found in mental state, behaviour and social functioning. Improvements were also found in cognition and activities of daily living.

The HoNOS-LD is a useful tool for measuring clinical outcomes in several relevant domains and guiding in-patient treatment in learning disability psychiatry. It may also provide a currency for payment-by-results and influence the commissioning of learning disability services.

This survey gathered data on the retirement intentions of consultant psychiatrists over the age of 50 years, in order to address retention issues. A questionnaire was sent to all 1438 consultants over this age in the UK.

A total of 848 questionnaires were returned, an adjusted response rate of 59%. The mean age at which consultants intended to retire in this sample was 60 years (s.d. 4.16), suggesting a potential loss of 5725 consultant years. Reasons for early retirement are complex: factors encouraging retirement include too much bureaucracy, lack of free time and heavy case-loads; those discouraging retirement include enjoyment of work, having a good team and money. Mental Health Officer status is an important determinant in the decision to retire early.

With numerous vacancies in consultant psychiatrist posts throughout the UK, premature retirement is a cause for concern, possibly contributing to an overall reduction in consultant numbers of 5%. Addressing factors that influence consultants' decisions to leave the health service early should form an important part of an overall strategy to increase consultant numbers.

To develop and introduce a drug treatment protocol for schizophrenia and to evaluate its effect on prescribing. Prescribing of antipsychotics was audited in January 1998. A prescribing protocol was then developed by a collaborative process involving all medical staff, and introduced in September1998. A second prescribing audit was conducted in February 1999.

The proportion of patients prescribed atypical drugs increased from 16.6% to 25.5%. Co-prescription of atypical and typical drugs was relatively uncommon compared with findings of other prescribing surveys. The use of anticholinergic medication was significantly more likely in patients receiving regular typical drugs alongside atypical agents than in those receiving atypicals alone.

Widely agreed prescribing protocols may promote improved prescribing practices. Co-prescription of atypical and typical drugs should be discouraged.

This paper describes the prevalence of substance misuse in a population with chronic psychosis and compares the results with staff estimates. Keyworkers were interviewed using validated questionnaires.

The prevalence rate of substance misuse was higher than in the general population but significantly lower than staff estimates. Staff had little specific training or experience in treating substance misuse.

Substance misuse is a significant problem among patients with chronic psychosis. Service providers should ensure than staff working with these patients are adequately trained in the management of this problem.