To evaluate patterns of antipsychotic co-prescription and to establish documented outcome, we reviewed 1441 in-patient and community prescriptions written in a large mental health trust. For patients co-prescribed regular atypical and typical antipsychotics for longer than 6 weeks, medication histories were taken and case notes examined to determine sequence of prescribing, documented outcome and reasons for co-prescription.

Fifty-three patients had been co-prescribed aytpical and typical antipsychotics for more than 6 weeks. In 62% of cases the atypical drug had been prescribed first and a typical drug added later. The most frequently documented reason for co-prescription was that symptoms persisted when prescribed a single antipsychotic. Clinical outcome was documented for 64% of patients: 45% of the total number treated showed some improvement, with seven of 53 patients noted to have shown improvements in psychotic symptoms.

Co-prescription of aytpical and typical antipsychotics often occurs as a consequence of poor outcome with single drug treatment. In this study there was minimal evidence to suggest that co-prescription improved outcome to an important extent. There remains little support for co-prescription of antipsychotics but considerable evidence to suggest that such practice worsens adverse effect burden. Co-prescription of atypical and typical antipsychotics should be avoided in all but very exceptional circumstances.

To investigate the attitude of staff towards the recovery approach in forensic mental health services and the impact of training on staff knowledge and attitudes. A specially constructed 50-item recovery approach staff questionnaire, which focused on the core components of the recovery approach, was completed by 137 members of staff in in-patient forensic services in Lambeth, south London.

Staff were generally very positive about the implementation of the recovery approach in forensic services and those who had received training scored significantly higher on the questionnaire than non-trained staff.

The great majority of staff agree that the recovery approach to care does have a place in forensic services. This is important and needs to be built into the implementation of this approach in forensic services.

Quantifying the relationship between waiting time and clinic attendance in child and adolescent psychiatry would allow better estimation of the resources needed to eliminate waiting lists in specific initiatives. All cases on a waiting list were sent a questionnaire, return of the questionnaire being necessary for an appointment to be made. Those who did not return the questionnaire or did not attend were contacted and a reason obtained whenever possible. The data were analysed using Cox regression.

Most who did not return their questionnaires had been waiting less than four weeks or longer than 30 weeks. Questionnaire return seemed a good estimate of intention to attend. Other factors improving questionnaire return were younger patient age, previous experience of the service, a clear common reason for referral, and a non-general practitioner referral source.

Waiting lists in child and adolescent psychiatry may have a natural ‘endpoint’ at 30 weeks beyond which families give up, while waiting lists of less than one-month may be too short to lose transient problems. Failure to include this and other indicators of non-attendance may lead to overestimates of resources needed to remove queues for treatment. Questionnaires may be useful in identifying those intending to attend.

To determine which terms receivers of mental health services wish to be known by (service user, patient, client, user, survivor) according to the professional consulted (psychiatrist, nurse, psychologist, social worker, occupational therapist). We conducted a questionnaire study to assess terms by like or dislike and by rank order. There were 336 participants from local catchment area secondary care community and in-patient settings in east Hertfordshire.

Patient is the preferred term when consulted by psychiatrists and nurses, but it is equally preferable to client for social workers and occupational therapists. Service user is disliked more than liked overall, particularly by those who consulted a health professional, but not by those who consulted a social worker. A significant minority wish to be regarded as a survivor or user.

National and local mental health services should adopt evidence-based terminology in referring to ‘patient’ or, in some groups, ‘patient or client’ in preference to ‘service user’.

To ascertain the views and experiences of psychiatrists in England and Wales regarding community treatment orders (CTOs). We mailed 1928 questionnaires to members of the Royal College of Psychiatrists.

In total, 566 usable surveys were returned, providing a 29% response rate. Respondents were generally positive about the introduction of the new powers, more so than in previous UK studies. They reported that their decision-making regarding compulsion was based largely on clinical grounds.

In the absence of research evidence or a professional consensus about the use of CTOs, multidisciplinary input in decision-making is essential. Further research and training are urgently needed.

A postal questionnaire survey was conducted of the directors of nursing of all mental health NHS trusts in England, in order to examine current activities and attitudes regarding nurse supplementary prescribing (NSP) in psychiatric settings.

Fifty-four per cent of nurse directors returned the questionnaire. They perceived that NSP was an important means for improving patient care and treatment, particularly in community settings. In their opinion, psychiatrists were generally not opposed to its introduction. To date, relatively few mental health nurses have received training in NSP.

Directors of nursing have positive views and experiences of NSP. Widespread implementation of NSP is likely to occur over the next few years and psychiatrists will need to consider how this will impact on their role.

The study investigated the personal impact of patient suicides on the members of community mental health teams and the sources of support utilised for coping with adverse effects.

Forty-four questionnaires were returned. Eighty-six per cent of staff reported having had at least one patient suicide, with an average of 4.2 suicides. The majority of staff reported that patient suicides had significant adverse effects on their personal and professional lives. Some of the effects were long-lasting (greater than 1 month). Staff found that peer support, reviews, dedicated staff meetings and support from senior colleagues were of most value.

Staff require skilled and dedicated support following a patient suicide in order to minimise its detrimental effects on personal, professional and team functioning.

To describe the pattern of referrals and characteristics of people aged over 18 seeking gender reassignment in Oxfordshire over a 6-year period (2011–2016).

A total of 153 individuals attended for assessment (of 162 referred); 97 (63.4%) were natal males and 56 (36.6%) were natal females. Mean age at referral was markedly different between the two groups, with females being younger. The number of referral significantly increased over the time period, by an average of 18% per year (95% CI 1.08–1.30). Eighty-seven patients sought transition from male to female, and 46 from female to male, while a smaller group (n = 13) had non-binary presentations. Twelve patients (7.8%) had autism spectrum disorder.

There are various possible reasons for the increased demand for services for people with gender dysphoria, which we discuss here. When planning services in the UK, both the increase in overall referral rates and the apparent earlier age at referral should be taken into account.

None.

To compare admission rates and bed occupancy before and after the introduction of community treatment orders (CTOs) in 37 assertive outreach service patients. The effect of CTOs on treatment adherence and illicit drug use were also evaluated. The views of patients and care coordinators were obtained through a focus group.

When CTOs were introduced, admission rates fell from 3.3 to 0.3 per year and average bed occupancy declined from 133.2 to 10.8 days per year. Treatment adherence improved from 4 (10.8%) to 31 (83.7%) patients, and an objective reduction in substance misuse was observed in 25 (67.5%) patients. Whereas patients expressed ambivalence towards CTOs, their care coordinators generally had a more positive view.

The decline in hospital usage following the introduction of CTOs is encouraging and could reflect improved adherence and engagement through intensive case management, leading to a reduction in readmissions. However, further studies need to look at quality of life, cost-effectiveness and the impact on patients.

Coping Through Football aims to improve well-being and reduce social isolation for younger people with severe mental illness in a deprived area of North East London. Interviews were conducted with 12 service users, 5 referrers and 2 coaches to obtain their views of the project's implications for health and well-being, quality of life and social/community relationships. A qualitative approach was used to derive themes from interview transcripts using some of the tools of grounded theory.

Themes included: identifying with past self; service with a difference: opening up the social world; safety; empowerment; and feeling good. Coping Through Football was seen by stakeholders as leading to increased well-being and social opportunities within a safe and understanding environment.

For many service users the football project played a key role in their recovery of personal and social roles. Social and community-based mental health projects benefit greatly from active community collaboration, in this case a professional football club and several non-statutory sport/leisure bodies.

To develop a programme to help undergraduate medical students and postgraduate trainees to improve their skills in communicating with people with intellectual disabilities through teaching sessions that had input from simulated patients with intellectual disabilities. We conducted four sessions of training for 47 undergraduate 4th-year medical students. The training involved a multiprofessional taught session followed by a clinical scenario role-play with simulated patients who were people with intellectual disabilities. The training was assessed by completing the healthcare provider questionnaire before and after the training.

There were improvements in the students' perceived skill, comfort and the type of clinical approach across all three scenarios.

By involving people with intellectual disabilities in training medical students there has been a significant improvement in students' communication skills in areas of perceived skills, comfort and type of clinical approach which will raise the quality of care provided by them in the future.

We audited 184 psychiatric wards against clinical practice guidelines for the management of violence. Staff and service users completed anonymous questionnaires. Environmental inspections were performed by two teams.

There were 4460 questionnaires returned. Nurses (78%) were significantly more likely to report the experience of violence than service users (37%). Drugs were reported by 72% of nurses and alcohol by 61% as causing problems. Other standards frequently not met included staffing levels, training, provision of activities, ward design and ambience.

Specific issues are identified that must be addressed by national and local action. A baseline is set against which the impact of this action can be judged. Priorities must include tackling drug and alcohol use in psychiatric wards.