This paper describes the results of a survey of adolescent offenders referred to a tertiary National Health Service forensic psychiatric service based in South Wales over a three year period. Seventy-seven adolescents aged between 13 to 18 years were seen (5.1% of all referrals to the Service during this time). The majority of the adolescents had committed major offences including serious sexual crime, wounding and murder. A high rate of mental disorder was observed in this survey as well as high levels of substance misuse. Eighteen per cent were admitted to a hospital for further assessment and treatment.

In 1991 the Prison Service began to develop a programme of treatment for sex offenders in custody. HMP Risley was the first establishment to successfully establish and run the ‘Core Treatment Programme’. This paper examines some of the issues involved in setting up such a programme, which was designed to be implemented by relatively inexperienced staff.

A survey of 100 completed Regional Secure Unit (RSU) in-patient episodes shows that most patients are young, male, short-stay and suffering from chronic psychotic disorders. Substance abuse is prevalent, and many currently face serious charges. A significant minority of patients had previously been admitted to the Unit, especially those admitted directly from the community. Nearly half of all discharges were directly into community placements, and nearly as many remained under the care of the forensic service. Despite the sampling frame, it is clear that a few ‘long-stay’ patients contribute disproportionately to overall bed occupancy, so that beds for acute admissions may be blocked. Further, ‘parallel care’ is operating to a significant degree in this service, with the inevitable accumulation of patients who will continue to require future in-patient care. These two factors in particular suggest that the ability of the RSU to fulfil its basic functions may become increasingly compromised, particularly with respect to emergency requirements for medium secure beds at the district level.

A consumer satisfaction survey of patients with learning disabilities and mental health needs attending outpatient psychiatry clinics was performed using a questionnaire administered by their carer. Sixty completed questionnaires were returned and the results were analysed to determine whether demographic or service variables were correlated with the degree of satisfaction. Younger patients living independently or with their family and those who were not prescribed psychotropic medication were more satisfied. The service variables associated with increased satisfaction were comfortable waiting areas, punctuality and good communication with the doctors.

Health services are now commissioned at a local rather than a regional level. It is essential for local consultants to have an input to the planning and commissioning process. For the child and adolescent psychiatrist this task is complicated by an absence of nationally agreed guidelines on the level of resourcing required for a district child and adolescent mental health service. This paper describes an approach to advising purchasers which offers them a choice of service models that differ in their levels of resourcing. Each of the service models is described briefly. The advantages and flexibility of this approach are discussed.

Quality of life scores were measured In a new hospital hostel in a rural community. These scores were compared to scores on patients in a similar hospital hostel in an inner city area in the United Kingdom and also scores on patients living in a range of different facilities in the community In the United States.

Public sector psychotherapy differs from private practice in its explicit responsibility for a population. This has major implications, with the need to ration a scarce resource inevitably affecting clinical practice. De facto rationing has existed within the National Health Service (NHS) for years, and the ‘unconscious' processes involved must be made explicit if NHS psychotherapists are to deal with their broader responsibilities, and influence current changes in the Health Service. Resource issues and the related psychological conflicts shape clinical practice and thus theoretical concepts. The effects on practice could be seen as a series of unhappy compromises, or a stimulus to the creative development of a specific NHS psychotherapy, as envisaged by Sigmund Freud.

The pharmacological treatment of depression and the time elapsed since last seen by a doctor were investigated among 507 adults who subsequently killed themselves. The proportion of people consulting a general practitioner or psychiatrist prior to suicide was lower than reported by the British government in the Health of the Nation document. General practitioners prescribed relatively low doses of antidepressants. Nineteen out of the 115 people receiving antidepressants used the drugs to kill themselves. Our findings emphasise the importance of prescribing adequate doses of antidepressants and underline the need for safer prescribing.

Despite the apparent advantages of group treatment for parents and their preschool children, this technique is not widely used in child psychiatry departments. Those units that have groups find them useful resources for the assessment and treatment of families with a wide variety of presenting problems. Experience is leading clinicians to run groups that are (a) time limited and closed; and (b) structured and focused in their work. Audit projects are being conducted in some centres to evaluate their usefulness, but no studies have been undertaken of groups using random allocation of patients. This should be done before their efficacy can be assured compared with other treatment models.

A previous survey (Gravestock, 1996) assessed factors associated with depot neuroleptic usage in 79 adults with learning disabilities using mainly community-based services. The data informed consensus standard setting and this audit focusing on 32 out of 79 original subjects. At two year follow-up, five subjects had been withdrawn from depots; there was a significant (P < 0.001) reduction in subjects' median depot dosage and reduced concomitant usage of oral neuroleptics and anticholinergics. The importance of completing the audit cycle and other psychotropic medication monitoring studies in community learning disabilities services are discussed.

Becoming a consultant is often viewed as the final hurdle in our lengthy professional training. Yet the consultant role carries with it additional responsibilities and stresses for which the recent appointee may feel ill-prepared. This paper describes a two-day course for recently appointed consultant psychiatrists. Feedback from the 24 offenders suggested the course was greatly valued.

A course on management within a psychiatry training scheme contributes to senior registrars' preparation to become consultants. Sessions should impart factual knowledge and consider interpersonal components of the management process.

Homicide is in the news and community care is being blamed, a view not justified by the facts. Much has been written about the homicides of Johnathan Zito and Georgina Robinson and there has rightly been considerable public and professional concern. There have been other reports on the murder of Johnathan Newby in October 1993 and William Bennett in July 1994. Yet another case is currently the subject of an inquiry and again the press is expressing indignation and horror. The anxiety and concern are natural but the reactions are not justified.

Educational pressure on children is worldwide. In the United Kingdom this is seen in the growth of structured classes and courses for two- to four-year-olds such as ‘Making French Fun’ and ‘Musical Appreciation for Under Fours' (Matthews, 1995). Such programmes are of particular interest to aspiring middle-class parents but other groups also have high educational expectations. Some parents with a West Indian background, believing the British educational system to be superior to that in their country of origin, look for high attainments which often results in their children showing psychosomatic symptoms. In developing countries the signs of educational pressure are especially evident.

The inaugural meeting of a Special Interest Group for Neuroscience in Psychiatry was held at the meeting of the College in Glasgow in 1995, chaired by Professor Stuart Checkley.

The following statement has been prepared for the group to announce its existence and stimulate discussion of its aims.