To describe the extent and variation in the use of Guardianship nationally. The Directors of Social Services were asked to provide details about Guardianship cases on two separate occasions one year apart.

There were 428 new Guardianship cases in 12 months. At the second enumeration, 73% of cases were within the mental illness category and 47% of these had serious mental illness.

There is much variation in the use of Guardianship. Further developments of this study will explore the reasons for this variation and will ascertain clinicians' views on Guardianship, supervised discharge and other community treatment orders.

A postal audit of practice in the South-East Thames Region of England before and after the Bournewood judgements.

There was a trebling in the rate of admission under section of elderly incapacitated patients occurred prior to the Houseof Lords' ruling. By the time of the ruling many consultants had not changed their practice. There is now, however, no impact of the ruling upon clinical practice. The majority of consultants remain concerned about the lack of safeguards for mentally incapacitated elders at the present time.

Although the Bournewood judgement was expected by some to have a permanent impact upon the management of the mentally incapacitated this has not happened. There is a need for effective and resource efficient safeguards for the mentally incapacitated to be developed.

To quantify perceived problems with psychiatric bed availability nationally using a questionnaire survey of all 210 UK mental health trusts.

One hundred and seventy-three (82%) trusts replied. Thirty (17%) are often over-occupied, 21 (15%) often have problems with bed availability. Ten (7%) often use extra-contractual referrals (ECRs). Frequent over-occupancy is associated with deprivation. Frequent use of ECRs is associated with relatively few beds.

Problems with bed availability are found nationwide, but outside southern England are relatively infrequent. Such problems are less pronounced than in Greater London.

Long waiting lists and failure to attend appointments are a common problem in child and adolescent psychiatry. We introduced a novel ‘triage’ stage waiting list initiative to decrease the long waiting time fora first appointment at our child mental health service.

The waiting time to first appointment was significantly reduced and increased satisfaction with this process was expressed by clinicians, the referred families and referrers.

The reduction in waiting time was sustained over time and the triage process has now been implemented as routine practice. Following this implementation, there is no longer a lengthy waiting list for treatment after initial assessment. We would recommend this initiative, which screened referrals more efficiently and accurately, as a successful model for other child and adolescent services with long waiting lists.

We hypothesised that the increased admission rate for men with major mental illness may bethe result of men being preferentiallyadmitted by psychiatrists. A questionnaire survey was devisedand sent to all psychiatric trainees on the South-East Scotland rotation. The questionnaire contained a series of psychiatric vignettes representing conditions varying in severity of risk.

Seventy-eight per cent responded to the questionnaire. Trainees were more likely to admit patients representing a greater degree of risk irrespective of the gender of the patient.

The increasing admission rates for men with major mental illness is unlikely to be due to admission bias by trainees.

This paper is based on two audits carried out in 1996 and 1998 atThe State Hospital, Carstairs. Each audit looked at anti-muscarinic drug use within the hospital, in relation to approved prescribing standards issued in 1996. All patients within the hospital on anti-muscarinic drugs were identified at the timeof each audit. These prescriptions were compared with the approved prescribing standards. In the 1998 audit additional information was obtained from the case notes and the consultants, when the approved standards were not met.

The percentage of patients on regular anti-muscarinic drugs, falling outwith the prescribing standards, reduced between the two audits. However, in 1998 a small number of patients were still outwith the approved prescribing standards set in 1996.

An improvement in the prescribing practice of anti-muscarinics occurred following the introduction of prescribing guidelines. However, the guidelines were not fully met in the 1998 audit. This demonstrates the need for further audit and continued monitoring of anti-muscarinic prescription at the State Hospital.

To determine the preference of flexible trainees in psychiatry for consultant posts. A questionnaire survey was conducted among all flexible trainees in psychiatry in the West Midlands Region.

The overall response rate was 19 out of 21 (90%). The majority 15 out of 19 (68%) hoped to gain such a post at the end of their training. Of those wanting a consultant post, 15 of the 19 (79%) would only consider working part-time. If such a parttime consultant post was not available, 12 of the15 (80%) said they would considera non-career grade post.

In the West Midlands Region there has been an exponential growth in the number of flexible trainees. Approximately a third are within psychiatry alone and most wish to continue flexible working patterns as consultants. This has major workforce planning implications for the future.