We retrospectively investigated the association between the Jarman and Townsend indices of deprivation and referral rates to community mental health teams (CMHTs) and in-patient admissions rates, including the contribution of general practice factors to these rates. The samples consisted of all community/out-patient referrals and admissions to four CMHTs over 1 year.

Low positive correlation was found between community/out-patient referral rates for all diagnoses and psychosis with the Jarman index, and between both the indices and admission rates for all diagnoses and non-psychosis. Referrals from general practitioners (GPs) varied nearly 40-fold and were not related to either indices, fundholding status or having practice manager or practice nurse.

Overall, the Jarman index appears to be a more useful index for planning psychiatric service provision. However, because of the small correlation with referral and admission rates, deprivation indices in themselves would be of limited value, as there may be other relevant factors that require investigating. GP characteristics investigated did not predict referral rates.

The study aimed to examine general practitioner (GP) views about the appropriate management of a patient with a depressive disorder. A questionnaire based around a patient case history was sent to 188 GPs from 11 primary care groups nationally.

The response rate was 62%. At first presentation, a third of GPs offered ‘watchful waiting’ and a third prescribed medication. If the patient's condition deteriorated, nearly all GPs initiated therapeutic doses of antidepressant medication immediately. If the patient failed to respond, 60% of GPs commenced second-line antidepressant treatment. Following recovery, a quarter of GPs would continue antidepressant treatment for 4 months or more.

GPs' interventions in the management of depression concur with expert national guidelines. There is scope for strengthening the effectiveness of pharmacological intervention in the later stages of treatment.

We aimed to determine, using clinical audit, the effect of implementing national guidelines on the quality of responsible medical officers' (RMOs’) reports to the mental health review tribunal (MHRT). We blindly assessed the quality of 50 consecutive reports concerning patients detained under Sections 3 and 37. Twenty-five reports were written before guidelines were circulated; a further 25 were written following the distribution of guidelines and a checklist with every request for a report.

The quality of reports, as measured by our checklist, significantly improved following the circulation of guidelines.

Increasing the awareness of guidelines by widespread circulation and the audit process is an effective way of improving the quality of RMOs' reports to the MHRT.

A retrospective survey to explore how consultant psychiatrists, senior house officers and community psychiatric nurses prioritised referrals to four sectorised community mental health teams.

Referral outcomes appeared to be comparable for patients with psychoses, sub-threshold mental health problems and personality disorders. However, differences in the outcomes were apparent for patients with a primary diagnosis of drug/alcohol misuse, as well as for patients with affective disorders and neuroses.

It may be necessary to establish clearer, consistent boundaries in order to consolidate services for patients with severe mental health problems.

To examine the vocational status of people with longer-term mental health problems in the inner London Borough of Wandsworth. Data collected over 10 years on 1 April each year as part of an annual census of adults with longer-term mental health problems using community mental health and rehabilitation teams were analysed to examine the vocational status of these groups.

Within the borough unemployment rates among people with longer-term mental health problems increased steadily during the 1990s, despite a decreasing rate of general unemployment for the majority of that period. Unemployment among people with long-term mental health problems increased from 80% in 1990 to 92% in 1999, and the unemployment rates among those with a diagnosis of schizophrenia increased from 88% in 1990 to 96% in 1999.

Work and employment is important in health as well as social functioning. Greater attention to vocational issues in clinical teams is required: the challenge for mental health services is to make employment interventions of demonstrated effectiveness available to all who need them.

Brief or missed seizures might indicate that electronvulsive therapy (ECT) is not being delivered effectively. This cycle of audit at an ECT clinic aimed to measure rates of brief or missed seizures in two study periods, before and after the acquisition of a more powerful ECT machine.

There was a significant reduction in the rate of brief or missed seizures in audit two. There was a significant increase in the restimulation rate in audit two, but without the desired effect of inducing adequate seizures.

Ineffective delivery of ECT might result in poor response to the treatment and should be minimised. Certain aspects of ECT delivery improved in the clinic studied but some patients received an ineffective second dose of electrical charge.

To describe Brunswick House, the first crisis house in North Staffordshire, and to assess the use of acute psychiatric wards and the local accident and emergency department by Brunswick House residents. A mirror design study compared the use of these facilities in the year before with the year after a resident's first admission to Brunswick House.

Data collected on a cohort of Brunswick House residents between March 1999 and December 1999 showed a reduction in both the use of acute psychiatric wards and use of the accident and emergency department after the index admission to Brunswick House.

Brunswick House provides an alternative to NHS facilities for people in crisis.

Training workshops were organised to teach junior psychiatrists ‘compliance therapy’. A questionnaire was administered to 19 trainees before and after participation in the workshop. Data from 54 non-participating psychiatrists from the same NHS trust were also obtained for comparison.

Those receiving training were similar to the comparison group except for having less confidence in dealing with non-compliant patients. After training, participants showed a broader awareness of the potential causes and costs of non-compliance and an increased confidence empathising with patients. Beliefs concerning management did not change significantly.

A brief training programme is capable of changing trainee psychiatrists' attitudes towards patient non-compliance in the desired direction.

To study the presentation, assessment and management of all patients attending St Thomas' accident and emergency (A&E) department with overt mental health problems. The method included a pragmatic definition of ‘overt mental health problems' and a range of strategies to maximise case ascertainment.

The department saw 565 presentations in a 3-month period. Patients were predominantly young, male, single, unemployed, housed outside the area served by the local primary care group and presented outside normal working hours.

This study confirms that A&E departments may be the most frequently used setting for urgent mental health assessments in central London. The patients attending differ from those using community mental health teams. It is argued that mental health liaison services based in inner-city A&E departments should be developed.

A postal questionnaire was sent to specialist registrars (SpRs) in the Wessex Region to evaluate senior trainees' reactions to information about the proposed changes in mental health legislation and to ascertain if the information had adversely affected their view of their future careers as consultants.

A high level of concern about the proposed changes and their potential impact on consultants was revealed. A majority of SpRs took a more negative view of their future career, especially those preparing a single Certificate of Completion of Specialist Training in general adult psychiatry, who were more likely to have adverse perceptions and to have thought of opting out.

The legislative proposals have the potential for considerable impact on recruitment and retention of psychiatrists.

Patient-held records have been introduced in mental health over the past 2 decades. This follow-up study aimed to evaluate one pilot project 5 years after the records were introduced. All patients initially interviewed 4 years previously were approached and asked about their use and opinion of the record.

Of the 19 people interviewed, 12 were still using the record and had a positive opinion of its usefulness. Of all community mental health team contacts, 72% were recorded in the patient-held notes.

Patient-held records are sustainable in a naturalistic clinical setting over the period of 5 years.

To introduce a monthly screening clinic for new patients referred to the community mental health team with less severe mental health problems.

Sixty patients were selected for screening in the first year. Their non-attendance rate of 48% was more than double the rate for all new patients. We did not diagnose severe mental illness in any patients on first assessment or during the 6 months of follow-up.

Patients referred from general practice with minor psychiatric morbidity may have particularly high rates of non-attendance. The brief screening clinic model offered us considerable savings in consulting time. The outcome for our service is shorter waiting times for patients with more severe mental health problems.

This paper reports the findings of a 1999 survey of academic old age psychiatry staffing and teaching in UK and Irish medical schools.

Just over half had staff established at the level of senior lecturer or above. These schools devoted more time to undergraduate teaching, covered more topics and used a wider range of teaching methods.

There is a need for further academic development in old age psychiatry to drive the development of the speciality, and to ensure that all medical undergraduates receive an adequate training in this subject area.

Factors leading to success in the MRCPsych Part I and Part II examinations, including age, gender and original medical school of training, were examined in the 1999 MRCPsych examination entrants to determine how far they are associated with the results. The ethnic breakdown of examiners of the MRCPsych examinations was also determined and compared with the origin of all consultant psychiatrists.

Younger age at taking the examination and training at a British or Irish medical school were found to be highly significant predictors of success in the MRCPsych examinations. When allowance was made for confounding variables, the gender of candidates did not contribute to success. There was no difference in ethnic background of examiners compared with consultant psychiatrists overall.

Factors affecting trainees wishing to undertake a psychiatric career need to be more closely examined. To ensure fairness and transparency in future examinations the ethnicity of candidates taking the examination needs to be addressed.

To compare methohexitone and propofol in electroconvulsive therapy (ECT). A retrospective within-subject comparison was made of the use of these drugs in separate courses of bilateral ECT in one clinic over 10 years. Patients taking mood stabilising or anti-epileptic drugs were excluded. The initial seizure threshold and seizure duration were of particular interest.

The median initial seizure thresholds were identical (75 mC). The median initial seizure duration with threshold stimulation was 25% shorter with propofol (21v.28 s). The median total numbers of treatments in the courses were identical (eight treatments).

The shorter seizure duration observed with propofol was not associated with a commensurate rise in the initial seizure threshold. The shorter seizure duration may therefore have no effect on the therapeutic efficacy of treatment.

To find out current practice in the use of abreaction by consultant psychiatrists a survey was conducted, by postal questionnaire, of all consultant psychiatrists working with adult patients in the Yorkshire area.

Out of 170 consultants, 133 (78%) returned the questionnaire; 64 consultants (48%) had used abreaction at some point in their career and 20 (15%) had done so in the past 5 years. The median number of times abreaction had been used in the previous 5 years was two and only seven consultants (5%) had supervised a trainee in using abreaction.

Abreaction is used rarely and only by a minority of consultants. Few consultants have supervised trainees in the use of abreaction. Future psychiatrists are unlikely to be skilled in the use of abreaction and its use will decline.

To use a questionnaire to assess and compare what referred children and their referrers would like from a multi-disciplinary post-abuse service based in Bridgend, South Wales.

It was found that the children and their referrers wanted different types of support and help from the service. Specifically, children wanted to be ‘listened to’ on an individual basis and to talk about the effect of their distressing experiences on their lives, but they did not want to talk about the details of the abuse and did not want to be blamed. Referrers wanted more practical help for the children.

The study highlights the need to listen to what the child wants from a post-abuse service rather than assuming that this is already known by the referrer or the therapist. It will also help referrers to think clearly about reasons for referral.

A1-day census, involving 3576 psychiatric in-patients prescribed antipsychotic medication, was conducted as a prelude to a multi-centre audit. The aim was to explore the extent to which a number of patient variables explain antipsychotic polypharmacy and the use of high doses of these drugs.

Prescriptions of more than one type of antipsychotic drug were made for 50.5% of patients. Patient factors that influenced the probability of polypharmacy were: younger age, being male, detained under the Mental Health Act and on a rehabilitation or forensic ward, and a diagnosis of schizophrenia. The effect of ethnicity was not significant. Polypharmacy was the most powerful factor influencing the probability of being prescribed a high dose. Identified patient variables accounted for only 18% of the variance in dose prescribed.

The patient and clinician factors that account for the unexplained variance need to be identified.

The study aims to describe the experience of an assertive community treatment team when commencing clozapine at home rather than in hospital, following a locally-devised policy. Any failed attempts and problems experienced are described.

There have been no serious adverse events with 13 patients who have been started on clozapine at home.

For an assertive community treatment team, home-initiation of clozapine is a practical option, particularly when patients refuse to come in to hospital.