This paper reflects on a special edition of the journal History of Psychiatry and a related symposium held at Somerville College, Oxford, exploring the innovations in mental healthcare in Oxfordshire led by Dr Bertram Mandelbrote between 1959 and 1988. I draw on clinical culture, biography, mental health policy and my lived experience to understand Mandelbrote's life and work, and his legacy and lessons for contemporary psychiatrists. I explore the ecological niche that Mandelbrote created and conclude with the probable importance of his relationship with Professor Michael Gelder, who led the University of Oxford Department of Psychiatry at the time.

Specialised rehabilitation units offer inpatient multi-disciplinary rehabilitation for individuals with severe and enduring mental illness. A cornerstone of therapy is the work in the community through further education and community organisations. However, coronavirus restrictions have meant that such external supports are no longer available for the duration of the crisis. This has led to opportunities for developing new ways of offering rehabilitation within hospital environments. This article describes some of the new initiatives developed. The benefits of the lockdown for service users are also discussed. Many found the cessation of visits from family members with whom they had an ambivalent relationship helpful. The lockdown improved relationships between patients on the unit and encouraged a greater feeling of community. The lockdown has also emphasised the importance of team self-awareness and an awareness of the nature of the treatments offered.

Traditional custodial care in mental hospitals has given way to brief hospitalizations and a variety of active inpatient treatment milieus, eg, therapeutic communities. But can only well-educated patients utilize this kind of complex, even demanding form of psychosocial care? A total of 1,538 patients and their first admissions from 1977 to 1993 at a closed therapeutic community ward at the Department of Psychiatry, University of Oulu (Finland) were assessed to analyze the association of the patient's educational level with some treatment and outcome characteristics. Educational levels were non-professional education (46% of all patients), lower professional (39%) and higher professional education (15%). There were no statistically significant differences in the treatment and outcome variables of patients in any educational level. The result indicates the achievement of one treatment goal on the therapeutic community model, ie, patient equality in spite of different educational status. This result may be especially important for less educated persons.

This paper represents a personal view of the evolution of the Mulberry Bush School and Organisation. I will define three developmental stages, and within these some “core concepts” which, in my view, have enabled our services to evolve. I will illustrate these with case studies.

The pre-post treatment change of 112 patients in two therapeutics Spanish communities is described. The Addiction Severity Index (ASI) was used at intake and at the end of the treatment program. Results of the treatment program were evaluated by applying composite scores (CS) of the ASI, and the evolution of each patient was evaluated using the Reliable Change Index (RCI). 69.7% of the sample completed treatment, and 30.3% dropped out prematurely. At intake, the percentage of people who could improve in the different areas of the ASI ranged between 35.1% for alcohol consumption and 95.3% for family relationships. At the follow-up, the percentage of subjects who showed significant statistical improvements in the different areas varied between 7.9% in family relations and 66.7% in alcohol consumption. The percentage of patients who deteriorated was less than 10% for all variables. Implications for further research and clinical practice are commented upon.

Objective: The study's aim was to review instruments suitable for assessing Australian Indigenous clients’ treatment needs, and changes in wellbeing while receiving treatment for substance misuse at a culturally competent residential setting in north Queensland, Australia.

Method: Searches of electronic databases, previously published reviews and websites was conducted. Instruments were selected according to their use in alcohol and drug treatment, developed for and/or validated with Australian Indigenous populations and applicability to measuring wellbeing.

Findings: Forty instruments were identified and their characteristics summarised according to five descriptive categories: (1) evidence of psychometric utility and previous use in alcohol and drug treatment settings, (2) developed for, used with, and/or validated specifically for Australian Indigenous populations, (3) a flexible administrative method of self-report and/or interview, (4) an administration time of less than 20 minutes and (5) freely accessible in the public domain.

Conclusions: Few instruments were found to have been validated specifically for use with Australian Indigenous people for use in drug and alcohol treatment. In order to measure wellbeing change and effective treatment, it may be possible to appropriately modify mainstream instruments, however, validation and sensitivity assessment of instruments for use with Australian Aboriginal and Torres Strait Islander people, is urgently required.

Backgroung – Little is known about specific treatment needs of mentally ill clients abusing substances and infected by HIV. The major gap concerns residential programmes. Aims – To explore differences in outcomes between seropositive and seronegative dually diagnosed opiate dependent clients who participated in a residential therapy programme. Methods – Data were gathered on 154 clients treated in a therapeutic community in Milan between October 1999 and September 2004. Odds ratios with 95% confidence intervals were used to study the association between HIV serostatus and outcome. Results – At 12-month follow-up, seropositive clients were more likely to relapse. Conclusions – The impact of HIV seropositivity on behavioural outcomes should be taken into consideration when planning residential programmes for the HIV (+) dually diagnosed population. Further research could test the need of incorporating dedicated treatments into existing programmes.

Declaration of interest: None.

Objective: To measure the effects of providing a therapeutic community environment for patients suffering from severe mental illness.

Method: 35 patients who remained in a therapeutic community environment for a minimum of 18 months were administered three instruments which measured psychiatric symptomatology (Brief Psychiatric Rating Scale), intrapsychic and interpersonal functioning (Therapeutic Community Questionnaire) and overall psychiatric and psychological functioning (Global Assessment Scale). Assessments were carried out at zero and 18 months.

Results: The Brief Psychiatric Rating Scale revealed significant positive changes on the two items of blunted affect and un-cooperativeness while the global assessment scale revealed that patients significantly improved after 18 months.

Conclusion: Patients who remained in a therapeutic community environment for 18 months demonstrated benefits on three particular variables. While no causative link can be proposed in this study, it does seem that this environment does improve the functioning of severely mentally ill patients.