This article considers the role that assessment of suicidal ideation may have in short-term prediction of suicide. Suicide risk assessment is a multifactorial process and it is assumed that assessment of suicidal ideation is one component. Denial that suicidal ideation has any useful role in risk assessment fails to allow for the marked ongoing short-term variability in severity of intent, which is a common feature of the suicidal state of mind. It is concluded that the assessment of suicidal ideation, provided it is carried out correctly and applied appropriately, should continue to be regarded as a central component of the overall prediction process. A ‘two-take’ approach to short-term risk assessment and mitigation is proposed that takes variability in severity of intent into account and includes anticipatory treatment planning for any problems that may occur in the near future.

To evaluate the feasibility of integrating a clinical librarian (CL) within four mental health teams. A CL was attached to three clinical teams and the Trustwide Psychology Research and Clinical Governance Structure for 12 months. Requests for evidence syntheses were recorded. The perceived impact of individual evidence summaries on staff activities was evaluated using a brief online questionnaire.

Overall, 82 requests for evidence summaries were received: 50% related to evidence for individual patient care, 23% to generic clinical issues and 27% were on management/corporate topics. In the questionnaires 105 participants indicated that the most common impact on their practice was advice given to colleagues (51 respondents), closely followed by the evidence summaries stimulating new ideas for patient care or treatment (50 respondents).

The integration of a CL into clinical and corporate teams is feasible and perceived as having an impact on staff activities. A CL may be able to collate ‘personalised evidence’ which may enhance individualised healthcare. In some cases the usual concept of a hierarchy of evidence may not easily apply, with case reports providing guidance which may be more applicable than population-based studies.

An emergency response service (ERS) was introduced to streamline the assessment of individuals presenting in a crisis in one sector of a large provincial city. Data on service activity, clinical details and outcome were recorded on consecutive referrals to the service over the first 6 months of operation, and all patients were offered the opportunity to complete the Client Satisfaction Questionnaire.

Seventy-five per cent of those referred accepted the offer of assessment, and the majority were seen in their own home within 2 hours. One in ten individuals were not offered any further mental health input and 17% were hospitalised. The number of admissions via primary care fell by 60% after the introduction of this service. However, at its peak of activity the service received an average of only two referrals per day and three each weekend. Only 30% of referrals were received outside of normal office hours. Service users and general practitioners were found to be more satisfied with the service than the staff that provided it.

The introduction of the ERS led to a faster, more consistent process of assessment of crisis referrals and assessment undertakings in the community, and appeared to increase the use of alternative treatments for individuals in crisis before resorting to admission. Funding opportunities are restricted for the development of crisis services. The development of emergency response services for the use of current staff from a number of community mental health teams is an option worth considering.

In order to establish whether there is consistency in the management of sexual assault allegations in a psychiatric in-patient unit, and to assess quality of data recording, a manual search of 177 case notes included in an audit project, carried out between October 1997 and May 1999 was carried out. Each recorded allegation was noted on a standard form.

There was little consistency between cases, and data recording was patchy.

There is no accurate method of recording or monitoring alleged sexual assault in the trust studied. In spite of a policy document, these cases are dealt with ad hoc.

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 explore the role of the consultant psychiatrist using an observational approach. Five consultant psychiatrists were shadowed by a trained observer. Observations were subjected to a qualitative analysis based on a grounded theory approach.

Six themes emerged as being significant; these were administration and secretarial support; training aspects of the role; clinical activity; the referral process; supervision, support and continuing professional development; and organisational systems.

The results indicated significant difficulties in the role of the consultant psychiatrist and the need for change. Any change in this role would have an effect on the roles of other professionals and on the whole system in which they work.

The provision of 24-hour specialist child and adolescent mental health services (CAMHS) is a key target for service commissioners. However, a lack of data exist on models of service delivery or levels of need for out-of-hours specialist CAMHS to guide service development. We aim to describe a model of 24-hour service provision and provide information on the demand for and outcome of assessments of a service in Dublin, Ireland, using a 6-year retrospective case study design.

A total of 468 emergency presentations occurred during the study period; 80% presented with self-harm or suicidal ideation. Two-thirds presented outside of working hours. All presentations received a specialist CAMHS consultation. Over 50% required admission to a paediatric ward and 80% required onward referral to specialist CAMHS.

There is a need for a 24-hour specialist CAMHS and this allows increased rates of specialist assessment and onward referral for a high-risk group.

A prospective study was undertaken to evaluate the effect of a stamped addressed envelope, as compared to a non-stamped but addressed envelope or no envelope, on response to a mailed questionnaire. The correlation between questionnaire response and subsequent attendance at the first appointment was also studied.

The overall response rate was 26% of 176 families offered first appointments at a local child psychiatry service. Families provided with a stamped addressed envelope were more likely to return their questionnaire and those families who returned the questionnaire were more likely to attend their first appointment.

The return of patient questionnaires has significant clinical and resource implications. Only essential questionnaires should be sent out to referred families as nearly three-quarters will not be returned. The return rate can be enhanced by providing a stamped addressed envelope but, if questionnaires are not returned within 10 days, the likelihood of return is minimal. As more than half of the families who failed to return the questionnaire also failed to attend their first appointment, questionnaires can be used as a measure of motivation and likelihood of attendance as well as a source of clinical information.

To detect any differences in the antipsychotic prescribing practices of consultant forensic psychiatrists working in different levels of secure care with patients diagnosed with schizophrenia, and to identify potential reasons for any differences. Prescribing data were collected from four secure hospitals within one National Health Service trust. A questionnaire was sent to consultant forensic psychiatrists working at those hospitals as well as those working in the trust's community forensic services.

Consultants working in high security prescribed more oral antipsychotics than consultants working in medium and low security, who prescribed more depot antipsychotics, as established via the prescribing data. The questionnaire provided insight regarding the reasons for these preferences.

There were differences in the antipsychotic prescribing practices of consultant forensic psychiatrists working in different levels of secure care, and, overall, the rate of depot antipsychotic prescribing was lower than might be expected. Although it was positive that the rate of polypharmacy was low when compared with earlier studies, the lower-than-expected rate of depot antipsychotic prescribing has clinical implications.

Currently, no separate service exists for patients with young-onset dementia in Cambridgeshire. These patients are managed together with late-onset dementia patients within old age psychiatry services. To inform service design, we sought to characterise young-onset dementia patients in our population. We first analysed service-level data and supplemented this with a detailed case review of 90 patients.

Young-onset dementia remains a relatively rare condition. Only a small proportion of those referred for assessment receive a diagnosis of dementia. Data collected on presenting complaints, comorbidities, medication and Health of the Nation Outcome Scales scores associated young-onset dementia with a greater incidence of depression than late-onset dementia. Outcomes in the two groups did not appear to differ.

The data presented here do not suggest a need to create a separate service. Practitioners should be aware of the increased incidence of depression observed in this group.