To describe Drayton Park, the first women-only residential mental health crisis facility in the UK and to investigate whether it is succeeding in its remit of providing a viable alternative to hospital admission. We randomly selected case files from 100 women admitted to Drayton Park since its opening and examined variables including demographic details, the reasons for referral, diagnosis and the source of referral.

Our findings show that the service is able to respond quickly to referrals and appears to be functioning safely. The women admitted have a relatively short length of stay, half suffer from depressive episodes and one-third have a relapse of schizophrenia or bipolar disorder.

This project appears to be succeeding in providing a safe alternative to hospital admission for women with severe and enduring mental health problems.

The aim of the study was to track service consumption in adult referrals to a specialised NHS eating disorders service over a 3-year period. We examined clinical records of a year's cohort (1999) of 147 referrals (96% female) assessed from the local catchment area.

The most common diagnostic group (42.8%) presented with some form of eating disorder not otherwise specified (EDNOS). There was no significant relationship between diagnosis and service consumption, so that full syndrome eating disorders were no more labour-intensive overall than EDNOS patients. Indeed, EDNOS patients accounted for 50% of all outpatient appointments and over a half of all in-patient days.

The results suggest that those planning services for eating disorders need to take into account the substantial demand from EDNOS patients.

To describe a group of prisoners who required transfer to mental health units from two London prisons. Data were collected from prison clinical records.

Overall, 149 patient-prisoners were transferred over a 17-month period. Around a quarter were not previously known to services. the aggregate wait was 36.5 years (averaging between 93 and 102 days per prisoner) and the total saving to the National Health Service (NHS) has been estimated at £6.759 million.

Both prisons manage a large number of prisoners with untreated psychosis. While in prison, they save the NHS considerable sums of money, but transfer delays prevent timely treatment and could now be legally challenged.

To explore attitudes and perceptions regarding workplace-based assessment (WPBA) among psychiatric trainees in Wales, identify current problems and recommend measures to successfully implement WPBA. An anonymous questionnaire-based, cross-sectional online national survey was conducted involving all psychiatric specialty registrars in Wales.

Out of 88 specialty registrars in Wales, 81 participated in the survey, a response rate of 92%. the survey highlighted widespread problems and negative attitudes among trainees towards WPBA. Numerous concerns, involving assessment tools, online system, quality of assessors and practicalities of assessments were identified.

The negative attitudes harboured by many trainees would certainly contribute towards undermining the efficacy of WPBA to improve training. In this context, specific measures with the potential to address the shortcomings identified during the survey are discussed, with a view to improving WPBA and rendering it more acceptable to trainees, and in doing so, facilitate the improvement of training.

Community treatment orders (CTOs) have been used more than anticipated. We report data from the North Wales audit about their current use and explain how a SMART framework can be used to potentially improve their effectiveness.

Findings from this audit confirm those from other studies, with the reasons for use of CTOs extending beyond that of medication adherence to risk management. The combined recall and voluntary admission rate was 40%, which raises questions about the effectiveness of CTOs.

More research is needed as it remains to be seen whether CTOs are able to achieve their intended aims. The SMART framework can be used to aid clinicians in ensuring that conditions placed on patients have a specific purpose and are clinically meaningful.

Mephedrone is a cathinone with amphetamine-like stimulant effects, and is a commonly used recreational drug. The adverse effects of mephedrone use have not been extensively studied. All individuals who self-presented between January and June 2010 to the emergency departments and acute mental health services in Edinburgh and Falkirk with adverse effects of self-reported mephedrone use were identified.

Twenty cases were identified and analysed. Severe agitation was the most common presenting problem (70%), with 40% of individuals developing psychotic symptoms and a further 20% reporting low mood and suicidality. One person died by suicide.

Mephedrone can produce amphetamine-like adverse psychological intoxication effects, particularly in those with a history of mental illness. Clinicians should consider advising patients on the adverse effects of mephedrone, where relevant.

This is a longitudinal cohort study describing the demand, capacity and outcomes of adult specialist eating disorder in-patient services covering a population of 3.5 million in a South-East England provider collaborative before and since the COVID-19 pandemic, between July 2018 and March 2021.

There were 351 referrals for admission; 97% were female, 95% had a diagnosis of anorexia nervosa and 19% had a body mass index (BMI) <13. Referrals have increased by 21% since the start of pandemic, coinciding with reduced capacity. Waiting times have increased from 33 to 46 days. There were significant differences in outcomes between providers. A novel, integrated enhanced cognitive behaviour theapy treatment model showed a 25% reduction in length of stay and improved BMI on discharge (50% v. 16% BMI >19), compared with traditional eclectic in-patient treatment.

Integrated enhanced cognitive behaviour theapy reduced length of stay and improved outcomes, and can offer more effective use of healthcare resources.

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.

The aim of the study was to identify the employment rates of people using local mental health services and examine any evidence in care plans for vocational or occupational interventions. We investigated case notes retrospectively.

A total of 297 case notes were examined: 88% of the patients were unemployed, but there was evidence of documentation relating to vocational needs in only 18% of out-patients; 8% in patients of community mental health teams; and 39% in acute wards; 8% of patients were engaged in work schemes; 10% of patients were in education; and 9% were engaged in vocational interventions with their care coordinator; the latter was less likely if the patient was from a Black or minority ethnic group (OR=2.44, 95% CI 0.18–1.05).

Despite high rates of unemployment, patients with psychiatric disorders are not referred for vocational interventions. Growing professional awareness of vocational possibilities for patients with severe mental illness should mean that many patients could return to competitive employment and return to mainstream society.

To evaluate the effectiveness of two psychodynamic psychotherapy teaching methods, a student psychotherapy scheme (SPS) and participation in a Balint group, in teaching first-year clinical medical students about doctor–patient communication and the doctor–patient relationship. The 28 students, who were randomly allocated to three groups (SPS group, Balint group starting at baseline and Balint group starting at 3 months and acting as partial controls), were rated on a questionnaire testing their knowledge of emotional and psychodynamic aspects of the doctor–patient relationship administered at baseline, at 3 months and at 1 year.

At 3 months, students in the SPS and Balint groups scored higher than the partial control group, the difference approaching significance at the 5% level. At 1 year, participation in either teaching method led to significantly higher scores compared with baseline.

Psychodynamic psychotherapy teaching methods are effective in increasing students' knowledge of the doctor-patient relationship and potentially also improving their communication skills.

To develop and evaluate a novel teaching session on clinical assessment using role play simulation. Teaching and research sessions occurred sequentially in computer laboratories. Ten medical students were divided into two online small-group teaching sessions. Students role-played as clinician avatars and the teacher played a suicidal adolescent avatar. Questionnaire and focus-group methodology evaluated participants' attitudes to the learning experience. Quantitative data were analysed using SPSS, qualitative data through nominal-group and thematic analyses.

Participants reported improvements in psychiatric skills/knowledge, expressing less anxiety and more enjoyment than role-playing face to face. Data demonstrated a positive relationship between simulator fidelity and perceived utility. Some participants expressed concern about added value over other learning methods and non-verbal communication.

The study shows that virtual worlds can successfully host role play simulation, valued by students as a useful learning method. The potential for distance learning would allow delivery irrespective of geographical distance and boundaries.