To describe the work of the ‘Vron’, a seven-bed active rehabilitation hostel which has operated in Gloucester for the last 15 years. Such units have been acknowledged as a successful alternative to hospital care for patients with severe mental illness, but nationally are grossly under-provided.

Demographic details, admission and discharge data were described for all 103 patients admitted over a 12–year period up to January 1996. Duration of hospital treatment fell from mean 105.8 days one year before and 138.0 days two years before admission to the Vron to: mean 28.6 days one year after and 57.1 days two years after discharge from the Vron. The change was highly significant for both one and two year analyses.

Residential rehabilitation, provided as part of a comprehensive rehabilitation service, was effective at reducing requirement for hospital care. Clinical approaches which contributed to this success were described. The results point to the value of a range of residential hostels, which can through skilled deployment effectively target individual needs for a wide ranging, heterogeneous population.

Electroconvulsive therapy (ECT) prescription rates in Scotland are decreasing. This study aims to look for possible causes, in particular psychiatrists' attitudes. Ninety-one Scottish psychiatrists completed a survey in 2009 relating to demographics, training, current practice, National Institute for Health and Care Excellence (NICE) guidelines and attitudes.

The mean number of times the psychiatrists had prescribed ECT in the past 2 years was twice. About 43% felt that their prescribing rates had decreased. Reasons for this included more effective medication, public and patient perception, and NICE guidelines. There was a significant correlation between doctors' gender and estimated prescription rates (P = 0.004), however, not with other prescription data. Almost all surveyed psychiatrists (97%) agreed that ECT has a place in current psychiatric practice.

Despite generally positive attitudes to ECT shown by psychiatrists in this study, prescription rates were low and decreasing. With more effective medication the role of ECT in therapy appears to be changing.

Antipsychotic medication, an effective treatment modality in the management of psychiatric/behaviour disorders in people with learning disability, is often criticised because of poor clinical practice. Rational and judicious use, subject to evidence-based guidelines and systematic monitoring, is mandatory. A five-year clinical audit programme on the quality of prescribing for this clientele was undertaken.

Significant quality improvement with minimal resource consumption was demonstrated.

Clinical audit facilitates high-quality prescribing: pragmatic and economic, it can easily be integrated into routine clinical practice.

To explore the experiences and attitudes of psychiatrists to a new electronic patient records system. A questionnaire was emailed to 115 psychiatrists across the South London & Maudsley National Health Service Foundation Trust.

The total response rate was 66% (senior house officers 75%, specialist registrars 57%, consultants 56%). Technical problems, difficulty with patient confidentiality, administrative burden and impact on clinical work were identified as concerns. However, psychiatrists recognised the potential benefits and the majority did not wish to return to using paper records.

Electronic patient records are rapidly being integrated into the daily practice of psychiatrists. More administrative assistance and specific training should be provided to support clinicians who use this system.

Our aim was to determine the role of evidence and other factors in specialist service development in liaison psychiatry. We held two focus groups with liaison psychiatry practitioners working in different services throughout Europe. A topic schedule focused the discussions, which were taped and transcribed. We used content analysis to identify the role of evidence and other factors that had hindered or facilitated service development.

Our content analysis revealed two factors relating to evidence and 25 other barriers and facilitators of service development, which we grouped into national factors and factors related to local services.

Evidence appears to have some impact on service development but many other factors are influential. Clinical service development cannot be understood simply as emerging in response to research evidence.

To identify the experiences of patients pursuing a personal injury claim, we carried out a retrospective questionnaire survey.

Sixty-one patients from a regional traumatic stress clinic took part. Most were satisfied with the conduct of legal, medical and psychiatric personnel. Thirty-two (53%) reported that the legal proceedings had had an adverse effect on their health/well-being, and about a third reported an adverse effect on domestic relationships. Twenty-four patients (40%) were dissatisfied with the provision of information. More information about the whole legal process would have been welcomed by means of an information leaflet (n=57, 93%), a helpline (n=48, 79%), or a videotape (n=42, 68%).

Although seeking redress may contribute to the patient's adjustment, this survey demonstrates that it is not a step to be taken without consideration. As part of their therapeutic management, mental health professionals should consider the implications of such a step with their patients.