We reviewed, prospectively, all patients who presented themselves at the reception of a large psychiatric hospital, which had no casualty department, to assess the extent and value of a long standing ‘unofficial emergency service’ that has been provided for decades. We found no evidence that the service was abused or that it led to unwarranted admissions. The service could provide a useful point of entry to mental health services for certain patients. The ‘ad hoc’ emergency service described here is hoping to become a recognised ‘Emergency Clinic’ in the reprovided service, after the closure of this 100 year old psychiatric institution in the very near future.

On Christmas Eve 2002, the Department of Health published the financial allocations to Primary Care Trusts (PCTs) for 2003/4. As usual, this was accompanied by a detailed ‘exposition book’, setting out how the distribution of the available £45.3 bn was decided (Department of Health Finance and Investment Directorate, 2002). Three years ago, I wrote a short article showing how a close reading of this publication could be used to identify notional mental health budgets in these allocations (Glover, 1999). Bindman et al (2000) demonstrated that many health authorities, particularly those that service more deprived areas, spend substantially less on mental health care. As this is the first time financial allocations have been made directly to PCTs, it is helpful to repeat that calculation for the new organisations.

The high rate of non-attendance for first appointments at psychiatric clinics is wasteful of health service resources. Previous studies have demonstrated reductions in the non-attendance rates when referred patients were asked to contact the clinic to confirm that they wished to be seen before an appointment was sent. The effect of introducing such a process to a community based alcohol service was investigated. Results showed that although there was a reduction in the non-attendance rate, the overall effect was to discourage patients from attending the clinic, resulting in a large reduction in the proportion of all referrals seen. Alternative approaches are discussed.

Over the past 20 years the Department of Psychological Medicine at King's College Hospital has gradually taken responsibility for the provision of psychiatric services to the East Lambeth sector of the Camberwell Health District. A small District General Hospital (DGH) in-patient unit was opened in 1972, and since then it has been the aim of the Department to provide a comprehensive locally based psychiatric service. Slow progress has been made compared with the developments that have taken place in the South Southwark sector of the District, which have been fostered by the Maudsley Hospital. With the impending closure of Cane Hill Hospital, on which the District has historically relied, the object of a completely local service is rapidly becoming a reality. Releasing the resources hitherto tied to the large institution presents an unparallelled opportunity for change.

In November 1980, two men, Mackenny and Pinfold, were convicted at the Old Bailey on several counts of murder which were of a particularly callous and brutal nature. They were sentenced to life imprisonment. In the preceding December (1979) another man, Childs, had pleaded guilty to all the murders with which Mackenny and Pinfold had been charged, and which he alleged had been carried out with them together. He turned Queen's evidence, and it was his testimony that was crucial and central to the Prosecution's case against Mackenny and Pinfold.

Although there are some well recognised physical disorders such as intracranial lesions that can present with mental illness, many psychiatric conditions do not appear to be associated with underlying somatic complaints. However, a number of recent studies have shown that there are often high rates of concurrent medical conditions among acute psychiatric in-patients that were previously undiagnosed or unsuspected. The author illustrates this point by presenting two case studies in which a significant medical condition was only identified after physical examination on a psychiatric unit.

Evidence bearing on the issue of what happens to patients from long-stay psychiatric wards in Britain is scarce. The results of a particularly well-planned resettlement programme may not be representative of the outcome from general policies of discharge from all psychiatric hospitals. The present study was undertaken in Sheffield to find the whereabouts of patients from long-stay wards after eight years, a longer period than usually studied previously. The expectation was that difficulties in tracing patients could be overcome with sufficient time and effort.

British Medical Association members are now able to use a new service to doctors which, until recently, has been largely exlusive to libraries in big hospitals and other institutions. At the time of writing, the BMA Library Dial-Up Medline Project has just completed its pilot stage and is due to be launched formally at the beginning of June. Trials started in November 1992 and the system is now up and running.

This paper sets out the rationale, process for development and the content of the new evidence-based practice syllabus, which is examined as part of the Membership of the Royal College of Psychiatrists' Paper 3. The syllabus was developed by the Critical Review Paper Panel of the Royal College of Psychiatrists. Suggestions for learning and teaching evidence-based practice are also put forward.

General practitioners (GPs) were surveyed by questionnaire to determine their views on the indications for specialist psychotherapy and their estimates about the number of patients they thought should be referred. GPs had good awareness of the types of treatments available. There was close agreement between referring and non-referring GPs and with specialists on the indications for treatment. Estimates about demand for services showed that those who had not referred in the previous year estimated higher rates than those who had referred. GPs and specialists show good overall agreement on level of service and the indications for its use.

This paper explores the extent of known child sexual and physical abuse in child psychiatric out-patient services in Leeds. We surveyed a one-month period, looking at all out-patient contacts, and found that at least 17.9% of patients had been physically or sexually abused and these patients took up 25.8% of out-patient time. When the 70 abused children were compared to a group matched for age group, clinical team and diagnosis It was found that they were more likely to be followed-up for longer and they received more therapeutic time over a given period than non-abused children. The implications for resources are discussed.

The early years of medical students' experience can clearly be important in shaping their attitudes for the future. Typically pre-clinical students are bombarded with basic science subjects and many express the view that it is difficult to see the relevance of much of their academic study to their ambition of working with people. The Behavioural Science Course which is generally held during the students' second year is one of the few courses which is devoted to the functioning of the whole person in society. Typically, this course includes psychology and medical sociology.

The sustained fall in Scottish homicide rates follows crime reduction measures informed by the epidemiology of suicide. The violence reduction unit targeted young men carrying knives in public. The restriction of weapons immediately to hand appears to have caused an absolute fall in homicide just as suicide reduction was observed following changes to domestic gas supply. Further homicide reduction may be accomplished in the domestic setting with targeted changes in kitchen knife design in home safety planning for high-risk households. Most commonly homicides involving those in recent contact with mental health services in the UK have domestic characteristics and similar safety planning may be targeted at those with mental disorder and a history of violence.