To evaluate whether the implementation of the Rapid Assessment, Interface and Discharge (RAID) integrated model improves access to psychiatric assessment and reduces cost of health service provision in an acute hospital. Length of hospital stay was calculated using a case-by-case matched control design. Readmission rates were calculated and survival analysis was used to measure endurance in the community following discharge.

In an acute hospital with 600 beds, the total savings in bed days through reducing length of stay and readmissions was 43–64 beds per day. The elderly care wards provided the majority of bed savings.

The development of a rapid response, age-inclusive, comprehensive psychiatric team integrated in an acute hospital can lead to significant savings in health service provision.

A1-day census, involving 3576 psychiatric in-patients prescribed antipsychotic medication, was conducted as a prelude to a multi-centre audit. The aim was to explore the extent to which a number of patient variables explain antipsychotic polypharmacy and the use of high doses of these drugs.

Prescriptions of more than one type of antipsychotic drug were made for 50.5% of patients. Patient factors that influenced the probability of polypharmacy were: younger age, being male, detained under the Mental Health Act and on a rehabilitation or forensic ward, and a diagnosis of schizophrenia. The effect of ethnicity was not significant. Polypharmacy was the most powerful factor influencing the probability of being prescribed a high dose. Identified patient variables accounted for only 18% of the variance in dose prescribed.

The patient and clinician factors that account for the unexplained variance need to be identified.

To describe and attempt to quantify the incidence of disinhibitory reactions to benzodiazepines and to identify those at risk. Medline search, 1966–January 2002.

The overall incidence of disinhibitory reactions is small, but those with impulse control problems, neurological disorders, learning disabilities, the under 18s and the over 65s are at significant risk.

It is important to be aware of the ability of benzodiazepines to cause behavioural disinhibition and to maintain a high degree of vigilance when these drugs are administered to patients known to be at risk. In patients who have experienced behavioural disinhibition with benzodiazepines, antipsychotic drugs should be used to modify behaviour in any future emergencies.

To examine the vocational status of people with longer-term mental health problems in the inner London Borough of Wandsworth. Data collected over 10 years on 1 April each year as part of an annual census of adults with longer-term mental health problems using community mental health and rehabilitation teams were analysed to examine the vocational status of these groups.

Within the borough unemployment rates among people with longer-term mental health problems increased steadily during the 1990s, despite a decreasing rate of general unemployment for the majority of that period. Unemployment among people with long-term mental health problems increased from 80% in 1990 to 92% in 1999, and the unemployment rates among those with a diagnosis of schizophrenia increased from 88% in 1990 to 96% in 1999.

Work and employment is important in health as well as social functioning. Greater attention to vocational issues in clinical teams is required: the challenge for mental health services is to make employment interventions of demonstrated effectiveness available to all who need them.

To examine the effectiveness of integrating evidence-based supported employment into an early intervention service for young people with first-episode psychosis. Demographic, clinical and vocational data were collected over a 12-month period to evaluate the effect on vocational outcomes at 6 months and 12 months of the employment of a vocational specialist, and to assess model fidelity.

Following vocational profiling and input from the vocational specialist and the team, there were significant increases in the proportion of clients engaged in work or educational activity over the first 6 months of the intervention, and in a subsample over a second 6-month period. The evidence-based Supported Employment Fidelity Scale was used to measure the degree of implementation, which scored 71, signifying ‘good implementation’.

The results suggest that implementing evidence-based supported employment within an early intervention service increases employment and education opportunities for patients within the service.

The upsurge of cyberbullying is a frequent cause of emotional disturbance in children and young people. The situation is complicated by the fact that these interpersonal safety issues are actually generated by the peer group and in contexts that are difficult for adults to control. This article examines the effectiveness of common responses to cyberbullying.

Whatever the value of technological tools for tackling cyberbullying, we cannot avoid the fact that this is an interpersonal problem grounded in a social context.

Practitioners should build on existing knowledge about preventing and reducing face-to-face bullying while taking account of the distinctive nature of cyberbullying. Furthermore, it is essential to take account of the values that young people are learning in society and at school.

The study was intended to rectify the lack of data on how Chinese people experience the stigma of mental illness. A questionnaire on perceived stigmatisation, experiences of rejection and ways of coping with stigma was completed by 193 persons attending a psychiatric out-patient clinic in Hong Kong.

Most of the participants were aware of the stigma associated with mental illness, but experiences of rejection were relatively less frequent. Eleven per cent of the respondents indicated that they were neglected by health care professionals and 8% had been avoided by family members. The most frequently reported coping method was maintaining secrecy about the illness.

In China, people with mental health problems experience stigma in various degrees. However, some of the people surveyed expressed feelings of relief that others were supportive and sympathetic towards their illness. Mental health professionals should maintain optimism in helping their patients to cope with the stigma.

To assess the degree of psychological morbidity and burnout in 138 psychiatrists in three Manchester teaching hospitals.

The results for senior house officers (SHOs), registrars, senior registrars and consultants were compared. The overall response rate was 76.8%. There was no significant difference in psychological morbidity between the three training grades, but SHOs and registrars reported significantly higher levels of burnout than either senior registrars or consultants. Dealing with violent patients was stressful for all psychiatrists, no matter what the grade.

Factors related to job stress in psychiatry need to be addressed. In particular, the provision of safer working environments needs to be considered for psychiatrists at all levels of training.

To study the mental health status of 66 genitally mutilated immigrant women originating from Africa (i.e. Somalia, Sudan, Eritrea and Sierra Leone). Scores on standardised questionnaires (Harvard Trauma Questionnaire-30, Hopkins Symptom Checklist-25, COPE-Easy, Lowlands Acculturation Scale) and demographic and psychosocial correlates were analysed.

A third of the respondents reported scores above the cut-off for affective or anxiety disorders; scores indicative for post-traumatic stress disorder were presented by 17.5% of women. Type of circumcision (infibulation), recollection of the event (a vivid memory), coping style (avoidance, in particular substance misuse) and employment status (lack of income) were significantly associated with psychopathology.

A considerable minority group, characterised by infibulated women who have a vivid memory of the circumcision and cope with their symptoms in an avoidant way, reports to experience severe consequences of genital circumcision. In terms of public healthcare, interventions should target these groups as a priority.

To investigate the attitudes that psychiatrists hold towards people with mental illness. Each member of the Royal College of Psychiatrists in the UK was sent a questionnaire based on previous research in this area, supplemented with relevant questions on management.

2813 of 6524 questionnaires were returned (43%). Psychiatrists' attitudes compared favourably with those of the general population. Among other findings, they believed that the risk of dangerousness was overemphasised, that misdiagnosis of schizophrenia in Black people is common, and that polypharmacy and the use of antipsychotic medication above British National Formulary levels occurs too often.

Psychiatrists' attitudes are substantially more favourable towards people with mental illness than those of the general population with individual, but important, exceptions. Some aspects of psychiatric management, especially of antipsychotic medication, may undermine this, however. Comparison with other groups, e.g. general practitioners, nurses and social workers, would be useful in planning how to reduce the stigmatisation of people with mental illness.