To describe the use of community treatment orders (CTOs) and outcomes for patients placed under CTOs within the first 8 months of use in Suffolk. We performed retrospective and prospective examination of health records to collect sociodemographic and clinical measurements with a specific data-collection tool.

All of the patients studied had a major psychotic mental illness. A significant proportion of the patients had a history of alcohol or substance misuse and contact with judicial services. Implementation of a CTO was associated with an increase in engagement, a decrease in the number of admissions, and increased time spent outside hospital.

This small localised study indicates that supervised community treatment can have benefits for some patients. The challenge now is to examine the practice of supervised community treatment and to receive meaningful feedback from people who are subject to such treatment.

To study the presentation, assessment and management of all patients attending St Thomas' accident and emergency (A&E) department with overt mental health problems. The method included a pragmatic definition of ‘overt mental health problems' and a range of strategies to maximise case ascertainment.

The department saw 565 presentations in a 3-month period. Patients were predominantly young, male, single, unemployed, housed outside the area served by the local primary care group and presented outside normal working hours.

This study confirms that A&E departments may be the most frequently used setting for urgent mental health assessments in central London. The patients attending differ from those using community mental health teams. It is argued that mental health liaison services based in inner-city A&E departments should be developed.

None.

To look at whether the opening of a day programme for the intensive care of people with severe anorexia nervosa in Leicester had the expected impact on admission rates, length of stay, cost of treatment and also simple measures of whether patients got better. Is this day programme an effective resource?

Since the opening of the day programme, in-patient bed days and overall costs of treatment for local patients have been reduced, and the early results in terms of weight gain and readmission rates are promising.

With many areas planning to set up eating disorder services for local patients, it is important to consider which are the best resources to invest in. The experience of a well-established specialist service in Leicester has shown that a day programme can be an enriching and cost-effective way to treat patients with anorexia nervosa, but that it does not replace the need for the availability of in-patient beds.

The aims were to determine whether the timeliness of contact with a consultation–liaison psychiatry (CLP) service is associated with shorter lengths of stay (LOS), whether this relationship persists for stays greater than 4 days and whether this association varies with age. The length of stay was correlated with the time from admission to contact with the service (the referral lag (REFLAG)), and the REFLAG's proportion of length of stay (REFLAG/LOS) for all 140 in-patients, those with stays greater than 4 days, and for those under and over 65 years.

The length of stay was significantly correlated with referral lag and logREFLAG/logLOS for all patients and for patients with stays greater than 4 days. The correlations remained significant for both age groups, but were stronger in the younger group.

Timeliness of contact with CLP was associated with shorter length of stay, particularly in younger patients. Psychiatric factors influencing length of stay in older patients should be studied by CLP services.

This audit examines the quality of ‘as required’ (p.r.n.) prescribing for in-patients before and after standard setting.

There were improvements in writing oral/intramuscular prescriptions and in the use of different drugs regularly and p.r.n. There was a trend for improvement in completion of guidelines for those on high doses but completion was not influenced by hidden p.r.n. prescribing. Writing p.r.n. prescriptions as a ranged dose was common and did not improve significantly.

By using some simple measures, improvements in some aspects of potentially problematic p.r.n. medication can be achieved.

This paper investigates the relationship between cluster (Mental Health Clustering Tool, MHCT) and diagnosis in an in-patient population. We analysed the diagnostic make-up of each cluster and the clinical utility of the diagnostic advice in the Department of Health's Mental Health Clustering Booklet. In-patients discharged from working-age adult and older people's services of a National Health Service trust over 1 year were included. Cluster on admission was compared with primary diagnosis on discharge.

Organic, schizophreniform, anxiety disorder and personality disorders aligned to one superclass cluster. Alcohol and substance misuse, and mood disorders distributed evenly across psychosis and non-psychosis superclass clusters. Two-thirds of diagnoses fell within the MHCT ‘likely’ group and a tenth into the ‘unlikely’ group.

Cluster and diagnosis are best viewed as complimentary systems to describe an individual's needs. Improvements are suggested to the MHCT diagnostic advice in in-patient settings. Substance misuse and affective disorders have a more complex distribution between superclass clusters than all other broad diagnostic groups.

A postal questionnaire was sent to 100 departments of psychotherapy within the UK in an attempt to gauge the use of psychotherapy services by patients in the third and fourth age.

Eighty-seven per cent of respondents felt that the needs of this group for psychotherapy were not met as well as those of younger people in their catchment areas. This is most marked in people over 65 years of age who are infrequently referred to psychotherapy departments. Suggestions are made for improving services.

The psychotherapy needs of this group need to be considered in service planning. All professionals need educating about the availability and applicability of the psychotherapies for the older patient. Without additional resources it seems unlikely that the needs of this patient group will be met.

We describe the Balint case discussion group method and how it can be applied to training psychiatrists. In a group that we ran, the performance of members on a clinical task before and after a year in the group was investigated. Written responses to a case vignette were appraised blindly by psychotherapists who were also examiners for the Royal College of Psychiatrists.

There were eight members in the Balint group, which met weekly for one year. We found that members' performance on the clinical task improved significantly following the year spent in the Balint group.

A Balint group, as part of an introduction to psychotherapy for psychiatrists, may represent a step towards achieving comprehensive training that is relevant to ordinary clinical practice.

Mental health day centres have been little researched. We carried out a 1-week census at the four day centres run by a London borough.

The centres catered for a g roup with long-standing mental health problems, mostly under community mental health team care. A surprising number were suffering from physical ill health. They attended the centres primarily for social reasons or to participate in creative groups such as music and art.Very few were concurrently attending day hospitals.

Further work is essential to understand the distinction between NHS day hospitals and Social Services day centres in terms of utilisation and client group.This client group's needs, particularly for physical health care, require urgent attention.