To examine what current routine statistics could show about the extent to which patients are admitted to hospital beds ‘out of area’, a quality indicator proposed in the National Service Framework.

Available data record that, on average, at least 6.9% of acute general psychiatry admissions in the English NHS happen outside the normal catchment area arrangement of a patient's health authority. However, deficiencies in the calculation – arising from lack of data, mainly about private sector admissions – and the absence of a central registry of NHS trust catchment areas suggest this is a substantial underestimate.

The most useful way for this issue to be examined is from year to year for individual trusts.

The use of alternative therapies by people with mental health problems seems to be rising. Are the people who access alternative therapies those with mild or more severe problems? A postal survey was undertaken of enquirers responding to a teletext article on self-help psychotherapies for obsessive–compulsive disorder and agoraphobia. Respondents were asked to rate the severity and duration of their problem and the therapies and services they had used.

Of 326 questionnaires sent out, 113 (35%) completed questionnaires were returned. Seventeen (15%) respondents had sought no help for their anxiety problems, 76 (67%) had been treated by their general practitioner (GP), 62 (55%) by a psychiatrist or psychologist and 48 (42%) had used alternative therapies. People who had sought help from their GP did not rate their problems significantly more severe than those who had not sought treatment. Those who had been treated by a psychiatrist or psychologist and those who had used alternative therapies rated their problem as being significantly more severe than those who had not sought help for it.

In this selected sample it was the more severe anxiety sufferers who had used alternative therapies.

We surveyed all psychiatric services in the six northeast strategic health authorities to determine how the provision of liaison psychiatry services related to College recommendations and the size of the general hospital trusts served.

Thirty-six (100%) services provided usable data, 8% of general hospital trusts had no liaison psychiatry service, 41% of teams were not multidisciplinary with their only staff being nurses, only 38% of services had dedicated consultant psychiatry time and only a quarter met the recommended minimum standard of 0.5 whole-time equivalents. No teams contained clinical psychologists. Disorder-specific out-patient clinic provision was idiosyncratic.

There is a lack of rational planning of liaison psychiatry services and as a result, many services are not needs-based and do not comply with College recommendations. One indication of this is the lack of multidisciplinary teams.

To apply process mapping, a component of lean management, to a liaison psychiatry service of an emergency department. Lean management is a strategy that has been adapted to healthcare from business and production industries and aims to improve efficiency of a process. The process consisted of four stages: individual interviews with stakeholders, generation of process maps, allocation of goals and assessment of outcomes.

There was a significant reduction in length of stay of psychiatric patients in the emergency department (median difference: 1 h; P = 0.015). Five of the six goals were met successfully.

This article demonstrates a management intervention that successfully reduced length of stay in an emergency department. Further to the improvements in tangible (quantitative) outcomes, process mapping improved interpersonal relations between different disciplines. This paper may be used to guide similar quality improvement exercises in other areas of healthcare.

An increasing number of mental health trusts in the UK are replacing the geographically sectorised model of service delivery with a functional one. We conducted a qualitative study of staff perception concerning this reorganisation in our Trust, to inform effective change management locally and elsewhere.

Perceived benefits were quick decision-making, positive risk management and improvement in clinical leadership. Dedicated consultant time would lead to improvements in junior doctor training. Concerns included lack of continuity of care, disagreement between teams and de-skilling of staff. Communication was seen as the key to overcoming these difficulties.

Detailed communication from management about the practicalities and reasons for change could facilitate effective transition.

There is a need for multi-disciplinary input into the diagnosis and management of attention-deficit hyperactivity disorder (ADHD). We describe the development of a multi-professional integrated care pathway incorporating education, community paediatrics, child and adolescent mental health services and general practice.

Using parent-held documentation this pathway forms the bass of a community-based ADHD clinic.

A training programme for schools and health professionals raises awareness of the features of ADHD and covers appropriate management within schools.

To identify training needs of the next generation of psychiatrists and barriers in prescribing first-generation antipsychotics (FGAs). We have surveyed psychiatry trainees in East Anglia with regard to their training experience, knowledge and attitudes to the use of oral FGAs as regular medication.

Two-thirds of trainees were aware that first- and second-generation antipsychotics (SGAs) have similar efficacy, and a similar proportion perceived the older drugs to have more or ‘stronger’ side-effects. Lack of training experience was noted as the second leading concern for prescribing FGAs. A quarter of trainees received no training exposure to the older drugs and two-thirds had never initiated these drugs themselves. Although nearly 90% of trainees felt confident about initiating an oral SGA as a regular medication, only about 40% felt confident with FGAs (P<0.001).

The survey highlights worrying gaps in training. FGAs can be used effectively, minimising side-effects, by careful dose titration, avoiding antipsychotic polypharmacy, high-dose, and high-potency drugs, thus ensuring they are not lost to future generations of psychiatrists.

This study examined the frequency of seclusion intervention and factors associated with its use in the acute general adult psychiatric ward serving the Southland area of New Zealand. Details of the use of seclusion and relevant demographic data were collected over a 12-month period in 2007–2008.

During the study period there were 30 seclusion episodes involving 23 patients. The median duration of seclusion was 17 hours. The duration of seclusion was found to be inversely related to the treatment received during the period of isolation. Most patients under seclusion had a diagnosis of psychosis, and the nature of this was directly related to the Mental Health Act order applied.

The duration of seclusion in this study is long but compares with a similar study from elsewhere in New Zealand. The duration of treatment while in seclusion could be reduced if optimal treatment is given.

To capture the local primary care experience of first-episode psychosis before developing a local early intervention in psychosis service. A survey of Northamptonshire general practitioners (GPs) using a confidential questionnaire was carried out.

Out of 284 GPs, 123 (43%) responded. General practitioners are unlikely to start treatment before referring to a specialist service: 63 GPs (51% of responders) start treatment in 10% or less of individuals with first-episode psychosis and 19 (15.5%) GPs start treatment in 75% or more before referring them to psychiatric service; 42 GPs (34%) refer those who request/accept a referral and 66 GPs (53%) refer all even if they refuse. Overall, 92 GPs (74%) agreed that an early intervention in psychosis service is needed and 77 (63%) GPs welcome having a mental health clinic in their surgery.

Individuals are more likely to accept referral to a psychiatric service if offered than to ask for it. People disengaging, stigma, the service being difficult to access/inappropriate and carers' lack of knowledge about mental illness are the likely causes for delayed referral.