We discuss the development of a service for children with learning disabilities within a child and adolescent mental health team using the Health Advisory Service Together We Stand tier system. The paper also includes an audit of the service 8 months after it was started.

We present a model of service that has proved successful to date. We give details from the audit of the service, its aims, funding, referral numbers, sources, types and criteria.

The audit suggests that the aims of the service are being achieved but given the fact that the numbers of new referrals significantly outweigh the discharge rate, it is concluded that a greater emphasis is placed on liaison, consultation and joint working with other agencies.

A retrospective review of the activity of a general practitioner employed specifically to provide a primary health care service to the residents of an ‘old long-stay’ psychiatric ward was undertaken.

All but one patient had a chronic physical health problem requiring active management. Presenting pathology covered all organ systems. The review indicated that these health problems had not previously been satisfactorily managed by psychiatrists. This service was acceptable to and valued by patients.

The success of the service was only achieved by dedicating specific resources to meet primary health care needs. The extent to which this model could be extended to ‘new long-stay’ populations located in dispersed hospital hostels is less certain.

Surveys of career intention among medical students, Membership Examination results and manpower figures are used to examine trends in recruitment to psychiatry over the last 10 years.

Problems of recruitment to psychiatry have increased. Consultant expansion contrasts with a fall in the number of medical students. The increase in the number of career senior house officers and specialist registrars is insufficient to fill existing consultant vacancies notwithstanding new and replacement posts. The popularity of general psychiatry and psychotherapy have declined.

Proposals include an increase in the number of medical students, the introduction of psychiatry in the pre-registration year, increased specialisation and closer integration of general adult psychiatry with general medicine.

To describe the formation and function of ‘stress-busting’ groups and report a survey on work-related stress among a small cohort of consultant psychiatrists.

Of 37 questionnaires, 25 were returned and 16 respondents (64%) rated their overall level of stress at work as moderate or severe. Stressful factors included lack of staff, paperwork, high-risk patients, difficult/hostile relatives and job demands interfering with family life. The most helpful stress-reducing strategies were talking to colleagues for support and catharsis, outside interests, support from family and friends, effective time management and exercise. Among 15 current members of ‘stress-busting’ groups, 14 (93%) found these to be helpful. The most successful format in the ‘stress-busting’ groups was one of ‘problem-solving with ventilation of stresses'.

‘Stress-busting’ groups may constitute a helpful approach to work-related stress and a utilisation of the skills of psychiatrists to our mutual benefit.

To describe the implementation of a plan to use a validated outcome measure in the care and treatment of people with severe mental illness within a district general hospital psychiatric service. Multiple techniques were necessary to promote actual change of practice.

A survey of practice found 77% of full Care Programme Approach patients to have recorded Health of the Nation Outcome Scales (HoNOS) scores in their care plans one year after the beginning of the implementation plan.

It is possible to incorporate the use of HoNOS in to everyday practice but it takes a lot of time, effort and resources. Mental health services may require a clearer indication from the NHS Executive regarding the use of such outcome scales before committing themselves.

The aim of the paper is to describe the pre-registration house officer training in psychiatry available in Sheffield. The report is the result of a postal questionnaire, involving all of those who undertook pre-registration house officer training in psychiatry, since the inception of this option.

The results suggest that the psychiatry option as part of pre-registration house officer training was regarded as useful by almost all undertaking this training. Some of the suggestions to improve the experience are already incorporated into the current posts.

The findings support the development of further posts of this type, and such developments may assist in overcoming some of the difficulties in recruitment into psychiatry as a career.

The aim of this study was to examine visual problems among patients admitted to an inner city acute mental health unit. We measured visual acuity using a Snellen chart. Patients were also asked about perceived eye problems and access to services.

Of 55 in-patients on five acute general adult wards at an inner city mental health unit over a 3-day period, 31 agreed to participate in the study. Twenty (65%) had impaired visual acuity and 19 (61%) had not been to an optician for 5 or more years. Seventeen patients (55%) reported experiencing difficulty with their eyesight. The main problems reported were blurring of vision and periorbital pain. Of these 17 patients, 15 (88%) had impaired visual acuity on Snellen testing. Half of those who had previously been prescribed glasses or contact lenses reported that they had been lost.

Visual impairment appears to be another area of physical health which is underrecognised and undertreated in people with severe mental health problems. Although there are numerous issues that must be addressed by mental health staff, patients should be asked about eye problems and supported in accessing opticians.

To use a questionnaire to assess and compare what referred children and their referrers would like from a multi-disciplinary post-abuse service based in Bridgend, South Wales.

It was found that the children and their referrers wanted different types of support and help from the service. Specifically, children wanted to be ‘listened to’ on an individual basis and to talk about the effect of their distressing experiences on their lives, but they did not want to talk about the details of the abuse and did not want to be blamed. Referrers wanted more practical help for the children.

The study highlights the need to listen to what the child wants from a post-abuse service rather than assuming that this is already known by the referrer or the therapist. It will also help referrers to think clearly about reasons for referral.

Dementia and depression are common psychiatric diagnoses in older people, and are common reasons for referral to liaison psychiatry services. The present study examined the accuracy of physicians' diagnoses for both disorders in consecutive referrals to a liaison old age psychiatry service.

Positive predictive values for depression and dementia were high, but levels of treatment of depression and documentation of past psychiatric history were both poor. Alcohol misuse and stroke accounted for the commonest accompanying disorders.

The findings have implications for the encouragement of physicians to treat depression when this is suspected. Educational programmes for this purpose may be useful, incorporating an exploration of attitudes and knowledge of physicians towards depression in older people.