We aimed to audit the documentation of decision-making capacity (DMC) assessments by our liaison psychiatry service against the legal criteria set out in the Mental Capacity Act 2005. We audited 3 months split over a 2-year period occurring before, during and after an educational intervention to staff.

There were 21 assessments of DMC in month 1 (6.9% of all referrals), 27 (9.7%) in month 16, and 24 (6.6%) in month 21. Only during the intervention (month 16) did any meet our gold-standard (n = 2). Severity of consequences of the decision (odds ratio (OR) 24.4) and not agreeing to the intervention (OR = 21.8) were highly likely to result in lacking DMC.

Our audit demonstrated that DMC assessments were infrequent and poorly documented, with no effect of our legally focused educational intervention demonstrated. Our findings of factors associated with the outcome of the assessment of DMC confirm the anecdotal beliefs in this area. Clinicians and service leads need to carefully consider how to make the legal model of DMC more meaningful to clinicians when striving to improve documentation of DMC assessments.

To improve the quality of written communication between general practitioners (GPs) and community mental health team (CMHT) members concerning patients newly referred to two inner-city CMHTs. Following a benchmark audit of a random sample of referral and assessment letters, locally agreed good practice protocols were shared widely, accompanied by a dissemination and implementation strategy.

Significant improvements occurred in both GP and CMHT letters; these were most dramatic after 1 year, but tailed off considerably in the second year despite continued efforts to implement the protocols' standards.

Planned dissemination and implementation strategies can help to improve routine clinical communication between CMHTs and GPs through the use of good practice protocols, thus improving shared working between primary and secondary care providers.

An audit cycle assessed compliance of healthcare professionals within Oxleas NHS Foundation Trust with the statutory requirements of the Mental Capacity Act 2005 in patient care. Each stage involved a retrospective review of relevant patient electronic records. The additional purpose of the audit was to make recommendations to improve compliance with the requirement of the Act by healthcare professionals and improve patient understanding of its provisions.

The audit cycle demonstrated some improvement in clinical practice as well as the need for further efforts at raising the understanding and compliance of clinicians and the public with provisions of the Act.

Healthcare professionals need further understanding of the provisions of the Act and their responsibilities. There is also the need to enhance public awareness to provisions of the Act in relation to their decision-making autonomy. Stakeholders need to put strategies in place for these to be achieved.

To determine whether the College guidelines in liaison psychiatry are being implemented, a survey of training opportunities at senior house officer (SHO) level was undertaken. A detailed postal survey was conducted in January 2000. Information was collected about the number and nature of SHO liaison psychiatry posts from a wide range of sources.

Nationally, 45.5 SHO posts in liaison psychiatry were identified. These were unevenly distributed, with a high number in London. Only five posts were available to general practitioner trainees. Nine regions anticipated an increase in training opportunities. Regional liaison representatives had incomplete knowledge of the availability of liaison training opportunities in their region.

The College guidelines to incorporate liaison experience into all training schemes have not been implemented. In four regions no training opportunities were identified whatsoever. A national database is needed to monitor training opportunities and inform further development of training posts.

To find out whether trainees have access to computers and computer software; to estimate the demand for more access and training; and to see whether requests for more computer access over a 2-year period led to change. A questionnaire was sent to trainees in November 1997, and again 2 years later.

Only half of the senior house officers and three-quarters of specialist registrars said they had access to computers. For those with access, this tended to be for word processing and Medline. Only one-quarter had access to the internet. There was a strong demand for wider access and for more training. There was little change in the provision of computers and software over the 2-year period.

To take advantage of developments in technology, psychiatrists need to have access to computers. This survey suggests that trainees are not being adequately prepared for the future.

We undertook three cycles of clinical audit of prescription charts to improve the quality of the prescriptions written in an in-patient unit. Pharmacy and medical staff reviewed a total of 1466 prescriptions on 242 prescription charts against local guidelines and provided feedback to medical staff. The pharmacist also regularly reviewed prescription charts on the wards between audits.

After three cycles of audit, 99.5% of prescriptions written were legible. The recording of drug allergies, section 58 status and patient age remained poor.

A combination of clinical audit and continual pharmacist review of prescription charts can improve the quality of prescriptions written by medical staff in an in-patient unit.

To investigate the recording of Mental State Examination (MSE) findings by psychiatric trainees as well as dating, timing and signing of entries into the clinical record. Data were collected from randomly selected case notes in three acute psychiatric units.

There was an initial decline of MSE recording from 69% to 58% in the first re-audit. Introduction of a standardised format and involvement of consultant trainers in the supervision of MSE recording led to an improvement to 83% in the secondre-audit. Adherence to medico-legal standards also improved.

The introduction of an MSE format and consultant supervision of records improved the standard of MSE recording as well as basic medico-legal requirements by psychiatric trainees.

We aimed to examine the burden of mental disorders in Pakistan over the past three decades. We used the crude data of disability-adjusted life-years (DALYs) obtained from the Global Burden of Disease Study database (1990–2019) to represent burden. Data were retrieved on 26 January 2021. Data for adults of reproductive age (aged 15–49 years) were analysed to discuss and interpret the disease burden. An analysis was conducted on total DALYs separately for the genders for ten mental disorders reported in Pakistan.

DALYs increased drastically with the onset of reproductive age. Depressive disorder was the most reported mental disorder, contributing 3.13% (95% CI 2.25–4.24) of total DALYs, and varied significantly between genders: females 3.89% (95% CI 2.73–5.29) versus males 2.37% (95% CI 1.62–3.25).

A nationwide high-quality epidemiological surveillance system should be implemented to monitor mental disorders and offer culturally appropriate preventive services.

Long-term admission trends in a large specialist National Health Service (NHS) hospital were examined over a 3-year period. These were compared with three earlier 3-year periods. the medical records were examined for admission numbers, source of admissions, length of stay, legal status, reason for admission and readmission rate.

The percentage of patients admitted from home decreased over time, whereas the admissions from group homes increased threefold. Long-stay admissions decreased in the second and third periods followed by an increase in the fourth period. There was a progressive increase in formal admissions and a decrease in informal ones. There was an increase in admissions of people with psychiatric illness and a decrease in admissions because of social difficulties. the percentage of first admissions gradually increased and the percentages of readmissions gradually decreased.

People with intellectual disability are more likely to be admitted for psychiatric reasons and to be detained under the Mental Health Act than in the 1970s. There should be a much greater interaction between hospital and community services to facilitate shorter stays and early discharge. Out-of-area placements need to be taken account of while commissioning for the total need in a geographical area.