To share evaluation findings of a new decentralised mental healthcare system addressing Axis I disorders, developed in four subdistricts of Aceh Besar in Indonesia following the 2004 Asian tsunami. Two complementary methodologies were employed: an adequacy survey that assessed whether agreed programme implementation tasks were completed, and an outcome study that utilised patient, caregiver and staff assessment of the programme to determine what changes, if any, resulted from participation in the programme.

The system is functional in 3 of 4 subdistricts, and 47 of 53 subdistrict clinics (puskesmas) have trained mental healthcare nurses. Both patients and caregivers reported statistically significant differences when ranking patient wellbeing and were able to qualitatively describe specific changes in patient symptomatology and social functioning.

Results indicate that (a) the creation of a decentralised system with outreach at multiple levels, (b) emphasis on staff capacity building within a wider household-to-hospital continuum of care, and (c) incorporation of community volunteers working with trained medical personnel led to effective treatment options for people with Axis I disorders in a resource-poor setting.

The psychiatric manifestations of Huntington's disease are myriad and difficult to control. The use of electroconvulsive therapy (ECT) is not commonly considered for this condition. We describe a patient with severe depression, psychomotor retardation, delusions and weight loss who responded to ECT with good control of her symptoms.

Both our case and the literature appear to confirm the efficacy of ECT in the treatment of depression in Huntington's disease and suggest that other psychiatric manifestations of Huntington's are also responsive.

ECT is an effective and safe treatment that should be considered earlier in the course of the disease in cases that show limited response to pharmacological therapy. It should also be considered as an adjunct to medical therapy that may simplify polypharmacy and allow better control in patients with debilitating psychiatric manifestations of the disease. There is limited and conflicting evidence for its efficacy in chorea.

This study aimed to investigate the prevalence of adverse childhood experiences (ACEs) among patients in a female forensic psychiatric in-patient medium-secure unit, and to analyse the link between ACEs, adulthood self-harm and associated comorbidities and risk factors. The study used a cross-sectional design, with data gathered from the anonymised electronic health records of patients.

It was found that there was a high prevalence of both ACEs and self-harm among this patient group, and that there was a relationship between the two; those with more ACEs were more likely to have self-harmed during adulthood. Of the individual ACE categories, it was also demonstrated that emotional abuse had a significant association with adulthood self-harm.

In medium-secure settings for women, implementation of trauma-informed care will be beneficial because of the high number of those with mental disorders who have experienced adversity during their childhood.

Self-harm among adolescent in-patients exercises all who work with them. the UK has an exceptionally high prevalence of this behaviour compared with the rest of Europe. However, in one in-patient adolescent unit, in-patient self-harm was significantly reduced. Details of our rationale and intervention are presented, together with a retrospective data analysis.

Using a range of practical and psychological interventions, the alarmingly high level of self-harm was almost completely eliminated and this level has been maintained to the present.

Our results suggest that self-harm in in-patients can be managed and reduced without adverse effects on the patients. Our methods may be applicable to other settings, although some staff may initially feel uncomfortable with such policy.

To develop a standardised clinical information form which helps health professionals provide clear and relevant information about individuals who believe mental disorders affect their ability to repay debt and have consented to creditor organisations or money advisors approaching professionals for evidence. The six-question form was evaluated by three stakeholder groups.

Overall, 35 responses were received from creditors/money advisors, 28 from mental health professionals and 29 from service users/carers. All questions scored acceptable levels of clarity and three questions scored acceptable relevance levels. Qualitative data were used to revise questions on the basis of concerns expressed by stakeholders about sharing diagnostic data, providing prognoses, and the risk of creditor misunderstanding.

The form is likely to be an acceptable standardised means by which health professionals can elicit information on debt from individuals with mental health problems, for use by creditor organisations or money advisors. The results of a pilot study are awaited.

None.

Nasogastric tube feeding under physical restraint is an intervention that clinicians working in specialist mental health in-patient units may need to implement.

To examine the impact of this intervention on people with lived experience, carers and staff.

People with lived experience and parents and/or carers were recruited via UK eating disorder charity Beat. Clinicians were recruited via the British Eating Disorders Society's research forum. Qualitative semi-structured interviews were conducted and transcribed, and the results were thematically analysed.

Thirty-six participants took part, and overlapping themes were identified. All participants spoke in relation to four themes: (a) the short-term impact on the patient; (b) the impact on those around the patient; (c) the long-term impact; and (d) the positive impact. Subthemes were identified and explored.

This lifesaving intervention can also negatively affect patients, parents and carers, peers and staff. Further research is needed to understand how interactions and environmental modifications can mitigate the negative impacts.

A postal questionnaire was circulated to all psychiatrists who had completed their basic specialist training on the Royal London Hospital training scheme within the last 7.5 years. The aim of the questionnaire was to explore their psychotherapy experience while on the rotation.

The response rate was 95%. The respondents had a broad experience of both didactic and case work that they valued highly. Over half of them wished for an even greater exposure to psychotherapy during their basic training.

The results of our survey suggest that with the dedication of both the trainees and trainers, it is possible to have a comprehensive psychotherapy experience while working on a busy inner-city rotation.