Non-attendance rates in a psychiatric out-patient clinic and the effectiveness of telephone or postal reminders in reducing non-attendance were evaluated. All patients who did not attend the clinic for their second appointment within 2 weeks were contacted by telephone or letter. Patients who failed to attend the clinic 6 weeks after the reminder were classified as non-attendees.

Rate of non-attendance before the intervention was 31.3% (n = 61/195). After the intervention this was reduced to 23.1%, a relative risk reduction of 26.2%. Being male, not being prescribed medicines, having a diagnosis of psychoactive substance use or dementia were risk factors for non-attendance (odds ratio, OR>1). Risk of non-attendance was low for bipolar disorder, schizophrenia and depressive disorder (OR <1).

A simple low-cost intervention in the form of a reminder reduced non-attendance rates. Routine implementation of this intervention should be considered in all psychiatry out-patient services in low- and middle-income countries.

Multidisciplinary activities of community mental health teams in Ireland are understudied. We explored symptom profile and multidisciplinary team contacts in a complete sector population (n = 504).

The frequency of attendance was greater in individuals with severe mental illness (P<0.001) and correlated with total Health of the Nation Outcome Scale (HoNOS) scores (P<0.001) and with the sub-scales for social disability (P<0.001) and symptoms (P<0.01). Sixty-two per cent of individuals were receiving shared care and were more likely to have severe mental illness (P<0.001) and higher total HoNOS scores (P<0.001). Frequency of attendance correlated with total HoNOS scores and subscale scores for social impairment and symptoms.

Frequency of service attendance and activities of multidisciplinary team members vary with symptom profile of service attenders but are focused towards individuals with more severe illness and greater problems identified by the HoNOS.

A.M. works in a National Health Service general adult community mental health team and is an elected member of the Royal College of Psychiatrists General Adult Faculty Executive Committee.

We established two ‘dual diagnosis’ community psychiatric nurse posts within community mental health teams in Lanarkshire to improve the service care for individuals with comorbidity. A questionnaire-based evaluation of the service over a 2-year period was conducted.

Comorbidity was under-reported by community mental health teams and under-referred to specialist addiction services. The presence of new specialist nurses enhanced the detection of comorbidity, improved staff perceptions of working with patients that misuse substances, and was associated with a clinical and functional improvement in patients over 2 years.

Our findings support the recent trend to provide integrated care for comorbid service users within mainstream mental health services, and suggest a model of service delivery that might be more widely developed to address the concern that such users ‘fall through the gaps’ between services.

To systematically review the published literature with respect to formulating a dose-response curve for flupentixol decanoate. A systematic literature search using the Cochrane Database was performed for studies that published both dosage information and data on relapse rates.

The data showed modest effects of dose on survival rates. Increasing dose may be associated with increased survival rates up to around 50–60 mg of flupentixol decanoate every 4 weeks. There was no evidence of increased survival rates at higher doses and higher doses may be associated with lower rates of survival. There is considerable uncertainty as to the true effects of dose of flupentixol decanoate on relapse rates.

There is no evidence that survival rates improve for doses above 50–60 mg every 4 weeks. These doses are much lower than doses commonly prescribed. Clinicians may wish to consider these data when prescribing flupentixol decanoate.

We conducted a postal questionnaire survey of the practice of rapid tranquillisation among 215 consultant psychiatrists in the West of Scotland, before and after the withdrawal of droperidol by the manufacturer.

One hundred and eighty questionnaires (84% of those sent) were returned. Droperidol had been used extensively, often combined with lorazepam, for rapid tranquillisation. The main replacement suggested for droperidol was haloperidol. About half of the respondents to our survey chose to comment on the withdrawal of droperidol. More than half of the comments were unfavourable, including lack of an adequate replacement and lack of consultation with the psychiatric profession.

The abrupt withdrawal of droperidol, partly for commercial reasons, was regrettable. There was no time for an adequate evaluation of possible replacement medications and a lack of consultation with the profession regarding the impact on clinical care.

To improve the rate of documentation of risk in new referrals to a community mental health team. A retrospective audit of 46 case notes was followed by a training session on risk of violence. The following 50 case notes were studied for changes in risk assessment.

Prior to the study there were very low rates of documentation of risk of violence. Significant improvements were made in 45% of the items in the history and mental state although not in the formulation of a risk assessment statement.

It is possible to improve the risk of violence documentation with no extra time, resources or paperwork and with true multi-disciplinary involvement.

Very little research has been undertaken to characterise the service user groups served by the voluntary sector mental health services in Britain. In view of the high reported cases of dissatisfaction with the statutory mental health services in the population of Caribbean origin in Britain, we sought to compare the male service users attending a voluntary sector service in Brixton, South London with those attending a service run by the mental health hospital for that catchment area. The service users and their case workers were interviewed and their case notes reviewed to obtain demographic information such as employment and forensic history and contact with other services. They were also assessed using the Global Assessment of Functioning (GAF) and the Camberwell Assessment of Need (CAN).

The service users attending the voluntary sector were significantly more disadvantaged in the areas of unemployment and contact with other health services particularly general practitioners. They had significantly lower scores on the GAF and had more unmet needs on the CAN, including numeracy and literacy skills. Both patient groups, however, reported problems with intimate relationships.

Service users attending voluntary sector services are likely to be more socially and materially deprived than their counterparts attending statutory services and specific strategies are required to assist these organisations in meeting the many needs of the service users.

To investigate liaison psychiatry services across 38 acute trusts in the south of England. We used a telephone survey and compared the results to service structure and function as recommended by the Royal College of Physicians and the Royal College of Psychiatrists.

Approximately two-thirds of trusts surveyed had a dedicated liaison service and this was not significantly related to hospital size. Most liaison teams were understaffed in all disciplines and only a third had a full-time consultant. Services for specialist patient groups were generally well provided for; 37% of teams had been created in the past 5 years and 33% were planning to increase their staffing levels in future.

Liaison services in the south of England are similar to those in other parts of the UK that have been surveyed. Although the services did not meet the Colleges' recommendations, our study shows some recent growth and development in this specialty.