Objective: The aims of this study were to assess the procedures for involuntary admission to both public and private psychiatric hospitals as determined by the Mental Treatment Act, 1945 which is one of the oldest pieces of mental health legislation in the EC. Method: Over a prospective five month period all involuntary admissions to both a public and a private hospital in Dublin were studied. Social-demographic data and clinical features of 54 involuntary admissions were recorded and analysed. Results: 11.2% of public admissions were involuntary as were 3.4% of admissions to the private hospital. The most common diagnoses were schizophrenia and mania. 74.1% of the patients had been previously admitted. 81.5% of the patients were detained in hospital for less than three months although they were committed for a potential six months. There was no formal method of decertification. Conclusions: There appears to be little need nowadays for differentiating between legislation for public and private patients. The duration of the initial reception order should be reduced from six months to a period of forty-eight hours for initial assessment and treatment. If necessary this could be extended to three months. Formal methods for decertification are required. Mental health legislation in Ireland needs to be modernised.

This case report discusses a 25-year-old male who was referred to community mental health services from primary care with symptoms of anxiety and depression related to climate change, which the referring clinician believed were of delusional intensity. This case report gives the history of his interaction with the service. A literature review is performed noting the dearth of case reports in this area and a subsequent discussion charts the emerging literature on mental health issues related to climate change. Finally the paper makes some broad recommendations for mental health practitioners on how to approach these issues.

This article provides an overview of the public health approach to suicide in Ireland. The authors provide detail on the current suicide prevention strategy in Ireland, Connecting for Life, which is a whole-of-government, systemic, multicomponent national strategy. As the strategy enters its final extended phase of implementation over the period 2020–2024, the public health elements of Connecting for Life are presented, including the population level and more targeted approaches. The findings of an interim review of the strategy are discussed, in addition to the local and national implementation structures which are in place to assist implementation and monitoring of the strategy.

Anorexia Nervosa (AN) has the highest rates of morbidity and mortality of any psychiatric disorder. Psychiatrists in Ireland have reported difficulties in managing patients with AN, particularly those with severe levels of illness. This paper explores these management difficulties, including the financial and organisational impediments to service provision, and the legal and ethical dilemmas involved in dealing with those patients who refuse treatment.

Objective: To measure (a) the prevalence of problem drinking in a population of methadone-treated drug users, (b) independent associations with problem drinking, (c) the effect of hepatitis C status on drinking behaviour, (d) the knowledge of drug users of their hepatitis C status and their perception of their drinking behaviour and (e) the attitude of drug users to the effect of alcohol on hepatitis C virus (HCV) related disease.

Method: A cross sectional survey of 130 drug users in treatment at the National Drug Treatment Centre, Dublin was carried out. A questionnaire incorporated the Alcohol Use Disorders Identification Test (AUDIT), and data were collected on sociodemographics, drug use history, perceived HCV status and drinking behaviour, and attitudes to the impact of drinking on HCV related disease. Hepatitis serology and drug urine data were collected from clinical records.

Results: The prevalence of problem drinking was 41% (95% CI 33-51%). Unstable accommodation, older age, male gender and longer duration of heroin use were independent associations with being a problem drinker. There was no significant difference in the prevalence of problem drinking across HCV status. Knowledge of HCV status was accurate, however 35% of those identified as AUDIT cases failed to recognise their problem drinking.

Conclusion: HCV infection among Irish drug users is compounded by a high prevalence of problem drinking with drug users failing to modify their drinking in response. Incorrect perception of problem drinking status could be a barrier to addressing this potentially remediable risk factor.

Objective: There is a paucity of literature on the content of referral letters to psychiatric services and few relating specifically to referrals to a department of old age psychiatry. There has been a significant increase in referrals over the last five years to this service, which may reflect the ageing population and a greater awareness of the service. Our objective was to evaluate the quality and legibility of information received, clarity of reason for referral and details of pre-referral management.

Methodology: The clinical records of the first 100 referrals in 2002 to this department were analysed. The referral letters were examined for the documentation of a number of demographic variables, reason for referral, interventions to date and level of urgency.

Results: The clinical records of nine patients did not have an identifiable referral letter at the time of this analysis. Of the remaining 91 analysed, 59% were referred by their GP, 33% were inpatient liaison referrals and 8% from outpatient departments. In the majority, patients' details were given, however, only 30% included a phone number. Next-of-kin was mentioned in 29%. GP's name was included in 71% of referrals from OPD and 7% of liaison referrals. The level of urgency was stated in 19%. Whether a domiciliary or OPD visit would be more appropriate was stated in 22%. The reason for referral was clear in 75%, with 43% including some aspect of Mental State Examination, 7% had included a MMSE score, 1% mentioned level of suicide risk.

Thirty-one per cent had pre-referral investigations and 45% had pre-referral treatment documented. The letters were clearly legible in 73%.

Conclusion: The information in the referral letter in many cases was insufficient to prioritise and expedite appropriate assessment. It is planned to introduce a proforma referral form, specific to old age psychiatry, which would include the information which is required and which would, hopefully, lead to a more efficient service.

Objectives: Continuing deinstitutionalisation has led to growing concern about the availability and accessibility of services for people with learning disabilities transferring to community living. This study was undertaken in order to assess the configuration of services in terms of availability and uptake for people with learning disabilities who have left long-stay hospital care and to identify gaps or barriers to service provision within the unique integrated health and social services structure in Northern Ireland.

Method: The ‘keyworkers’ of 195 people – most of whom were aged 40-59 years with a diagnosis of moderate intellectual impairment – were interviewed by a researcher one year after discharge using the Service Interview.

Results: While a wide range of generic and specialist services was available, ‘packages’ of care consisted largely of public sector services (eg. GPs, chiropodists and social workers) and relied, to some extent, on the type of community accommodation. Although services appeared well co-ordinated in terms of care reviews and keyworker arrangements, 40% of people required more one-to-one support particularly in areas related to integration. However, services were perceived by care staff to be satisfactory

Conclusions: The development of community care has been slower in Northern Ireland than elsewhere and a large proportion of resources remain tied up in hospital care. However, existing community-based services appear to be addressing individual needs. Some former patients, though, may have been subject to transinstitutionalisation in the sense that their choice of accommodation was restricted mainly to large private sector homes and work and daytime opportunities were insufficient to facilitate integration. Service planners and providers need to give further consideration to the likely effects of different forms of rehabilitation, reprovision and resettlement and to be aware that the pattern of service provision is likely to be different for the more dependent cohorts of people who leave hospital in the future.

Objectives: To carry out a survey on the use of video conferencing equipment by a rural child psychiatric multidisciplinary team and to determine what impact the introduction of this equipment had on service provision.

Method: Several aspects were studied including user satisfaction and estimations of cost saving, on the basis of avoidance of travel to and from the regional base in Galway. A questionnaire was also developed to determine whether alternative contact would have been made if if this new technology were not in place.

Results: The results of the initial six months following commencement were investigated. Use of the equipment was attempted 17 times during this period. Most members of the child psychiatry team participated in its use. Visual problems accounted for 66.7% of reported technical difficulty and 88.9% of users rated their level of satisfaction with the equipment as ‘Satisfied’ or ‘Very Satisfied’.

Conclusions: Apart from the start-up cost implications of installing this equipment, it satisfied its aim of increasing contact between the rural service and St Anne's Children Centre in Galway. The equipment was easy to use and for the most part reliable.

The authors summarize a case wherein trazodone was utilized to maintain therapeutic seizure duration during electroconvulsive therapy (ECT) and review the literature in detail (36 references).