The mental health of third-level students is of major societal concern with the gap between the demand for services and supports offered at crisis level. In Ireland, similar to elsewhere, colleges have responded to this need in vastly differing ways, with student counselling services available to all institutions, and student health departments and sessional psychiatry in some of the larger institutions, with none operating as a single multidisciplinary service. There is an increasing recognition for a more systematised approach, with the establishment of International Networks, Charters and Frameworks. These advocate for a whole institutional approach to student mental health, in addition to the development of an integrated system of supports with effective pathways to appropriate care. This paper, by members of the Youth and Student Special Interest Group of the College of Psychiatrists of Ireland, contextualises student mental health currently and describes future directions for this emerging field. It is a call to action to develop a structure that supports the needs of students with mental health problems across the full range of the spectrum from mild to severe.

Increasing exposure to video technology has provoked descriptions of psychopathology related to playing video games. However, there exists no description of hallucinatory phenomena occuring in psychotic illness deriving from such material. The subject of this report is one such patient suffering from a persistent auditory hallucination of computer music and other non-verbal information.

Objective: The purpose of this study was to determine the prevalence of a range of mental disorders in an elderly community dwelling population in Dublin using AGECAT, a reliable and standardised computerised diagnostic system that has been previously validated in community epidemiological surveys.

Methods: A total of 451 individuals over the age of 65 in a GP group practice were interviewed using AGECAT.

Results: Approximately one in five subjects had a mental illness according to AGECAT criteria. The prevalence of depression was 13.1% and did not change appreciably with age. 5.5% of subjects met organic ‘case’ criteria, and the frequency of organic cases increased with age, approximating 15% in the over 80 year age group. Neurotic disorders occurred with very low frequency, representing 1.1% of the subjects tested.

Conclusions: These findings have implications for mentalhealth services planning at a local level, and underscore the utility of AGECAT as a tool for comparative crosscultural epidemiological surveys.

Objectives: To describe a home-based treatment (HBT) service. To profile the patient population using HBT. To determine why HBT was used and to record disposal.

Method: All patients treated by HBT during the first two years of this new service were identified from the HBT logbook. A checklist recording demographic, diagnostic, presenting complaint data and details of HBT contact was used to analyse the patients' charts. A statistical package JMP was used to analyse the data.

Results: Two hundred and six patients (275 episodes) were treated using HBT. These were 101 (49.1 %) males and 105 (50.9%) females. Of these, 89 (43.2%) were single. Forty-eight (19.4%) lived alone and 53 (25.7%) were unemployed. The most common presenting complaint was severe depression (39.3%). A depressive disorder was the most frequent diagnosis (28.7%). Twenty six (13%) episodes of HBT ended in admission. One hundred and eighty five (67.3%) were referred to outpatients and 26 (9.5%) were discharged to the GP.

Conclusions: Home-based treatment is feasible for a wide range of patients with an array of presenting complaints. This model of service delivery is viable in a rural setting. Admission will still be required for some patients. Further work is needed to examine its sustainability and its generalisability to other Irish settings.

Objective: With the increasing demand for clinical psychology services and the existing shortage of clinical psychologists, it is theoretically and clinically important to identify variables associated with non-attendance for clinical psychology appointments. The study reported here attempted to: (a) examine the effect of waiting time for an appointment on non-attendance to clinical psychology services; (b) investigate variables associated with prolonged waiting time; (c) explore the nature of the relationship between waiting time and length of psychological treatment.

Method: The records of 49 3 patients offered an appointment to attend a clinical psychology service over a period of 24 months were analysed. Subsequently information on sex, age, type of referring problem, previous treatment history, treatment venue and waiting time for appointment, was collected and statistically analysed.

Results: Non-attendance was significantly related to prolonged waiting time and young age. Controlling for the effects of waiting time and age, patients with complex problems and new patients wh o had never sought psychological treatment in the past were less likely to attend. Length of waiting time was higher in groups with previous treatment history, patients seen at a hospital based department, and patients with complex problems and anxiety disorders. Finally, length of psychological treatment (total number of sessions required) was not affected by prolonged waiting time.

Conclusion: Non-attendance for clinical psychology appointments was associated with (a) young age, (b) prolonged waiting time (over six months), (c) complex psychological problems, and (d) new patients. The limitations and clinical implications of these findings are critically discussed.

Twenty-six women who had been sexually abused in childhood were assessed by means of structured interviews as to the nature of the abusive experience and subsequent psychiatric disorder. Nineteen (73.1%) fulfilled the criteria of Post Traumatic Stress Disorder and a comparison was made between PTSD and non-PTSD groups with regard to quantitative abuse variables. The phenomenon of latency or delay in onset in PTSD symptomatology was investigated. The possible implications of those findings were discussed.

Objectives: This study investigates the problem of assaults on psychiatrists by their patients.

Method: A postal questionnaire was circulated to 178 psychiatrists and trainees working in the Dublin area enquiring about assaults experienced in the previous three years.

Results: Of those 147 (82%) who responded 57 (39%) had been assaulted. There were few discriminating factors between those assaulted and those not but those in child psychiatry were less likely and those in general adult psychiatry were more likely to have been the victim of an assault. Only 10% of respondents had received any formal training in violence management. Assailants tended to be male (63%) and known to the doctor involved (71%). Personality disorder (37%), schizophrenia (29%) and substance abuse (26%) were common assailant diagnoses. Management responses to the assaults were generally internal with administrative staff involvement in only four cases.

Conclusions: Factors which potentially protect or expose clinicians to a greater risk of assault are not well defined and need to be further explored. Simple clinician or patient variables are not especially predictive of violence risk. Clinicians need to acquaint themselves better with the basic practices of violence prevention and management. External measures (such as involving administration) could be used more frequently to combat this common problem.

Objectives: Renewed scientific and media interest in suicidal behaviour has resulted in a number of initiatives examining and defining this complex and tragic phenomenon. However, in comparison to the study of adult suicidal behaviour, that of adolescents is still under researched. This study aimed to identify the extent and nature of parasuicide in young people under 17 years of age in the Foyle area in the 28 month period up to and including April 1997.

Method: The psychiatric assessments of all those admitted to hospital as the result of parasuicide during this period were examined. A psychosocial and clinical profile of this group of young people was then constructed. Any reported stressors recorded in the assessments were noted, and an attempt was made to ‘track’ contact with helping agencies in each case during the months immediately before and after admission.

Results: One hundred and twenty four young people were admitted during the period under review, the vast majority following an overdose.

Conclusions: Family conflict, family illness and bullying were the three most frequently recorded stressors. Twothirds had no apparent contact with services in the three months prior to admission, and of these, half were not referred on to specialist services after they had been discharged from hospital.

Objectives: To establish the prevalence of postnatal depression using standardised methods of diagnosis and to evaluate early detection of postnatal depression.

Methods: Prospective cohort study. Prevalence established using two-step screening with EPDS and semi-structured clinical interview for ICD-10 diagnosis. EPDS recorded at day three-five postnatal evaluated as predictor of depression at week six postnatal.

Results: Prevalence established at 14.4%. EPDS recorded at day three-five postnatal when combined with past history of depression was a predictor of depression occurring at week six postnatal.

Conclusions: We found a similar prevalence of postnatal depression in this Irish sample to other international prevalence studies. There are implications for hospital based screening to identify those at risk of developing a postnatal depression.

Objectives: Structured professional judgement is now the most widely accepted approach to clinical risk assessment and risk management. The Suicide Risk Assessment and Management Manual (S-RAMM) is a new structured professional judgement tool closely modelled on the HCR-20. This is the first prospective validation study for this instrument.

Methods: Two post-membership registrars jointly interviewed 81 of 83 current inpatients to rate the S-RAMM. Two assistant psychologists independently rated the HCR-20, GAF and PANSS. All incidents of self-harm, attempted suicide, suicide and violence to others were collated from hospital reporting of critical incidents over the next six months supplemented by examination of other records.

Results: For combined self-harm and suicide outcomes, the S-RAMM total score using the receiver operating characteristic had an area under the curve AUC=0.89, (95% CI 0.79 to 0.99). The S-RAMM performed as well for the prediction of self-harm and suicide as the HCR-20 did for violence, and better than measures of mental state (PANSS total score) and global function (GAF).

Conclusions: The S-RAMM has better than minimum acceptable characteristics for use as a clinical or research tool for suicide risk assessment, and performs almost as well as the HCR-20 does for violence. Further prospective studies are now required, in other populations.

We report on a patient with a rare type of dissociative disorder, dissociative psychosis (hysterical psychosis), in whom gustatory, olfactory, visual and auditory hallucinations occurred. Auditory and visual hallucinations have been described in previous cases of dissociative psychosis, and olfactory and gustatory hallucinations have been described associated with sexual assault but this case is unusual in that hallucinations occur in all modalities in one patient, as yet not described in the literature The basis of the dissociative disorder lay in a childhood sexual trauma and therefore the traditionally advocated treatment for such a case is the psychotherapeutic abreaction of these previous traumatising events. This approach caused worsening symptomatology and the patient experienced frequent lapses into dissociative psychosis. However, focused cognitive-analytic therapy concentrating on the patient's personal conflicts at the time of presentation resulted in a resolution of symptoms and a return to health.

A right is an entitlement that one may legally or morally claim. Human rights are of particular importance in mental health care owing to the existence of laws that permit involuntary admission and treatment under certain circumstances, and compelling evidence of persistent social exclusion of some individuals with mental disorder. Ireland’s mental health legislation, which is currently under review, meets most international human rights standards in areas of traditional concern (involuntary admission and treatment) but not in other areas (especially social and economic rights). These deficits would be addressed, at least in part, by replacing the principle of ‘best interests’ with the principle of ‘dignity’ as the over-arching principle in Irish mental health legislation. Such a change would help ensure that decisions made under the legislation actively facilitate individuals with mental disorder to exercise their capabilities, help promote human rights and protect dignity. Even following such a reform, however, it is neither practical nor realistic to expect mental health legislation alone to protect and promote all of the broader rights of individuals with mental disorder, especially social and economic rights. Some rights are better protected, and some needs better met, through social policy, mental health policy and broader societal awareness and reform.

Suicide, assisted suicide and euthanasia are elusive and controversial issues worldwide. To discuss such issues from only one perspective may be limiting. Therefore, this paper was written by authors from various regions, each of whom has been asked to reflect on the issues. The countries/cultures are: Australia, China, Cuba, Ireland, India, Japan, Russia, South Africa, The Netherlands, North America (Turtle Island) and United States. Historically and today, suicide is viewed differently. Assisted suicide and euthanasia are equally seen from multifarious perspectives. Highlighting development in the Netherlands, Australia's Northern Territory and Japan (ie. the famous Yamanouchi Case), the review shows growing re-examination of the right to die. There appear, however, to be no uniform legal and ethical positions. Further debate and discussion globally is needed to avoid myopic perspectives.

Objectives: The demand for places in supported accommodation is likely to rise due to the increasing longevity of people with intellectual disabilities and as their parents become unavailable or unable to care for them. However few attempts have been made to ascertain carer's views on alternative accommodation.

Method: Four studies were undertaken in Northern Ireland to ascertain carer's views using three different methods. In all, 387 carers participated with the response being greatest for individual interviews conducted in the family home and least for self-completed questionnaires and attendance at group meetings.

Results: The majority of carers envisaged the person continuing to be cared for within the family. The most commonly chosen out-of-home provision was in residential or nursing homes, living with support in a house of their own and in homes for small groups of people. Few carers chose living with another family. However only small numbers of carers envisaged alternative provision being needed in the next two years and few had made any plans for alternative living arrangements.

Conclusions: The implications for service planning are noted, primarily the need for individual reviews of future needs through person-centred planning; improved information to carers about various residential options and their differential benefits, along with more services aimed at improving the quality of life of people living with family carers. These need to be underpinned by a commitment of statutory agencies to partnership working with family carers. The implications for mental health services are noted.

Objective: It has been suggested that presentation with self-neglect, domestic squalor and hoarding, represents a distinct syndrome, widely known as Diogenes' syndrome. The validity of this syndrome is controversial and we suggest that in previous series of such patients other psychiatric diagnoses, particularly obsessive compulsive disorder (OCD), may have been missed.

Method: A series of 50 patients admitted for treatment of OCD were examined, looking for presentation with self-neglect, domestic squalor and hoarding. Response to treatment was also measured by comparing pre and post-treatment scores on the Beck Depression Inventory and Activity Checklist.

Results: Of the sample 8% presented with all three features. This sub-group of patient had a poorer outcome than other patients with OCD.

Conclusion: Presentation with self-neglect, domestic squalor and hoarding is not uncommon in patients with severe OCD and this supports the suggestion that patients previously described as having Diogenes' syndrome may have had undiagnosed OCD.