We assessed the appropriateness of treatments recommended by health shop staff for symptoms of mild-to-moderate depression using participant observation with ten members of staff from ten different health shops selling herbal medicinal preparations.

A wide range of treatment options were suggested by health shop staff when presented with common symptoms of depression. The majority have no firm evidence base, with the exception of St John's wort (Hypericum perforatum).

Most alternative treatments recommended by health shops for the treatment of depression have a poor evidence base. Implications for training and communication between agencies are discussed.

We surveyed the experience of working as a non-consultant career grade psychiatrist (NCCG). A postal questionnaire was sent to 140 NCCG psychiatrists in the south-west region.

A total of 90 doctors responded (65% response rate); 30 (33%) had never had supervision and 45 (50%) were not eligible to sit the MRCPsych examination. Only 41 respondents (46%) had administrative support for non-clinical work.

Good supervision, comprehensive job plans and opportunities for further professional development are essential requirements for this group of doctors.

To identify the experiences of patients pursuing a personal injury claim, we carried out a retrospective questionnaire survey.

Sixty-one patients from a regional traumatic stress clinic took part. Most were satisfied with the conduct of legal, medical and psychiatric personnel. Thirty-two (53%) reported that the legal proceedings had had an adverse effect on their health/well-being, and about a third reported an adverse effect on domestic relationships. Twenty-four patients (40%) were dissatisfied with the provision of information. More information about the whole legal process would have been welcomed by means of an information leaflet (n=57, 93%), a helpline (n=48, 79%), or a videotape (n=42, 68%).

Although seeking redress may contribute to the patient's adjustment, this survey demonstrates that it is not a step to be taken without consideration. As part of their therapeutic management, mental health professionals should consider the implications of such a step with their patients.

We evaluated the various aspects of ‘do not resuscitate’ (DNR) decisions taken for psychiatric continuing care patients within NHS Ayrshire and Arran. Records were reviewed and nursing staff were asked their opinions about DNR orders in general and the way these were implemented on their wards.

There were 35 DNR orders among 88 continuing care patients in mental health wards for older adults. There were no DNR orders for the 25 continuing care patients in general adult psychiatry wards. Quality of life was the main issue when taking a DNR decision. Medical and nursing staff were involved in all decisions and the family in most. Patients were involved in only two cases. The documentation of the DNR order itself was satisfactory but documentation of the reasons behind the decision was inadequate. Patients with DNR status were perceived by ward staff to have more physical debilitation and more dependence on others. Local guidelines were being followed in most aspects, but these needed to be reviewed, as suggested within the resuscitation policy itself.

Decisions not to resuscitate may often be difficult to reach in psychiatric patients. Wards follow heterogeneous policies despite a resuscitation policy existing within the trust. Documentation needs to be improved and medical and nursing staff must reach a consensus regarding what constitutes quality of life and the appropriate time for a DNR decision.

A survey was conducted to determine the experience of verbal and physical abuse among specialist registrars and the availability of training on managing abusive patients. A self-report questionnaire was sent to all specialist registrars working in the Northern Deanery.

Completed surveys were received from 30 out of the 49 trainees (61% response rate). Twenty-three respondents (77%) reported being abused; all reported verbal abuse and 2 (9%) reported physical abuse. The experience of trainees of abuse differed between White doctors and those from other ethnic groups. The majority of trainees had received no training to deal with abuse.

In view of the high prevalence of abuse experienced by trainees, interventions to prevent both verbal and physical abuse should be identified. There should also be formal support for managing abuse and improved recording of abusive incidents.

To determine the opinions of psychiatrists on mental illness among themselves and their colleagues a postal survey was conducted across the West Midlands.

Most psychiatrists (319/370, 86.2%) would be reluctant to disclose mental illness to colleagues or professional organisations (323/370, 87.3%). Their choices regarding disclosure and treatment would be influenced by issues of confidentiality (n=245, 66%), stigma (n=83, 22%) and career implications (n=128, 35%) rather than quality of care (n=60, 16%).

The stigma associated with mental illness remains prevalent among the psychiatric profession and may prevent those affected from seeking adequate treatment and support. Appropriate, confidential specialist psychiatric services should be provided for this vulnerable group, and for doctors as a whole, to ensure that their needs, and by extension those of their patients, are met.

We conducted this survey to assess the current experience of psychotherapy training in the Northern Deanery and discuss possible effects changes might have on the future of this training. A postal questionnaire assessed the training experienced by the 41 trainees on the Northern Region Senior Unified Senior House Officer (SHO) Psychiatry Training Scheme in 2004. The results were compared with the guidelines from the Royal College of Psychiatrists.

The response rate was 61%. Particular areas of strength included conducting a long case (64%) and obtaining sufficient teaching in psychodynamic and cognitive–behavioural therapy theory (88%); 92% rated their experience of the training as satisfactory or better, and 68% intended pursuing further training in psychotherapy.

Trainees ought to be familiar with the psychotherapy guidelines from an early point in their training. Specific areas of difficulty within the scheme need to be addressed. Proposed changes to specialist training are likely to have an impact on the psychotherapy training experience.