We set out to ascertain how common this is for psychiatric trainees in South Thames and the effects it has, if any. An anonymous postal questionnaire was circulated to 400 trainees.

Of the 400 trainees, 203 (51%) responded and 109 (54%) of the respondents had had one or more patient suicide and 168 suicides were reported.We judged the effect of the suicide on the doctor to be moderate or severe in 126 (75%) of the 168 suicide events.

Patient suicide must have a higher profile in training. Formal systems need to be created to provide support and education in this area.

To determine the annual rates of assaults and threats to psychiatrists, describing the situations and staff involved, using a retrospective postal questionnaire of 139 doctors working in South Wales.

Over the year, 17% of respondents reported one or more assaults (of these, 42% were assaulted more than once) and 32% reported one or more threats. The most junior senior house officers (SHOs) were significantly more likely to have experienced an incident, regardless of the individual's gender or attendance at a course in managing aggression. Most assaults (61%) were committed by patients from general adult psychiatry, and half occurred during urgent assessments. Eighteen (58%) of the assailants were known to have previously assaulted amember of staff, and this information was known to the doctor before the assault for 16 (88%). Five (16%) of the assailants had been drinking alcohol prior to the assault. Twenty-nine (78%) of the assaults were documented in the case notes and 6 (19%) were reported to management.

Some staff (in particular, inexperienced SHOs) are at greater risk, and efforts should be made to identify and help these individuals and/or grades to deal with aggression. All psychiatric staff should be trained to manage violence. Staff should be encouraged to report incidents to management, so that employers can identify and address problem areas.

We undertook a postal questionnaire survey of all consultant psychiatrists working in Scotland to examine whether psychiatrists themselves may contribute to the misunderstandings surrounding schizophrenia by avoiding discussion of the diagnosis with their patients.

Two-hundred and forty-six (76%) responded. Ninety-five per cent thought the consultant psychiatrist was the most appropriate person to tell a patient their diagnosis of schizophrenia, although only 59% reported doing so in the first established episode of schizophrenia, rising to 89% for recurrent schizophrenia. Fifteen per cent would not use the term ‘schizophrenia’ and a variety of confusing terminology was reported. Over 95% reported telling patients they had mood disorders or anxiety, under 50% that they had dementia or personality disorders.

Greater openness by psychiatrists about the diagnosis of schizophrenia may be an essential first step in reducing stigma.

To examine what current routine statistics could show about the extent to which patients are admitted to hospital beds ‘out of area’, a quality indicator proposed in the National Service Framework.

Available data record that, on average, at least 6.9% of acute general psychiatry admissions in the English NHS happen outside the normal catchment area arrangement of a patient's health authority. However, deficiencies in the calculation – arising from lack of data, mainly about private sector admissions – and the absence of a central registry of NHS trust catchment areas suggest this is a substantial underestimate.

The most useful way for this issue to be examined is from year to year for individual trusts.

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.

This study aimed to compare the subjective quality of life and attitudes to medication between groups of patients with schizophrenia taking either olanzapine or traditional antipsychotic medication.

The two groups were matched for age, gender, length of illness and antipsychotic group demonstrated more extrapyramidal side-effects (EPS) and akathisia. Within this group, those with EPS scored lower on the affect balance scale of the Lancashire Quality of Life Scale than those without. More patients in the olanzapine group reported that medication was taken to prevent symptoms returning.

These results lend support to the hypothesis that the presence of EPS impairs quality of life and suggest that olanzapine therapy may improve patients' attitudes to medication.

We surveyed the usefulness of a structured method of recording history and mental state examinations with a treatment plan in terms of conveying information about diagnosis and management, compared with informal methods of recording data. A survey of admission records by nursing and medical raters was followed by introduction of a standardised assessment format for use by trainees and a re-audit. Initial psychotropic medication was also scrutinised.

The assessment schedule improved clarity of diagnosis for the medical and nursing raters alike, but improvement in management plan quality was mainly apparent for the medical rater. The audit also exposed widespread use of hypnotic agents.

It is suggested that structured assessment schedules facilitate adherence to good standards of clinical practice and may benefit trainees undertaking professional exams as well as having a multi-disciplinary and medico-legal relevance.

Services were compared for the management of deliberate self-harm with existing national guidance. A postal survey was sent to all clinical directors of adult psychiatry at all NHS trusts assessing adult patients admitted to general hospital following deliberate self-harm in England.

Responses were received from 129 (65%) trusts.Thirty per cent of trusts do not use secondary psychiatric services for psycho-social assessment following deliberate self-harm; 52% have designated self-harm liaison staff and 69% of general hospitals have a ward to which most cases of deliberate selfharm are admitted. However, only 18% have staff with psychiatric experience. In 82% of trusts training is provided for junior psychiatrists at induction but in only 56% are observed-assessments undertaken. Forty-two per cent of the trusts have a deliberate self-harm services planning group.

Standards for deliberate self-harm services fall substantially below existing national guidelines, particularly in the areas of planning and training.

An audit project was carried out in a mental health trust in North-West London on two successive years to determine the average case-load size of defined severe mental illness for each professional discipline.

The average case-load for non-consultants varied from 16 (for occupational therapists) through to 98 patients (for senior house officers). Community psychiatric nurses had an average case-load of 21 and consultants had an estimated average case-load of between 185 and 317 patients. The proportion of patients with severe mental illness ranged from 49% to 67%.

The case-loads of consultants in community health teams are too large to exercise the statutory duties of a responsible medical officer and, therefore, need revision.

To determine the rates at which clinical teams within one NHS trust placed older people on a Care Programme Approach (CPA) register and to examine the degree to which clinicians' use of the register conformed to trust policy. Two retrospective case notes surveys were carried out 6 months apart within a completed audit cycle.

Consultant teams varied considerably in their application of the CPA policy. Feedback to clinicians after the first survey had a variety of effects on subsequent use of the CPA register.

Health service policies exist to reduce variation in clinical practice and to ensure minimum standards. Clinical audit may be a useful tool in identifying irrational variation within the framework of clinical governance.

We wished to ascertain to what extent patients had given informed consent to their medications. Therefore, 68 long-term psychiatric in-patients were interviewed about their knowledge and attitudes towards their medications.

Two-thirds of patients did not know the purpose of their medication; one-tenth knew about the side-effects. Longer length of stay, older age and voluntary status were associated with less knowledge. Despite poor knowledge, most patients accepted their treatment. However, few realised that they had any choice.

The prevalence of true informed consent is low among this group and raises issues about patients' rights.

Safety features of rooms used for clinical interviews were assessed throughout our mental health unit. Following this pilot survey, 12 safety standards were agreed and adopted by a multi-disciplinary audit meeting. Recommendations were disseminated throughout the trust. Adherence to the accepted standards for interview room safety was assessed at 6 months and 1 year after baseline. Following each assessment, results were presented so that the audit cycle was completed twice.

At 6 months 46 interview rooms were assessed against the 12 accepted standards and many were found to be unsatisfactory. After presentation of these results, the 1 year assessment discovered few changes in safety features of the 50 rooms now being used.

Unsafe rooms compromise the safety of staff and patients and this is clearly unacceptable. The audit process in itself failed as amethod of improving standards.

We conducted a telephone survey of medium secure units in England and Wales to determine the distribution of women patients.

The survey identified 1836 medium secure beds, housing 342 women patients. Women in the NHS were housed primarily in mixed-gender units (170 women, 94%). Most NHS beds in single-gender units were for men (56 beds), whereas most private sector beds in single-gender units were for women (79 beds).

Increased awareness of the often inappropriateness of services for women in mixed-gender units has led to units deciding not to admit women patients and, inadvertently, more single-gender beds for men in NHS units than for women. The NHS units have to rely on private sector units to provide beds in single-gender units for women, perhaps at the expense of effective continuity of care.

The clinical practice of electroconvulsive therapy (ECT) by New Zealand psychiatrists was surveyed by questionnaire. This paper compares the findings with national and regional surveys conducted in Great Britain, and considers the influence on clinical practice in New Zealand of the Royal College of Psychiatrists' ECT Handbook.

ECT has the same level of support from psychiatrists in New Zealand as in Britain, but is less frequently used. Modern brief pulse machines are used by 16 of 19 (84%) services from which data were received. The ECT Handbook was the most nominated source of information on ECT. Most (87%) respondents were aware of at least one set of ECT guidelines. However, these have apparently failed to influence some important aspects of practice. In particular, many medical conditions are still perceived as absolute contraindications.

The Royal College of Psychiatrists and the Royal Australian and New Zealand College of Psychiatrists need to place even greater emphasis on the importance of training in ECT for both trainees and qualified psychiatrists, and on the promotion of approved guidelines.

This study considered patients admitted to hospital following deliberate self-poisoning. The characteristics of the patients and the outcomes of assessments by trainee psychiatrists and a mental health nurse were compared.

There were no significant differences in the outcome of 68 assessments performed by a trainee psychiatrist and 77 by a mental health nurse. The nurse assessment service was well-received by the poisons unit, a medical ward specialising in overdose treatment, and trainee psychiatrists.

Psychosocial assessments following self-poisoning can be provided by appropriately trained and supervised mental health nurses. The introduction of a nurse-led service should enhance relationships with the local poisons unit and reduce the workload of junior doctors without compromising their training needs.