To examine trends in appeals to mental health review tribunals and hospital managers' panels in a hospital covering two outer London boroughs from 1997 to 2007. Data were also used to explore associations between demographic variables, including ethnicity, and the results of appeal hearings.

The number of detentions under Mental Health Act Sections 2, 3 and 37 rose from 203 in 1996 to 279 in 2006. the percentage of these that went to appeal increased from 34% to 81% during the same period. However, there was no observed trend in the result of the appeals. the results were not associated with gender, ethnicity, marital status, age or the section involved; 12% of appeals were successful.

The study shows rising use of the Mental Health Act over the past 10 years and an increasing volume of appeals against its use. Since appeals are no more likely to result in discharge, the increased use of the Mental Health Act is not balanced by increased rates of discharge by review hearings. the study also demonstrates the rising workload for all involved in appeal hearings.

The Rainbow programme was introduced in January 2004 as a structured in-patient treatment for anorexia. There were two strands to the programme evaluation: a notes review of a cohort of in-patients and a series of questionnaires to users, carers and staff.

There was an improvement in adherence to the National Institute for Health and Clinical Excellence guidelines and 94% of staff responders found the Rainbow programme framework useful.

The Rainbow programme improved the level of care provided. There is scope for improvement in the distribution of the programme manual.

A national survey of members of the Scottish division of the Royal College of Psychiatrists to establish the training in neuropsychology they have received, their views on neuropsychology service provision and on potential formal postgraduate neuropsychology training opportunities.

A 54% (n = 288) consultant psychiatrist response rate was achieved. the responses suggest that where specialist neuropsychology services exist, they are not perceived to be sufficient to deal with clinical demand. Consultant psychiatrists indicated that there are limited training opportunities in neuropsychology for psychiatrists, and this seems to be reflected in their limited confidence in interpreting basic recommended neuropsychological assessment tools. There seems to be a definite desire among consultant psychiatrists for postgraduate training opportunities.

Scottish psychiatrists desire an increase in formal neuropsychology training opportunities.

The local experience of having to take over the care of patients newly moved to the Bristol area revealed the lack of clear information on their complex needs. Official guidelines do not exist, therefore a consensus list of expected handover information was produced. the records of two patients were analysed in each of the six teams that agreed to be audited. A standardised handover form was devised and introduced (Part 1). Part 2 of the audit was performed 18 months after the implementation of changes to practice.

Part 1 revealed that diagnosis (11/12) and medications (12/12) were the best-documented items during handover correspondence. Follow-up duration (3/12), crisis plan (3/12), professionals involved (0/12) and risk assessment (3/12) if documented were done so only for patients with complex needs. Part 2 showed improved documentation of information (11/11 for the first two items and 10/11 for the remainder).

Absent or concealed information in patient notes may contribute to disruption to the continuity of care following patient transfers. the use of a succinct, structured and easily distinguishable handover form in patient records may facilitate communication between professionals.

The risk of developing fatal tachyarrhythmias can increase in patients receiving antipsychotic medication. Two surveys were conducted, one to evaluate junior doctors' knowledge of the QTc interval and the second to investigate the experience of electrocardiographic (ECG) monitoring among patients on four acute psychiatric wards.

The first survey revealed that junior doctors were lacking in knowledge regarding the QTc interval. the second revealed that ECG monitoring of high-risk patients was inadequate. Half of the high-risk patients who required an ECG were not given one, whereas 6% who did not require one still received this investigation.

There is a need to increase knowledge about the cardiac risk of antipsychotic medication on psychiatric wards. Following simple recommendations could improve clinical practice.

Assaults in healthcare settings have resulted in a range of national strategies aimed at reducing the incidence of violence. This study aimed to quantify the use of prosecution of assailants as a response, and to examine what other responses were used. the responses to violent incidents in three Northern Ireland psychiatric in-patient units in the year 2003 were ascertained retrospectively.

Of 245 incidents meeting the legal definition of assault, police were contacted in 10, and 1 resulted in a prosecution. Seven in-patients accounted for 30.4% of assaults. of the assaults, 46.5% were dealt with by staff using de-escalation alone.

These results demonstrate the infrequent reporting of such assaults to the police. A more structured approach should be taken to this important decision. Factors relating to the prosecution of assaults in psychiatric in-patient units are discussed.

The assessment of the future dangerousness of firesetters is problematical but psychiatrists may be requested to perform assessment of arsonists for the courts. We surveyed the views of psychiatrists and others (n=54) on how 11 candidate historical variables might contribute to future dangerousness.

Hierarchical cluster analysis indicated that variables fell into three groups related to level of perceived dangerousness. Apparent intention to endanger life and setting fire to an occupied building were the items thought by psychiatrists to most indicate highest future dangerousness. Having previously set fires that caused extensive damage, failure to extinguish previous fires or alert the authorities were perceived as indicating moderate future dangerousness.

The study adds to what is known about how psychiatrists formulate assessments of future dangerousness.

To investigate the effect of the 2004 tsunami on suicide rates in Sri Lanka. the number of suicides in the 2 years prior to and 1 year after the tsunami were considered for the study. Data from districts affected by the tsunami were compared with those from unaffected districts.

No significant differences were found between the number of suicides before and following the disaster or between areas affected and unaffected by the tsunami.

Worldwise, the impact of disasters upon suicide rates is variable. It is possible that the tsunami failed to have any profound effect on societal forces affecting suicide rates in Sri Lanka.

A questionnaire was distributed to patients in a psychiatric hospital in Birmingham, UK, to identify the factors that affect their satisfaction with the ward round.

The questionnaire was completed by 42 patients (53% response rate). Waiting time was the only variable to be significantly correlated with total score of patient satisfaction. Regression analysis also identified diagnosis and patients meeting their consultant before the first ward round as significant predictors of patient satisfaction.

Reducing waiting time and ensuring that the consultant meets the patient before the first ward round would make a significant improvement to the in-patient experience, without causing much disruption to standard clinical practice.

To estimate the proportion of attrition at which results of drug trials for people with schizophrenia lose enough credibility to become mistrusted by relevant groups of stakeholders. A piloted questionnaire was sent to 128 local clinicians, 100 relevant researchers and 104 service users and carers.

We received the biggest number of responses from the service user and carer group (n=81, 76%); 43% of clinicians and 32% of researchers responded. All three groups suggested that the follow-up rate for a 12-week schizophrenia drug trial should be around 70–75% for the trial to be credible.

This survey suggests that relevant stakeholders, including researchers, fundamentally mistrust results of the majority of drug trials in schizophrenia. Adopting a more pragmatic trial design can help address this.

To establish the prevalence of, and risk factors for, psychiatric symptoms in Ground Zero ironworkers. Questionnaires commonly used to screen for psychiatric symptoms were completed by 124 workers.

We have established the prevalence of screening positive for symptoms of post-traumatic stress disorder, panic attacks, generalised anxiety, depression and alcohol misuse. Among the risk factors were alcohol misuse, injury to or death of a family member, friend or co-worker at Ground Zero and one or more adverse life events since 9/11.

Ironworkers at Ground Zero tend to have significant psychiatric symptoms likely to be associated with the traumatic experience of working there during the clean-up operation. Risk factors for psychiatric symptoms were established.

The Impact of Events Scale was administered to 104 in-patients detoxing from alcohol or opiates to determine the prevalence of psychological trauma, the severity of its symptoms and the types of trauma responsible for symptoms.

Out of the 104 in-patients undergoing detoxification, 75 had symptoms of psychological trauma; in 60 patients the symptoms were in the treatable range. Patients with alcohol-dependence were more severely affected. ‘Life events’ traumatised a higher proportion of individuals than ‘traumatic events’.

Psychological trauma requiring treatment is commonly found in substance misusers. This is rarely addressed despite the cormorbid disorder running a complicated clinical course. There are conflicting opinions about best practice, but consideration should be given to providing patients with accessible treatments for psychological trauma.

The study aimed to assess the current provision of psychoeducation programmes for patients with mental illness in the UK. A postal questionnaire was sent randomly to 100 community mental health teams regarding the delivery and characteristics of psychoeducation programmes. Non-responders were contacted via telephone after 8 weeks.

The response rate was 87%. Eight services provided group psychoeducation, 40 provided individual psychoeducation within the care programme approach, and 39 did not provide any psychoeducation programme.

Patients with mental illnesses have limited access to psychoeducation in routine care. Group programmes should perhaps be more widely implemented as a relatively low-cost intervention.

We studied a representative cohort of 161 patients over 65 years of age, admitted non-electively to medical and geriatric wards of a large teaching hospital. Assessment for dementia was made using DSM–IV criteria. Psychiatric records were then examined, masked, to determine the involvement of psychogeriatric services.

There were 111 possible cases of dementia (69%), of which 30 (27%) had prior local psychogeriatric case notes; in 22 cases (20%) the patient had a prior psychiatric diagnosis of dementia. of 161 patients, 19 (12%) were seen by psychogeriatric services during their admission, of whom 12 (7%) were already known to psychiatric services. Dementia was diagnosed in 17 (complicated by delirium in 2), depression in 1 and hypomania in 1. Many patients with a possible diagnosis of dementia had no psychiatric assessment.

Psychogeriatric assessment was performed on a minority of older people admitted to medical care. This population may include older people with undiagnosed dementia and unmet psychiatric care needs.

To survey the attitudes of in-patients on an all-female ward to staff gender. All patients were invited to complete an anonymous questionnaire which was then repeated on a four-weekly basis for 4 months. Staff members were surveyed once within this period.

Only 15% of patients (n = 52) wanted all staff members to be female, whereas 87% reported feeling comfortable with male staff; 51% would prefer a predominantly female, mixed-gender staff. All staff (n = 11) were in favour of mixed-gender staffing.

Current best practice for staffing single-gender acute in-patient units is unclear. This survey is in line with findings from other studies in that a large majority of female in-patients prefer to be in a unit with mixed staff.

This paper assesses the economic impact of a crisis resolution team (CRT) in South London, using data from a prospective controlled trial. Two cohorts of patients were compared. After referral with a psychiatric crisis, the first cohort received existing services and the second cohort had access to input from a CRT. Baseline and follow-up 6-month costs were measured for 181 cases.

At follow-up, mean costs were £1681 less for the post-CRT patients, which was not statistically significant. However, a significant difference of £2189 was observed when patients with any CRT contact were compared with those with none.

The crisis resolution team resulted in lower costs. Such services can thus help to release funds for other forms of care.

To develop a child and adolescent mental health service in a low-income country. This was a collaborative effort involving governmental and non-governmental organisations in the UK and Pakistan, where a training clinic was established.

We assessed and treated 169 children and adolescents. A team of mental health professionals was trained, including one consultant psychiatrist; the consultant psychiatrist is now leading the clinic. Links were further developed with healthcare, social care and educational organisations, as well as efforts made to engage the public in relation to child and adolescent mental health.

Our development highlights a model of research collaboration and service development which may be sustainable in low-income settings. Such initiatives need support from a variety of organisations. There is a need to consider whether there should be a formal funding mechanism to support the Royal College of Psychiatrists Senior Volunteer Programme.