The experience of violence towards members of community mental health teams was explored using a questionnaire. Response rates were 97%. The number of staff experiencing various types of violence was greater than in previous studies. Staff were generally well-informed about the theoretical issues and had sensible attitudes towards the risk of violence. Appropriate training was found to be lacking and other Department of Health and Social Security recommendations were not being followed. These included information about whereabouts of staff, and mechanisms for communication. We recommend that training issues are addressed locally and that safe theory should be translated into safe practice which is regularly monitored.

In this lecture I will ask: is morale poor among doctors? If it is (and let us for a moment assume that it might be), why is it that? If it is worse recently then is the deterioration an inevitable part of the process of rapid change in the National Health Service (NHS)? Is it, on the other hand, remediable?

Two recent developments have served to highlight the contradictory and discriminatory nature of UK mental health legislation, and indeed all ‘mental health’ acts. These are the Court of Appeal ruling in L. v. Bournewood (1997) and the increasing use of coercion in an attempt to alleviate society's fears of the dangers posed by the mentally ill in the community (Holloway, 1996). At the same time, a third development, the proposal for a Mental Incapacity Act, and the consequent Government Green Paper (Lord Chancellor's Department, 1997) Who Decides provides a framework rendering mental health legislation redundant.

Standard approaches to the prevention of suicide have concentrated on the rigorous assessment and management of suicidal risk. Using deliberate self-harm as a specific example, we discuss the relative merits of this ‘high-risk’ strategy and compare it with a population-based preventive strategy. We conclude that a combined approach offers the best hope for reducing the rate of suicide, although it may not fit easily with medical models of care.

Mental health morbidity is perceived as being predominantly urban based. Little is known about the health of the UK's rural residents. This paper summarises existing knowledge of rural health and social indicators. There is a relative dearth of information in this area making the application of urban-based (and biased) factors perhaps unreliable. Some rural areas have levels of deprivation similar to urban areas, even using urban-biased factors, though they encounter specific problems of service provision and accessibility. Currently, there seems to be no valid method of measuring rural deprivation and comparing it with urban deprivation. We highlight this inequality by describing discrepancies in day care provision between urban and rural areas.

The concept of a ‘crisis card’ originated in the voluntary sector as an advocacy tool for use in mental health emergencies. This type of self-help initiative, and variations which include advance planning for mental health crises, are becoming more common, and have received Government and media attention (Brindle, 1993). The Health Committee's Fifth Report to the House of Commons (1993) on ‘Community Supervision Orders' included evidence given by Survivors Speak Out on the use of crisis cards or treatment contracts as an optional alternative to community supervision orders. Survivors Speak Out described how a user, “when in a rational state of mind, can set out in writing (on a crisis card) how they would like to be treated in circumstances when they are not the best judge of their own interests”. The Government's response was to encourage the informal use of crisis cards and the development of best practice and guidance on their use bearing in mind the central role of the user (Department of Health, 1993). They also recommended that ways of amending the law to provide for crisis cards to be legally effective should be examined. The Report of the Inquiry into the Care and Treatment of Christopher Clunis recommended that the Royal College of Psychiatrists should design a card for mentally ill people. This appeared to be a response to the identified need for improved provision of information, communication and liaison across geographical boundaries where necessary (Ritchie et al, 1994).

This study explores the outcome and longer-term sequelae of suffering chronic fatigue syndrome in childhood. Ten such children, ranging from 10 to 16 years of age at diagnosis, were followed up into adulthood, an average of seven years. Most were completely well or markedly improved (seven of nine). Only children fully engaged in therapy made a total recovery. However, respondents felt medical staff did not believe their symptoms and that rehabilitative strategies were unhelpful. No physical or mental illness was subsequently diagnosed to account for the original symptom presentation. Childhood sufferers maintained the same pattern of symptoms as adults. Depressive symptomatology was present in two cases. The overall longer-term prognosis for children suffering chronic fatigue syndrome is good. A successful doctor-patient relationship is essential to improve compliance with management plans.

A questionnaire was completed by 135 of the 161 (83.9%) National Health Service (NHS) trusts who provide specialist health services for people with learning disabilities in England and Wales. From these, cumulative frequencies were calculated to describe the current level of provision of NHS beds. Results vary in different parts of the country, but the majority of NHS trusts provide assessment and treatment admission beds, long-stay beds (including those NHS trusts who have completed their resettlement process) and respite care beds. A half of NHS trusts directly manage NHS day places. The high response to questionnaires indicates the current high level of interest in this issue.

This study reports on how 139 nursing and 42 medical staff in trauma units viewed psychiatric aspects of trauma, their training and the impact of their work upon them. Insufficient attention was paid in their units to the psychiatric aspects of trauma. There were important gaps in staff knowledge relating to the diagnosis and prevalence of post-traumatic stress disorder, and to the use of night sedation. Nearly all staff favoured providing information regarding post-traumatic psychiatric reactions for relatives, but nearly half had reservations about giving such information to patients. Job satisfaction was reported by most, but their emotional and training needs were generally not met.

General practitioners in a south London health authority were sent a questionnaire about their experience and views concerning the treatment of childhood chronic fatigue syndrome. Most thought childhood chronic fatigue syndrome had a significant psychological component, but opinion was divided over referral to a psychiatrist. The involvement of self-help organisations was supported but the place of rest and exercise unclear. The optimum primary care management of childhood chronic fatigue syndrome needs to be established.

A survey of one year's lithium results for a hearth district of 170 000 disclosed unacceptable delays in checking abnormally high values. Only 17% of moderately elevated levels were rechecked within a week. The problem was most marked with patients monitored in general practice, but one particularly high result in a patient monitored in psychiatric out-patients remained unchecked for over three weeks as a result of poor communication between general practitioner and psychiatrist. A trial of an on-the-spot monitoring service using new technology has simplified procedures and reduced to zero the number of results taking over a week to check.