The difficulty in achieving good quality community mental health care for homeless people has received increasing attention during the last few years. Less consideration has been given to the provision of inpatient care. By comparing data collected before and after its inception, we examined the impact of a specialist community mental health team for homeless people on ‘no fixed abode’ admissions in Birmingham. Although the team was successfully involved in the admission and discharge process in a substantial proportion of cases, many admissions still took place out of hours and involved the police, while discharge was often against medical advice and occurred without follow-up. These findings and their implications for the provision of homeless services are discussed.

The roles of community mental health professionals may overlap and need clarifying. A survey is described of 95 occupational therapists (OT) and 200 community psychiatric nurses (CPN), of their views on their respective roles, and information on current practices. Administering medication and crisis intervention were regarded as specifically CPN roles, yet 26% of CPNs did not regularly administer medication. Half of the CPNs' clients were not chronically mentally ill, and over two-thirds of the nurses regularly carried out counselling and anxiety management. Assessing activities of daily living and work skills were seen specifically as OT tasks, yet 60% of the OTs did not usually assess work skills in practice. Roles overlapped considerably, suggesting that a more efficient approach might be to develop a generic core training for community mental health workers.

Owing to the large and increasing number of vacant consultant posts in psychiatry, and the suspicion that premature retirement was an important cause of this problem, a questionnaire was sent to all consultants who were believed to have retired from their National Health Service (NHS) posts before their 65th birthday during 1995 or 1996. One hundred and forty-two (82%) of 173 questionnaires were returned. Responses to these Indicated that disenchantment with some aspect of the previous Conservative Government's ‘NHS Reforms' was a more important reason for retirement than ill health, a wish to devote more time to other interests, or even bed closures. Increasing bureaucracy and paperwork was a key factor for many.

This study examined the impact of caring on women who were primary care-givers to those with schizophrenia. From the 46 women and 21 men carers assessed for the study, women were considered primary care-givers more often than men (83% v. 57%). Higher levels of burden among women primary carers were associated with living with patients, and more hours in contact with them. Worse perception of patients' social functioning was associated with higher levels of burden. The findings of the study showed that women primary carers have particular needs, and services should consider how to provide support for them in their multiple roles, and over longer periods of time.

Ensuring clinically effective practice and service models is now a major challenge for the National Health Service. It requires a clear focus on the purpose of healthcare provision – care which is most likely to result in the best possible individual or population outcomes within existing resources.

Questionnaire data are presented from a national multi-professional survey. Only 12% of respondents had local quantitative data on adults with learning disabilties (LD) and mental health needs (MHN). More described local provision as part of specialist LD services than integrated with generic mental health services. LD services were rated as more accessible and more available than generic mental health services. Clinicians agreed about the important elements of psychiatric assessment, treatment and their preference for using the ICD–9 and ICD–10 diagnostic classifications. The planning, delivery and evaluation implications for psychiatric services for adults with LD are outlined.

The management of young offenders by specialist psychiatric adolescent forensic services is currently the subject of considerable debate at the Royal College of Psychiatrists and at the Department of Health. It is important to know what has been done in dealing with this very important group of vulnerable young people. This study aims to delineate how medium secure units become involved with this group and what happens to them.

The use of metaphors as the main marketing strategy in psychotropic drug advertising in journals and the quality of information provided in these advertisements has been criticised. We investigated marketing strategies and information provision in advertisements appearing in three different psychiatric journals. The majority of advertisements in two of the journals used metaphors as their main marketing strategy. The level of prescribing information varied between journals. Our findings suggest that improvements are needed in psychotropic drug advertising in journals.

There appear to be more posts being advertised for consultants in psychiatry than available suitably qualified applicants. The process of advertising, contacting interested candidates and compiling an information pack is reviewed in an attempt to formulate an ‘ideal approach’.

Increasing referrals to psychiatric clinics, combined with restricted medical manpower, require innovative ways of meeting the demands. We appointed a nurse to help in an out-patient clinic. The nurse recorded new patients' case histories and presented them to the consultant, who could then see the patients in less time. In the first 15 months the clinic saw 260 new patients, compared with 190 in the previous period. The median waiting time for appointments came down from 32.5 to 22.5 days (P=0.018). Patients reported a high level of satisfaction with seeing a nurse and a doctor.

The Oxford University Department of Psychiatry was founded in 1969 during a period in which new psychiatry departments were being established in most undergraduate medical schools. It was the realisation of plans that had been formulated over at least 10 years by local psychiatrists and by leading members of the Clinical School, most notably by Sir George Pickering, the first clinically active Regius Professor since Osier.

Most clinicians understand the advantages of basing their practice on the best available evidence, but sometimes doubts are voiced about the feasibility of applying the strategies of evidence-based medicine (EBM) in everyday clinical practice. This article describes one strategy for beginning to use EBM in ‘real-time’ which could already be used by the majority of clinicians. The rapid developments in clinical informatics are likely to enhance the feasibility and value of this strategy.

The legal and moral status of the concept of consent are examined. The notion of informed consent as the sole basis for acceptable treatment is found to raise moral difficulties and to have potentially damaging side-effects on the relationship between doctors and patients. It is argued that developing trust between doctor and patient is crucial to obtaining valid consent.