This article describes the principles and structure, staffing and training of an integrated psychotherapy service for the people of West Berkshire and South Oxfordshire (Reading, Henley, Wokingham, Newbury and Didcot) a population of 530 000.

The service is integrated internally as a joint outpatient and therapeutic community service that can provide psychodynamic psychotherapy across a wide range of length, intensity and styles. Externally it is integrated with the general adult psychiatry service, referrers, social services and community mental health teams.

We examined the extent of alcohol misuse among final year medical students and explored their attitudes to their drinking and the drinking of others in order to gain insight into why junior doctors frequently fail to identify alcohol misusers. The questionnaire included AUDIT (Alcohol Use Disorders Investigation Test), personal details and an attitudinal component. Response rate was 92%. Forty-six students (37.8%) scored as alcohol misusers. Teetotallers had a more judgmental attitude towards ‘alcoholism’. Extremes of drinking behaviour among students may affect later patient care.

The aim was to find out if professions differed in their contributions to the workload of two multi-professional community mental health teams. Both teams aimed to provide community mental health care in London, targeting those with severe mental illness and using the care programme approach. Junior psychiatrists had fewer contacts than other professionals but medical staff tended to contribute more to assessments. Community mental health nurses tended to have the most contacts. Community mental health team planners should be aware of inter-professional differences when designing teams.

Group psychotherapy for adults reporting childhood sexual abuse is a well recognised form of treatment but little attention has been given to the possible adverse effects. This paper reports on three patients seen within a NHS trust department of psychotherapy who had taken part in an incest ‘survivor group’. They described individual satisfaction with their improvement but appeared, when viewed externally, to have deteriorated.

Constant observation is used in psychiatric practice mainly to prevent acutely III in-patients from self-harm. All in-patients in a psychiatric hospital and a general hospital psychiatric unit who had been on constant observation over a 6 month period were identified (13 patients). These patients and their primary nurses were interviewed using different questionnaires. Most patients felt they had benefited from being on constant observation, but disliked the intrusion on their privacy. The nurses agreed that it had helped most patients, but a significant number of nurses found it frustrating and stressful. Our results suggest a need for an information sheet to be given to patients placed on constant observation; that the period on constant observation should be reduced where possible, and that support should be provided for the nurses involved.

In the light of recently published Royal College of Psychiatrists' guidelines on the use of high dose antipsychotic medication, electrocardiographic and blood investigations were performed on 11 patients with learning disabilities receiving such treatment. All patients had normal electrocardiograms (ECGs). Four patients had asymptomatic low white cell counts and mild anaemia was detected in three individuals. Three patients were hyponatraemic; liver function tests were essentially normal. Issues around routine monitoring of such patients are discussed.

The Mental Health Act as an instrument of statute law is unable to address practicalities of caring for mentally disturbed persons who are awaiting formal detention. The common law relevant to this area is ill-defined and depends on interpretation of precedent. The resulting confusion and consequent problems will become more apparent with the advancement of community care, and is a matter which warrants urgent review.

Across the UK counselling and support services are being developed as an extension of emergency planning for major incidents, with the aim of offering psychological help in the immediate aftermath of a disaster. In Strathclyde, Social Work and Mental Health Services Jointly established Liaison Teams with the task of planning and preparing for a major incident. We describe the response of a Liaison Team to a serious bus accident and present reflections from a psychodynamic perspective on some of the factors which may bear on planning and delivery of services.

The Royal College of Psychiatrists launched a five year campaign in 1992 to better inform health practitioners and the public about depression. A questionnaire survey of Sheffield general practitoners (GPs) to assess the impact of the Defeat Depression Campaign on their knowledge and clinical management of depression was carried out in May 1994, half way through the campaign. Overall, 75% of GPs who responded indicated that the Defeat Depression Campaign had had little or no impact on their clinical practice. It would appear that at its mid-point the Defeat Depression Campaign failed to achieve its main goals in relation to educating GPs about depression and its management.

The aim was to examine the impression that both general practitioners and psychiatrists have a low level of awareness and knowledge of the Edinburgh Postnatal Depression Scale (EPDS), have little experience in its use, and would not feel confident in giving advice on issues arising from its use by health visitors.

This paper reports the results of a postal survey conducted to ascertain the views of general practitioners on the service provided by a newly established community mental health team for the elderly. The possible implications of GP fundholding for specialist provision of mental health services are discussed.

It is unusual for an exhibition of unknown artists to open with critical acclaim and draw crowds to a major gallery. What is more remarkable is that few of the artists received formal tuition, none belonged to a movement or painted commercially and they did not expect their work to be seen by an audience. The artists were mentally ill people residing in asylums throughout Europe whose work was collected between 1918 and 1921 by the German psychiatrist and art historian Hans Prinzhorn (1886–1933).

The high rate of non-attendance for first appointments at psychiatric clinics is wasteful of health service resources. Previous studies have demonstrated reductions in the non-attendance rates when referred patients were asked to contact the clinic to confirm that they wished to be seen before an appointment was sent. The effect of introducing such a process to a community based alcohol service was investigated. Results showed that although there was a reduction in the non-attendance rate, the overall effect was to discourage patients from attending the clinic, resulting in a large reduction in the proportion of all referrals seen. Alternative approaches are discussed.

The risk of suicide pervades much of day-to-day clinical practice. Effective management encompasses its recognition, evaluation of severity, and the use of techniques which reduce it to an acceptable level during treatment of the condition which it complicates.

Frameworks within which services are delivered to people with mental health problems neglect the specific needs of those with dependent children. These children have been identified as having risks to their development and well-being. A system of monitoring social assessments of mental health crisis is used to examine the characteristics of parents assessed in seven Local Authorities across 3 calendar years. Parents of dependent children are underrepresented, and are more likely to be women and to suffer from affective psychosis. Ethnic minorities are over-represented. Parents are less likely to be detained following assessment. Further work is needed to establish whether the needs of the family as a whole are addressed.

Parasuicide referrals and subsequent transfers to psychiatric in-patient care were recorded for January to April, 1972 to 1996. Information regarding the psychiatric outcome of transfers for the years 1985, 1990 and 1994 was obtained by case note review. Parasuicide referrals show a decline from 1972 to 1990 but they have more than doubled since then. Referrals transferred to in-patient psychiatric care fell from 10.7 to 2.8% during 1985 to 1994. Fewer patients with acute stress reaction, adjustment disorder, personality disorder and substance misuse are being transferred. Transfers of patients with ‘severe mental illness' have remained constant.

For many years, doctors in the staff grades, clinical assistants and associate specialists have made a substantial contribution to the care of psychiatric patients in the NHS but their position within the NHS and the College has been largely unrecognised. This article will describe recent attempts to remedy this situation. Numerically they comprise an important group of doctors (Table 1) and have always been more important in psychiatry than in other specialities, particularly in non-teaching districts where there are fewer consultants and junior doctors.

A client held record for patients with long-term mental illness was introduced by a community mental health team in east London. The record was evaluated by asking the opinions of 45 patients and examining how their client record had been used. Over 80% of the patients found the record and the information it contained useful, 74% of contacts were recorded in the booklet and the client held record had begun to be used by many professionals for purposes other than appointments and medication. A client held record can increase patient involvement in care and help communication between professionals.

A review of standard texts used by trainees reveals a wealth of differences in the description of primary delusions. The views of 52 consultants and trainees were obtained regarding the various descriptions present in textbooks. This demonstrated a high degree of disagreement between clinicians as to which description most clearly matched their own view. A scheme for the classification and description of primary delusions is suggested.

The responses of somatisation disorder (SD) patients to reading their main clinical summary were compared with those of general psychiatric patients, to assess whether the sharing of information and psychiatic opinion might help in the management of SD. Overall the SD patients responded favourably on 8 out of 11 measures; 28 of the 30 (93%) thought it was a good idea to have read the summary and 26 (87%) thought it had provided helpful information. Significantly more of the SD patients (57% compared with 27% of the general psychiatric patients) had their concerns about undiagnosed illness increase as a result of reading their clinical summary.