This paper describes the development and initial audit of a protocol for the assessment of young people up to the age of 18 years who presented to the accident and emergency department (A&E) with self-harm. A key part of the project was education and training.

Regular training of senior house officers (SHOs) in A&E may have contributed to an increase in young people being admitted to a bed for proper assessment (as per the protocol), but psychosocial assessments undertaken by SHOs in A&E were still only partial, and there was no apparent use of the mental state examination.

Child and adolescent mental health services have an important role to play in liaising with local A&E departments in training of junior staff in psychosocial assessment and the use of the mental state examination. This is especially relevant in the light of the new training requirements of the foundation years.

The recent Medical Training Application System (MTAS) has been fraught with problems. A survey of MTAS applicants from two London training schemes and a request for emails from trainees and trainers documenting problems with the system were undertaken with the aim of canvassing the views of candidates and shortlisters/interviewers about MTAS, and providing evidence of the system's failings.

A total of 101 candidates responded to the survey, and the first 92 emails sent to the Royal College of Psychiatrists were analysed. The majority of respondents (73%) were dissatisfied with MTAS and 63% thought the system unfair. UK and European Economic Area (EEA) applicants (71%) were more successful in being shortlisted than non-EEA candidates (48%). The majority of applicants (70%) planned to reapply in subsequent rounds if they failed to secure a training post.

Both surveys showed clearly that the system was not working well. The trainees and trainers both felt that the system was flawed and that the reasons for the failure included a centralised system without any piloting, and the question design. In addition a lack of resources added to the stress and burden on both trainees and trainers.

To assess the effect of factsheets from the Royal College of Psychiatrists' Changing Minds campaign on stigmatised attitudes of members of the general public towards those with mental illness. Participants were recruited at random from a panel of over 1200 members of the general population and presented with questionnaires containing single-page factsheets adapted from the Changing Minds campaign describing schizophrenia or substance use disorders. The Attitudes to Mental Illness Questionnaire (AMIQ) was used to measure the effect on stigmatised attitudes.

In total 200 questionnaires were distributed; 158 completed questionnaires were received (response rate 79%). The AMIQ scores for the alcoholism and schizophrenia vignettes did not differ between experimental and control groups. Fidelity questions included in the questionnaire indicated that participants had read and understood the factsheets.

Didactic factsheets produced for the Changing Minds campaign were largely ineffective at changing stigmatised attitudes towards schizophrenia and alcoholism.

The drug treatment and testing order (DTTO) is a treatment option imposed by courts and the first multi-agency initiative in the treatment of substance misuse in the UK. We used separate focus groups for service users and staff involved with DTTOs in Hertfordshire to qualitatively investigate their experiences of the orders. Interviews were recorded and analysed using grounded theory methods.

Analysis highlighted areas of concern related to the central issue of forced treatment, which was more challenging for staff than for service users. The area of most concern was multiagency collaboration.

Multi-agency initiatives require extensive liaison across agencies.

To find out why consultant psychiatrists chose psychiatry as a career. A questionnaire was developed and posted to 87 consultant psychiatrists in substantive posts within a London psychiatric training scheme.

The survey had a response rate of 83% (72 out of 87). The majority of consultants (n=40) chose psychiatry as a career after leaving medical school. The most important reasons cited were empathy with the patient group (36.1%), the interface of psychiatry with the neurosciences (25%), the better working conditions expected in psychiatry (20.8%) and medical school teaching of the subject (19.4%).

The study highlights the need for recruitment efforts after medical school. The findings also reflect the lasting influence of medical school exposure to psychiatry. Interventions for improving recruitment in psychiatry are suggested. The under-recruitment of British medical graduates is masked by overseas recruitment into the specialty.

Psychiatric senior house officers currently receive little formal training in how to give testimony at mental health review tribunals. The development of a simulated tribunal workshop for trainees, which is group-based, interactive and experiential in nature, with meaningful user and carer input is described.

We have incorporated simulated mental health review tribunal workshops into our academic programme and these have been successfully evaluated. Feedback has shown a marked increase in the confidence levels of trainees regarding tribunals.

The new Mental Health Act (England and Wales) is likely to place increasing demands on psychiatrists, in terms of giving testimony at mental health review tribunals. Simulated training for senior house officers, incorporating user and carer perspectives, can improve their skills and confidence in presenting at actual tribunals.

Core features of New Ways of Working include concentrating on service users with complex needs, acting in a consultative role and carrying out interventions that are timely rather than routine. In this service-mapping exercise a retrospective analysis of 150 case notes was performed to evaluate clinical activity in general adult out-patient clinics and to attempt to measure the complexity of the workload.

Analysis of care programme approach (CPA) level revealed that 40% of patients were not on CPA and 16% of patients were on enhanced CPA. Only a third of the sample had a non-medical care coordinator. Absolutely no changes were made to the management plan in around half of the sample. A minority of patients needed to be seen acutely, within a month, or had their appointment brought forward.

Current out-patient activity of consultant teams does not appear to be consistent with New Ways of Working. Psychiatrists will be required to reflect on their roles in out-patient clinics to avoid ‘routine’ appointments and to use their time more efficiently.