To assess safe practice in psychiatry and self-perceptions of safety among trainees (Senior House Officers (SHOs) and Specialist Registrars (SpRs)) and consultants, a questionnaire was sent out to all general adult and old age psychiatrists, including trainees, in a teaching hospital and a district general hospital in East Anglia.

A total of 29 SHOs, 11 SpRs and 27 consultants were approached (response rate 92%). In the past year 69% SHOs, 45% SpRs and 11% consultants attended breakaway training. Interview rooms were frequently below the Royal College of Psychiatrists' standards; 87% of the rooms did not have a panic button and 62% were isolated. Most doctors had felt threatened over the past 6 months but only 31% carried a personal alarm. Despite similar frequencies of assaults, consultants felt safer at work than trainees.

Safety is important for doctors throughout their careers and should be regularly reviewed by individuals as well as audited by hospital trusts.

An audit of clients in specialist and shared care services was undertaken in 2003 and in 2005 to investigate the capacity, quality of prescribed medication and profile of clients, and to assess the impact of the new General Medical Services contract on drug misuse treatment.

Capacity in specialist services increased by 55% from 2003 to 2005, but not in shared care, and type and dosage of prescribed medication improved for shared care. Profile of clients suggests that stable clients are treated within shared care.

Attention should be given in training general practitioners to provide shared care treatment, increasing the number of clients accepted in shared care, and considering new treatment models.

To collate referrers' views on primary consultations in child psychiatry, feedback data were collected by questionnaires over a 12-month period.

Referrers found reports clearly written, informative and helpful, but wished for further, more direct involvement, support and follow up, and also for a clear plan of action for the children referred.

Primary consultation clinics should be further developed and audited in the future, in view of the recent changes in child and adolescent mental health services.

NHS Direct is increasingly used as a first source of health advice and information, receiving an average of 600 000 calls per month. We performed an audit of suicides in Hampshire and the Isle of Wight over a 2-year period to determine the characteristics of those who died by suicide and had been in recent contact with NHS Direct.

Of 278 suicides resident in Hampshire and the Isle of Wight, 30 (10.8%) had contacted NHS Direct in the preceding year. Of the 30 callers within the preceding year, 12 (40%) made multiple calls, 7 (23%) called within 2 weeks of death, 9 (30%) callers reported mental health problems, 17 (57%) reported physical problems, and 4 (13%) just requested information. Eighteen (60%) calls resulted in urgent medical referral, 17 to a general practitioner and 1 to accident and emergency.

The high incidence of physical, often pain-related, problems merits further investigation.

To evaluate a new integrated weight management and fitness service for long-stay psychiatric patients who were obese or overweight with physical health risks. Body size and fitness were measured before and after each 10- to 12-week programme.

The number of patients referred to the programme was 145; 102 were accepted, 95 started a programme and 46 completed it. Analysis was by intention-to-treat. There were significant reductions in weight (P=0.001), body mass index (BMI, P=0.001) and waist size (P=0.001), and considerable improvements in hand strength (left hand, P=0.03; right hand, P=0.015), flexibility (P=0.022), lung function (P=0.001) and aerobic capacity (P=0.001).

An integrated programme of weight management and fitness is effective in reducing body weight and waist size, and in improving physical fitness in long-stay psychiatric patients. The long-term effect on patient's health and fitness needs to be monitored and strategies are needed to reduce patient withdrawal.

To describe patient characteristics and clinical activities at a British military department of community mental health (DCMH). Data were drawn from a clinical database over a 1-year period (n=409).

Mean age was 29 years, 50% were single and 76% were from the junior ranks. Women were over-represented compared with the wider military population. Mean length of service prior to presentation was 5 years. The main presenting problem was alcohol misuse (33%) followed by depression (19%). Twenty-five per cent were referred for psychotherapy and 68% returned to full employment after treatment.

Patient characteristics of those treated at a DCMH differ from those in the wider military. An out-patient occupational mental health service returns a substantial number of patients to occupational fitness within the Armed Forces.

Antipsychotic prescriptions were analysed for a large sample of psychiatric in-patients and out-patients in Hong Kong. Case notes for patients receiving high doses were reviewed and compared with the most recent consensus statement issued by the Royal College of Psychiatrists.

Demographic and prescription data were obtained from 1254 in-patients and 19 986 out-patients. Antipsychotic medications were prescribed to 1129 in-patients and 7520 out-patients, with 9.2% of in-patients and 1.8% of out-patients receiving a high dose. Almost all case notes failed to record the clinical indications for high-dose prescribing or that the patient had been informed. Electrocardiograms were performed in a very small proportion of patients receiving a high dose.

Low levels of adherence to established guidelines for high-dose antipsychotic prescription were found in this study, with clinical and medico-legal implications. The results of this study highlight the need for staff education and regular audit of antipsychotic doses in the in-patient and out-patient setting.

Psychiatrists are expected to follow guidelines in relation to patients' responsibilities regarding driving. In this study we reviewed advice on driving recorded for patients discharged from hospital following an acute psychotic episode. Guidelines on appropriate advice were then sent to all medical staff looking after in-patients.

The first cycle of the audit included 48 patients. No advice was recorded. The second cycle included 70 patients. Advice was recorded for 8 patients. Six of these patients received a standard discharge letter with a prompt for ‘driving advice’.

In contrast to current guidelines, advice regarding driving is not routinely given to patients with an acute psychotic episode. A standard discharge letter with prompts on driving may improve adherence to guidelines.