To audit completion of the Treatment Outcome Profile (TOP) form in individuals attending substance misuse services in England. Forms are completed at the start of treatment and every 3 months thereafter. All forms at 3-drug treatment services were inspected over 6 months.

RESULTS

Forms were inspected for 200 service users; 86% were fully completed. Two-thirds (67%) of service users had no declared funding for illicit drug use in the previous month (mean spending £988; s.e. = 149) despite denying any paid employment and criminal activity.

CLINICAL IMPLICATIONS

The section on crime in the TOP form is unreliable and completely invalid.

Reaching into the community to treat people with anxiety and depressive disorders raises the spectre of wrongful use of scarce resources at best, and of disease mongering at worst. We recruited for an internet-based treatment for social phobia.

RESULTS

Applications were received from 789 people, and 205 were rejected because of severe depression or suicidal thoughts. Many were excluded because they had another disorder or were in treatment. Some dropped out, only 7 were subthreshold cases and 291 people with social phobia were treated.

CLINICAL IMPLICATIONS

Despite easy access to clinicians, the burden of untreated serious mental disorder in the community remains considerable.

To describe a group of prisoners who required transfer to mental health units from two London prisons. Data were collected from prison clinical records.

RESULTS

Overall, 149 patient-prisoners were transferred over a 17-month period. Around a quarter were not previously known to services. The aggregate wait was 36.5 years (averaging between 93 and 102 days per prisoner) and the total saving to the National Health Service (NHS) has been estimated at £6.759 million.

CLINICAL IMPLICATIONS

Both prisons manage a large number of prisoners with untreated psychosis. While in prison, they save the NHS considerable sums of money, but transfer delays prevent timely treatment and could now be legally challenged.

A questionnaire was distributed to consultants with a special interest in electroconvulsive therapy (ECT) at clinics participating in an ECT accreditation process. This aimed to ascertain a consensus of clinical practice regarding informing patients about the treatment and assessment of memory during ECT.

RESULTS

The response rate was 64%. There is consensus on informing patients about the possibility of permanent memory loss. Memory is assessed before and during an ECT course by clinical interview and Mini-Mental State Examination, but rarely at long-term follow-up.

CLINICAL IMPLICATIONS

Patients need to be informed about the possibility of permanent memory loss before consenting to ECT. Clinical teams need to make greater efforts to assess memory, particularly after this treatment.

Assaults in healthcare settings have resulted in a range of national strategies aimed at reducing the incidence of violence. This study aimed to quantify the use of prosecution of assailants as a response, and to examine what other responses were used. The responses to violent incidents in three Northern Ireland psychiatric in-patient units in the year 2003 were ascertained retrospectively.

RESULTS

Of 245 incidents meeting the legal definition of assault, police were contacted in 10, and 1 resulted in a prosecution. Seven in-patients accounted for 30.4% of assaults. Of the assaults, 46.5% were dealt with by staff using de-escalation alone.

CLINICAL IMPLICATIONS

These results demonstrate the infrequent reporting of such assaults to the police. A more structured approach should be taken to this important decision. Factors relating to the prosecution of assaults in psychiatric in-patient units are discussed.

To explore the impact of diagnosis on people who experience psychosis. Eight participants were interviewed about the impact that diagnosis had on them.

RESULTS

The research found that the impact of diagnosis can involve both positive and negative elements. It can be a ‘means of access’ as well as a ‘cause of disempowerment’. It can help by ‘naming the problem’ and hinder by ‘labelling the person’. It is a ‘cause of social exclusion’ for all, but despite this service users can be successful in ‘achieving social inclusion’.

CLINICAL IMPLICATIONS

The findings have implications for how diagnosis is imparted by psychiatrists if they are to help to facilitate recovery and social inclusion.

The epidemiology of self-harm in older people is poorly understood and a low incidence rate hampers research efforts. Regional surveillance for this may assist with research and improve clinical services accordingly. This study involved undertaking a scoping exercise to explore current management of self-harm in elderly people in selected North London hospitals, by interviewing healthcare professionals directly involved in their treatment.

RESULTS

The study showed varied methods of coding clinical information across trusts, with no consistent method of surveillance.

CLINICAL IMPLICATIONS

Implications of this exercise involve generation of a summary document that will educate stage two of the project, which is the convention of a working party to implement a surveillance system across the region.

We carried out a web-based survey to establish the proportion of London psychiatry senior house officers who undertake personal psychotherapy. Demographics, training characteristics and psychotherapy experience were examined using descriptive statistics. Predictors of personal psychotherapy status were examined using logistic regression.

RESULTS

The majority of trainees who undertook personal psychotherapy included training as a reason for doing so. Of the participants,16% had undergone personal psychotherapy and of the remainder, 73% reported that they would consider it in the future. Ethnicity was the only predictor of psychotherapy status, with White British trainees nearly four times more likely to pursue it.

CLINICAL IMPLICATIONS

Personal psychotherapy appeared to have relevance to training from both a pastoral and a learning perspective. If training schemes wish to support this practice they will need to address difficulties trainees may face in accessing therapy. Trainees might also be encouraged to think about the effect of cultural factors on their attitudes towards psychological therapies.