bluuebunny/crossref_metadata_2025 huggingface dataset:
East-Anglian trainees' day
Authors: Hunt Neil , Prior Nigel , Vize Christine
Published: May 2008

The East-Anglian CTC Trainees' Day was held at Friern Hospital, London, on 14 December 1989. The programme comprised a morning session with two speakers and lunch sponsored by Duphar, followed by an open forum on CTC training issues and an address by the final speaker. Approximately 30 trainees attended, mostly SHOs and registrars. Professor A. Wakeling, chairman of the East-Anglian Division of the Royal College, was present and took the opportunity to meet trainees from the region.
Adolescent substance use: a two year population follow-up
Authors: Swadi Harith
Published: May 2008

Exactly two years after a large survey of substance use among secondary school adolescents in London in 1987 (Swadi, 1988), a similar survey among a sub-sample using the same questionnaire was carried out. Of 242 second- and third-year pupils from one of the six schools in the original sample, 219 were available for the follow-up. In 1989 they were in the fourth and fifth years; the sexes were equally represented. The follow-up survey aimed to investigate the trends with respect to the prevalence of use of various drugs and to investigate the effect of the absence of a specific drug-prevention programme on such trends. Comparisons are also made with survey results from the fourth and fifth year at the same school in 1987.
Monitoring the standards of care in the hospital setting
Authors: Johnston S. J.
Published: May 2008

The way in which doctors practise medically undoubtedly has effects on the ways in which other staff, the nurse, occupational therapist, physiotherapist etc. are able to practise, just as their style affects the doctor. But all share the common aim of providing the best possible care for their patients. Changing service provisions have affected mental handicap services more than most. It is crucial at a time of great change within health service systems that good medical practices evolved over many years experience are not lost or neglected by changing philosophies or care models. Medical aspects of care of the mentally handicapped person which evolved in hospitals should be flexible enough to be used in the settings used by any district. Medical standards of care must be maintained and improved despite changes to the service.
A support group for women psychiatrists
Authors: Bernal Jane , Seltzer Abigail , Harvey Carol , Livingstone Jill , Carrick Janet , Dalton Joy
Published: May 2008

We were members of a support group for women psychiatrists which we found rewarding and which stimulated us to question many assumptions. We describe our experiences in the hope that trainees and consultants alike will consider the potential of similar groups in their own working lives.
Blacks and psychiatry: a framework for understanding access to psychiatric services
Authors: Moodley Parimala , Perkins Rachel E.
Published: May 2008

In efforts to improve the acceptability of psychiatric services and their ease of access, the issue of how people get psychiatric help when they need it is one of growing concern. There is now increasing evidence that psychiatric services operate differently for black and white people in Britain, and much concern that services may differentially disadvantage blacks (Francis et al, 1989).
Can we rehabilitate everyone?
Authors: Atkin Tim , Meats Philip , Sincock Caroline
Published: May 2008

There is an increasing momentum for the provision of care for people with chronic mental illness to be made in settings other than mental hospitals. One concern arising from this shift in emphasis is with those patients who may find it particularly difficult to live in the community.
The Cassel saved
Authors: Ramsay Rosalind
Published: May 2008

In-patient psychotherapy at the Cassel Hospital will continue at least for the time being. Early last year, however, its future was in doubt. In January, the managing health authority, Riverside, faced an annual spending deficit of £6.7 million. The hospital costs £1.25 million to run each year; in February, district management recommended closure of the 70 year old Cassel as the top item on their proposed shortlist of economy measures.
A tentative start: evaluation of alternative forms of care for chronic users of psychiatric services
Authors: Colgan Stephen , Bridges Keith , Brown Langley , Faragher Brian
Published: May 2008

In the past decade there has been a rapid diversification of services provided for patients with chronic psychiatric illnesses. Although these services are thought to be beneficial for those who use them, there has been little in the way of objective evaluation. As new services begin to compete for the limited resources available, it has been recommended that they should demonstrate their effectiveness. This paper reports a small pilot study on the value of an arts based service known as START (Bridges & Brown, 1989) which won a BBC ‘It's My City’ competition in 1989. It has been a popular component of the rehabilitation services of the Department of Psychiatry, Manchester Royal Infirmary since its inception in 1986.
Serendipity in psychiatric sub-specialty selection and training
Authors: Parry-Jones William
Published: May 2008

The word serendipity has its origins in a fairy-tale about ‘The Three Princes of Serendip’, the latter being the former name for Ceylon. The heroes of this fairy-tale were always making discoveries, by accident and sagacity, of things they were not in search of. The earliest use of this term was by Horace Walpole, the essayist, who coined it in a letter of 1754. Later, he wrote a little fairy comedy on this theme, which was produced successfully at the Haymarket Theatre, London. The term means, therefore, the gift of being able to make delightful discoveries by pure accident and this is why it is used sometimes as the name for an antique shop or a second-hand clothes store. It is likely that most people could give examples of serendipitous incidents in their lives and the purpose of invoking the concept of serendipity in relation to sub-specialty selection by trainees is concerned with the possibility that chance can be a major determinant of outcome in this process. This issue is related to wider concern that the optimum methods for the well-informed recruitment of trainees into the sub-specialties and special interest areas in psychiatry have not yet been organised satisfactorily.
Medication compliance and dispensing among psychogeriatric patients
Authors: Ballard C. G. , Mohan R. N. C. , Handy S. , Dodwell D.
Published: May 2008

Compliance with medication regimes is fundamental to successful treatment and hence familiarity with factors influencing the level of patient compliance is essential. In relation to the psychogeriatric population poor compliance is a major and worrying problem largely neglected by researchers.
Facilitating moves into the community: a new mental health services initiative
Authors: Ramsay Rosalind
Published: May 2008

Stephen Dorrell, the government Health Minister, has criticised the current “gross misallocation” of resources for patients with mental illness. The Department of Health estimates that more than half the district health authorities' budget of £1.5 billion for mental health services is still being channelled into the 90 remaining large specialist mental hospitals. There are now only 40,000 patients in such institutions. However, according to government calculations, a total of 2¼ million people in this country have a mental illness which is “serious enough” for them to need consultant psychiatrist care. All those sufferers from mental illness living in the community must make do with the remaining DHA budget. In other words, 98% of the mentally ill are supported by less than half the total resources allocated by districts for mental health services.
Alprazolam and panic disorder
Authors: Healy David
Published: May 2008

In May 1988, the greater part of an issue of Archives of General Psychiatry was given over to reports of the results of a clinical trial of alprazolam for panic disorder. More recently, in March 1991, supplement no 365, of Acta Psychiatrica Scandinavica (APS) was devoted to a further trial of alprazolam for panic disorder. Few other psychotropic compounds have received such concentrated coverage. What, if anything, emerges from the studies reported?
Chelmsford and its aftermath
Authors: Ellard John
Published: May 2008

In mid-1963, Dr Harry Richard Bailey admitted a patient to Chelmsford, a small private hospital in a north-western suburb of Sydney. Between then and April 1979 he, and subsequently a handful of associates, treated a large number of patients with deep sedation, often combined with ECT. The patients' diagnoses included schizophrenia, bipolar disorder, alcoholism, and drug addiction; nothing suggests that the diagnosis and the treatment had any particular connection. Records exist for some 1,100 patients, 24 of whom died as a consequence of the treatment; 16 of them were under the age of 50. Others suffered brain damage, convulsions, delirium, pneumonia, hallucinations, cardiac irregularities, abscesses, urinary tract infections, fractures, and other complications.
A decade of psychiatric audit in Southampton
Authors: Edwards J. Guy
Published: May 2008

In Southampton we have been carrying out audit that conforms to the Government's definition in the White Paper Working for Patients (1989) for over a decade. During the last six years the results of the audit have been presented in regular meetings, while the specific projects on procedures used for diagnosis and treatment, the use of resources and outcome that we have undertaken date back much longer than this.
Mental illness in the family: an experiment in medical student teaching
Authors: McFadyen Anne
Published: May 2008

In 1987, 38% of Royal Free medical students answered the question “How could the child psychiatry course be improved?” by asking for “more”-in particular, they wanted more “hands on” experience.
A cat, surpassing in beauty, and other therapeutic animals
Authors: Allderidge Patricia H.
Published: May 2008

In 1860 the Illustrated London News published an engraving of a male ward in Bethlem Hospital, in which two slightly wary looking whippets or small greyhounds are wandering among the patients, while one of them keeps a watchful eye on a smug cat seated beside the chair of a chess player. At intervals along the walls are birdcages and goldfish bowls, all with their appropriate occupants. Another engraving shows a female ward, where similar cages and bowls can be seen hanging between the windows, though the free-range livestock is absent. Each room is also furnished with a huge aviary reaching from floor to ceiling.
The 6th Prague International Conference on Child Development and Personality Formative Processes
Authors: Worrall Anne
Published: May 2008

When the 6th Prague International Conference was announced in September 1989, the organisers can have had little idea that within two months the communist regime in Czechoslovakia would collapse and the Berlin wall be breached. The conference was postponed until August 1991. That week the failed Soviet coup led to the disbandment of the USSR as such. It was an exciting time to visit Prague. It was a disconcerting time too, I was still not sure whether my contribution was meant to be a poster or a paper. Writing received no response, fax machines were unavailable, phoning at first resulted in repeated Sprechen Sie Deutsch? but eventually in an assurance that my accommodation had been booked So I arrived as Rusyne airport with a paper and a poster, having ascertained during the journey that delegates to two other unrelated conferences in Prague had had similar experiences!
Mental health services and resources
Authors: Blom-Cooper Louis , Murphy Elaine
Published: May 2008

Of the very large sum of money spent on mental health services, almost all comes from the public directly in the form of central or local government taxation. In 1990, approximately £2 billion was spent in the National Health Service directly on mental health services. That represents 10% of total health service expenditure. In addition, local authority social services departments spend around £50 million annually on residential and day care services for people with mental problems. A further £100 million is spent on supplementary benefit for board and lodgings payments and a considerable amount expended by prisons, courts and the police. These figures omit the growing amount of money spent on supporting elderly people with senile dementia outside mental illness hospitals, in residential and nursing homes. Almost two thirds of all residential care for elderly people provide care for those with mental disorder, adding a further staggering £5–600 million by 1990. The current direct care costs of disabling mental disorder to the public purse is approximately £3,000 million (£3 billion). For all the huge amount of money, resources appear inadequate, ill-directed and uncoordinated. Several actions need to be taken to improve the use of these vast resources.
Multiple choice examinations and the MRCPsych: “Between guesswork and certainty in psychiatry”
Authors: Race Julian H.
Published: May 2008

More than two decades ago, Aubrey Lewis delivered a visionary Bradshaw lecture to the Royal College of Physicians (Lewis, 1958). The address centred upon the place of scientific method as applied to the art of psychiatry. In his concluding remarks, Lewis emphasised the ardours and perils of guessing. Nowhere is the temptation to guess more clearly illustrated than in multiple choice examinations.
Teaching interview skills to preclinical medical students
Authors: Dawkins Judith L. , Drummond Lynne M.
Published: May 2008

The early years of medical students' experience can clearly be important in shaping their attitudes for the future. Typically pre-clinical students are bombarded with basic science subjects and many express the view that it is difficult to see the relevance of much of their academic study to their ambition of working with people. The Behavioural Science Course which is generally held during the students' second year is one of the few courses which is devoted to the functioning of the whole person in society. Typically, this course includes psychology and medical sociology.
Medicine and the law
Authors: Kellam Alexander M. P.
Published: May 2008

This comment by Diana Brahams, Barrister at Law, is the latest on automatism in her regular series in The Lancet on the Law as it affects medicine. It is a subject to which she has had occasion to return frequently (Brahams, 1983a, 1983b, 1989) as several recent cases have developed the legal concept of automatism to the increasing confusion of many psychiatrists. Automatism has also been thoroughly discussed in a recent monograph in Psychological Medicine by Peter Fenwick (1990) which is to be recommended to anyone having to prepare a report dealing with this problem.
Richard Wagner (1813–1883)
Authors: Jones Mark
Published: May 2008

Mark Jones continues this occasional series by taking a look inside Wagner's tetralogy The Ring of the Nibelung which was first performed complete in 1876 at Wagner's own opera house in Bayreuth.
Parental responsibility
Authors: Kennedy Roger
Published: May 2008

One of the main concepts in the new Children Act (1989) is that of parental responsibility, which will significantly alter the practice of family law and that of mental health professionals dealing with the troubled family. Instead of an assumption that parents have absolute authority over their children, there is the notion of a partnership between parents and children, with the power of the parent decreasing as the child grows in maturity and understanding. There is an emphasis on partnership between parents and those who will have to share in having parental responsibility when it has broken down. Thus the new Act is essentially child centred. It affirms the principle, current in Wardship proceedings, that the child's welfare shall be the court's paramount consideration.
An evaluation of health visitors' and social workers' level of knowledge and satisfaction of a local child and family psychiatric service
Authors: Markantonakis Aristos , Mathai John
Published: May 2008

Although childhood psychiatric disorders are commonly seen in general practice, only a few children in the community gain access to professional help. Whether a child is referred or not depends on various factors to do with the child and family and others, such as what the GP expects from the referral. Severity per se is not the only referral determinant. Whether GPs know what the child psychiatric services in the area have to offer could also be expected to affect referral (Markantonakis & Mathai, 1990). We are aware of the need for general practitioners to be made more aware of the services that we have to offer.
The development of a district based forensic service
Authors: Hayes Gwilym , Soliman Ahmed
Published: May 2008

Recent reports have highlighted the continuing lack of adequate provision for the difficult or offender patient. The move to community care, coupled with the closing of the larger institutions, has put a strain on traditional forensic services. They are being increasingly asked to deal with the difficult, nonoffender (Glancy) patient in addition to their more traditional offender-type (Butler) patient. This paper describes how one unit has developed to serve the needs of Rotherham and neighbouring health authorities. We do this by illustrating the current lack of provision and by describing the types of patient treated over a two year period.
Child protection by child and family guidance workers
Authors: Oliver J. E.
Published: May 2008

In 1990 I saw every member of the Child and Family Guidance Service within the Swindon Health Authority to discuss children from their last (unselected) six or 12 families in relation to child protection issues. All 19 professionals were part-time workers, some only doing three, two, or one sessions per week of child and family guidance work. They were seven psychiatrists (consultants and a senior registrar), two psychologists, six psychiatric social workers (including family therapists), and four specialised therapists (family, child psychotherapy, nurture-group and art). There were 14 female and five male professionals.
Postgraduate training course in the psychiatry of mental handicap
Authors: Kohen Dora
Published: May 2008

Among other things, good medical practice demands continuation of training at every level of professional life. Post-membership psychiatrists who have started their senior registrar (SR) jobs may face a lack of formal training. In many subspecialities of psychiatry this has been extensively remedied by various training courses and programmes.
A retrospective study of charts according to size: implications for management and prevention?
Authors: O'Shea Brian , Falvey Jane
Published: May 2008

In 1975 Sims published his celebrated paper on ‘Factors Predictive of Outcome in Neurosis’ (Sims, 1975). A big chart was associated with a poor prognosis.
Old people and ECT: what difficulties are encountered in obtaining anaesthetics for the elderly?
Authors: Benbow Susan M.
Published: May 2008

Since developing an interest in the use of electroconvulsive therapy (ECT) in late life, I have received correspondence from psychiatrists describing difficulties in obtaining anaesthetics for elderly patients who are perceived as frail or physically unwell. Nevertheless, Pippard & Ellam (1981) found in their survey of the use of ECT in 1980 that 37% of courses were given to people aged 60 years and over. I decided to survey old age psychiatrists' views on ECT, and to look at difficulties encountered in obtaining anaesthetics. Old age psychiatrists specialise in the care of mentally ill elderly people and are dealing with patients who are particularly likely to have physical problems in addition to mental illnesses. Their experience of ECT is therefore of wider relevance to all who prescribe ECT for elderly or physically ill people.
A study of the measurement of changes occurring in long-term psychiatric patients discharged to residential care in the community
Authors: Skinner Adrian E. G. , Williams Christine M.
Published: May 2008

As more health authorities close large psychiatric hospitals the provision of small local facilities in which former residents of such hospitals are housed is increasing. Such houses tend to share many common characteristics dictated both by practical necessity and by deliberate policy – they tend to be large Victorian houses chosen because they have a larger number of bedrooms and they tend to be run in a much less formal manner than hospital wards (Goldberg, 1985).
Audit in two acute psychiatric units
Authors: Dutta A. , Parker R. R. , Fleet T. W.
Published: May 2008

The Royal College of Psychiatrists (1989) has recently produced its own preliminary report on medical audit. It defines medical audit as: “The systematic, critical analysis of the quality of medical care, including the procedures used for diagnosis and treatment, the use of resources and the resulting outcome and quality of life for the patients.” This definition is in essence similar to that of the Royal College of Physicians.
8. Psychotherapy
Authors: Guthrie Elspeth , Black Dawn , Margison Frank
Published: May 2008

The general prospects for consultant posts in psychotherapy are mixed. Despite frequent recommendations, it is not an area which is generally undergoing expansion and the development of posts varies across the country.
A project in re-inforcing the effectiveness of the primary care team in the area of mental health
Authors: Rosen Maria
Published: May 2008

It seems that increasingly patients are being referred to primary care teams and GPs in health centres rather than to psychiatrists in a hospital setting. With the growth in the number of patients being maintained in the community, it is becoming more important to pay attention to this sphere and to aid primary care teams to be clinically effective. It was from this perspective that I became involved as facilitator to a primary care team on a one year project.
Management experience of senior registrars in the West Midlands
Authors: Boodhoo Jean Antoine , Gadd Elaine M.
Published: May 2008

Clinicians, in particular consultants, are and always have been operational managers (Kennedy, 1989). Senior registrars also exercise considerable day to day management responsibility, often without any formal training (Hindle, 1990). Attitudes to management training have changed rapidly over the last five years from the “support” offered by the College Working Party (1985) to an “intrinsic part of psychiatric training” (CTC Working Party Report, 1990). Constantly increasing expectations of the clinicians' management role have led to an increasing recognition of the need for clinicians to develop specific management skills and have resulted in rapid expansion of training available. A further survey examining the extent training needs are currently being met is therefore justified.
Achieving a balance: establishing a new regional scheme for psychiatric registrars in South East Thames
Authors: Herzberg J. L. , Watson J. P.
Published: May 2008

Until recently, a doctor beginning a career in psychiatry would usually apply for a combined SHO/registrar rotation lasting approximately 3½ years. Trainees could expect promotion from SHO to registrar after about 18 months, subject to passing the Part I of the MRCPsych examination and also to their educational and clinical progress having been judged to be satisfactory by the scheme tutor and organising committee. Life has changed! The emergence of Achieving a Balance (Department of Health, 1988), the proposals of which are intended to be phased in over the next ten years, has meant that scheme organisers have had to quickly change the basis on which their rotations are run. This paper is an account of how this has been done in the SE Thames Region.
Family Courts Consortium
Authors: Hendriks Jean Harris
Published: May 2008

This Consortium has a distinguished political-legal history. Its predecessor, the Family Court Campaign, was launched in 1985 by Lady Faithfull, then chairman of the all party parliamentary committee for children. Its aims were those of the Finer Committee (1974).
Hating heroes
Authors: Appleby Louis
Published: May 2008

The press hated ‘Shrinks’. London's Evening Standard dismissed it as “one part guilt, two parts torment”. The Guardian called it “really naff” and predicted it would be axed or, if it was lucky, rescheduled until after everyone with taste had gone to bed. But it wasn't, and there must have been many real-life shrinks who were glad of it.
Research troikas: a plan for fostering psychiatric research in a region
Authors: Sims Andrew
Published: May 2008

Without research psychiatry is brain dead! Perhaps the most significant discriminator between medical practice and the ‘alternative therapies’ is the responsibility, often honoured, of the medical profession to evaluate and hence vindicate its treatment methods. For the individual practitioner, research helps to maintain the highest standards of involvement in clinical care. In psychiatry many new methods of treatment and innovatory types of treatment service have been introduced over recent years. Their continued and extended use should not be justified by the zeal of their advocates but by demonstration of their efficacy.
Information on drug and alcohol services in the United Kingdom
Authors: Dunn John
Published: May 2008

How would one find out the following information? Where to find a needle exchange in North Shields, residential rehabilitation for a drug user in Gwent, advice for a solvent misuser in Bradford, an urgent detoxification for a heroin user in London or alcohol counselling in Fife? One could contact the duty psychiatrist at the local hospital or even the duty social worker in the relevant social services district. However, if they did not know the Regional Drug and Alcohol Unit should be able to help. But if they were unable to, where else could one turn?
A review of training in neuropsychiatry
Authors: Nicol A. , Bird J.
Published: May 2008

The boundary between neurology and psychiatry has never been sharply defined. It remains the case that a number of conditions (e.g. epilepsy, head-injury sequelae, dementia, and conversion hysteria) are seen by both neurologists and psychiatrists (Reynolds & Trimble, 1989). Few neurologists would dispute that there may be a marked psychiatric element to the presentation of multiple sclerosis, and it has long been noticed that even unmedicated chronic schizophrenic patients sometimes exhibit abnormalities of movement and so-called “soft” neurological signs such as dysgraphia and clumsiness (Lishman, 1988). These and other conditions may all on occasion present to the neuropsychiatrist.
Evaluating a trainee led induction day in psychiatry
Authors: Kidd Brian , McGilp Robin , Stark Cameron
Published: May 2008

Many psychiatric training schemes hold induction days for their new junior doctors. This practice has now become a College recommendation and has frequently been a mandatory requirement for the approval of training schemes by the Royal College of Psychiatrists (Sims, 1990). Such days often concentrate on orientating the new trainee, looking in particular at facilities rather than the development of skills.
Psychodynamic lessons in liaison psychiatric teaching for medical students
Authors: Doctor Ronald
Published: May 2008

Medical students at University College Hospital are attached to medical firms during their first clinical year, where they receive one hour of liaison psychiatric teaching every week. The teaching usually takes the form of a presentation to the group of a patient seen by one of the medical students on the medical ward, followed by a discussion with particular emphasis on the doctor-patient relationship.
1. Basics and purchasing tips
Authors: Johnson Bankole A. , Wells Lynda T.
Published: May 2008

Computers are essential tools for medical research, communication and management. Informed choices require a basic knowledge of computers. Many doctors have, however, been frustrated by unnecessary jargon.
Asylum architecture
Authors: Floate Susan
Published: May 2008

The College library is continuing with its project to photograph some of the large old psychiatric hospitals. With the planned closure and possible demolition of many of these institutions it seems worthwhile to record the architecture of the buildings, although inevitably most have been extended, renovated or dissected over the years. Initially hospitals in the vicinity of London are being photographed but we hope to include establishments throughout the country and would be pleased to receive photographs of any architecturally interesting psychiatric hospitals to add to our collection. (Photographs on this spread by Mr C. Priest/MAGPIE Reprographics.)
On being shadowed
Authors: Harris N. P.
Published: May 2008

During my psychiatric training to date I have been observed at work by medical students, psychiatric nurses and social workers, by video cameras and the members of family therapy teams, by consultant psychiatrists and others. All these experiences of being observed have been challenging and educative; probably I share them with most psychiatric trainees.
The United Kingdom Standing Conference for Psychotherapy: Psychotherapy Register
Authors: Pokorny Michael R.
Published: May 2008

I have been asked to explain the structural changes that are taking place in UKSCP and to describe how these will lead to the formation of a register of psychotherapists early in 1993. I shall briefly survey the present balanced structure, describe the most recent changes and show how they will work in practice.
The development of community based adult mental health services
Authors: Powell Jackie , Lovelock Robin
Published: May 2008

Service initiatives such as the decentralisation of adult mental health care by way of multidisciplinary patch teams have wide-ranging implications for professional practice. The successful development of community based services demands that staff adopt different roles from those appropriate to the hospital setting.
Practical experience from a regional secure unit
Authors: James Adrian
Published: May 2008

The Royal College of Psychiatrists' Working Party on Medical Audit has emphasised the multidisciplinary nature of patient care in psychiatry (Royal College of Psychiatrists, 1989). Much has been published on individual audit topics and on definitions of the various aspects of audit such as peer review, performance indicators and quality assurance. The essential element of audit is its systematic nature and little has been written concerning an overall structure for clinical audit within an individual psychiatric setting. It is not sufficient to start with ‘a simple project with minimum of cost in terms of both time and money expended’, as recommended by the Royal College of Psychiatrists' Working Party. What is needed is an overall structure for regular review so that the systematic nature of the process is not lost and that recommendations from audit meetings are reviewed regularly for their usefulness and level of implementation.
Psychiatric wards in DGHs? An architect's comments
Authors: Barefoot Peter
Published: May 2008

“Little as we know about the way in which we are affected by form, by colour and light, we do know this, they have an actual physical effect.” Florence Nightingale, Notes on Nursing
The Criminal Procedure (Insanity and Unfitness to Plead) Act 1991
Authors: Kellam Alexander M. P.
Published: May 2008

This short Act, which amends some parts of the Criminal Procedure (Insanity) Act 1964, came into force on 1 January 1992. It applies only to cases where arraignment was after that date (start of trial when charge[s] is read to the defendant), and only in the Crown and higher Courts. It enables Courts to try the facts of a case even when the defendant is “Under Disability” (= Unfit to Plead) and, when finding a person “Under Disability” or “Not Guilty by Reason of Insanity”, to order other disposals than indefinite detention in hospital. The legal definitions remain unchanged.
The treatment demand for bulimia: a catchment area report of referral rates and demography
Authors: Lacey J. Hubert
Published: May 2008

In the light of proposals to change the system of providing NHS health care, it is important for future district or regional procurers to have reliable data on which to base their treatment ‘contracts’, bearing in mind not only current but also the potential demand of a mature market.
Role of the duty psychiatrist
Authors: Nicholls Judith E.
Published: May 2008

Recent changes in psychiatric services have produced a movement away from large hospitals to management within the community. A successful home treatment service with 24-hour cover has been described for severe acute psychiatric illness, though hospital admission was not entirely avoided (Dean et al, 1990). It is difficult to manage violent patients or those who will not comply with medication at home. If relatives are not supportive hospital admission will be required. Although living alone is not a contraindication to treatment at home, those who require constant supervision because they are, for example, suicidal need to be admitted. Concurrent physical problems may also necessitate hospital admission. Any future services must therefore include some in-patient care.
Referrals to an out-patient forensic psychology service
Authors: Hambridge J. A.
Published: May 2008

Following the recommendations of the Butler Report (Home Office, 1975), there has been a slow growth in the number of Regional Secure Units (RSUs) (Snowden, 1985), which aim to assess and treat mentally disordered offenders in England and Wales in conditions of “medium security”. One particular recommendation of the Butler Report was that:

“The main emphasis in forensic psychiatric services … should be on community care and out-patient work.” (paragraph 20.14)
The Mental Health Act 1983 – what does the patient think?
Authors: Rusius C. W.
Published: May 2008

Mental disorders may seriously impair insight and therefore cause some patients to refuse potentially life-saving treatment which they would otherwise accept. Opinion on the ethics of current legislation regarding compulsory admission and treatment varies with open debates leading to heated and emotive exchanges. During the reading of the 1982 Mental Health Amendment Bill intense lobbying of MPs took place (Bluglass, 1984). Some argued against compulsory detention because of its infringement on personal liberty while others argued that it was necessary for the adequate treatment of mental disorders which impair insight. They pointed out one's right to receive appropriate treatment whether or not insight is impaired.
Medical audit among Scottish child psychiatrists
Authors: Morton H. G. , McCabe R. J. R. , Parry-Jones W. , Pickett J.
Published: May 2008

Working for Patients (DOH, 1989) has provided considerable impetus to the development of medical audit. The Royal College of Psychiatrists (1989) Preliminary Report on Medical Audit defined and distinguished between clinical audit, peer review and performance indicators, and referred to some of the particular problems affecting the development of audit in psychiatric practice. There are special concerns for child and adolescent psychiatrists developing medical audit programmes because of the wide diversity of child and adolescent practice and the considerable variability of resources in the subspecialty. Nicol (1989) has described the initial concern of the National Child Psychiatry Section's Working Group on audit with the Korner Report (HMSO, 1982) and the proposals on performance indicators outlined by the DHSS in 1987.
Dangerousness: a novel approach
Authors: Bartholomew Allen A.
Published: May 2008

The problem of dealing with the individual considered to be dangerous is very real and not the least difficulty being the matter predicting the degree of dangerousness if one accepts that dangerousness can be predicted at all.
Admission profile: towards community based services
Authors: Augustine R. S. , Kurian P. N. , Michael A.
Published: May 2008

This audit examined 65 consecutive admissions to a psychiatric hospital in the Irish Midlands over six months. The admissions came from a defined sector with a total population of 39,000. In the year prior to the study major changes in the delivery of psychiatric care in the sector were instituted. These changes included the introduction of admission guidelines and extra resources in the community. The general practitioners who see mental illness at first contact were informed of these changes. Attempts were made by the sector psychiatrist team to screen for appropriateness of admission with regard to the special groups such as alcoholics, the aged and the mentally handicapped.
Higher training: what is it trying to achieve and what is its rationale?
Authors: Copeland John
Published: May 2008

This paper attempts to address the question, “What is higher training for?”. It then tries to explain some of the principles which have guided the work of the Joint Committee on Higher Psychiatric Training (JCHPT) up to now, and which are sometimes misunderstood by trainers and trainees, and finally, discusses some current problems. The views expressed should not be taken as reflecting the future policy of the JCHPT.
Behavioural disturbance in people with epilepsy and a mental handicap
Authors: McQuail Paul
Published: May 2008

People with a mental handicap may have a variety of behavioural symptoms, and according to DSM-III-R those commonly seen include passivity, low self-esteem, low frustration tolerance, aggressiveness, poor impulse control, and stereotyped self-stimulating and self-injurious behaviour. There is, however, no diagnostic subclassification of these in DSM-III-R.
Rehabilitation in a district general hospital
Authors: Maddocks W. T. Astrid , Maddocks Peter D.
Published: May 2008

The Psychiatric Unit at Wexham Park Hospital has served a population of 230,000 with no entry to long-stay beds since 1972. There have been between 45 and 60 available beds for all types of mental illness except dementia. Various group homes and unstaffed halfway houses have been started, but the accumulation of more disabled patients showed the need for both a staffed group home, and rehabilitation to fit them for it. There was no separate ward or building in the hospital which could be used, and so rehabilitation had to be arranged on an acute ward. The staffed group home has a lower staff-patient ratio than a hospital hostel.
Needs for continuing care of demented people: a model for estimating needs
Authors: Wattis John P. , Hobson Janet , Barker George
Published: May 2008

The way in which residential and other forms of continuing care have developed in the United Kingdom has been reviewed (Lewis & Wattis, 1988). It has been a story of unclear policy and confusion, especially in respect of people with dementia. At present there is a lack of clarity about who is responsible for providing continuing care for demented people. Traditionally, their care was shared between social services Part III (including EMI – for the ‘elderly mentally infirm’) homes and NHS psychogeriatric and geriatric beds.
The general psychiatrist as specialist
Authors: Cox John L.
Published: May 2008

Although the definition of a specialist as an individual knowing “more and more” about “less and less” could be construed as a somewhat cynical critique of certain aspects of contemporary psychiatry, the Universal English Dictionary defines a specialist as a person engaged in a “special line of study or special branch of a profession”; a definition more relevant to this article which attempts to resolve the paradox of the “generalist as specialist”, and to outline the way in which general psychiatry is a special branch of a profession.
Three psychiatric day centres in a London borough
Authors: Orrell Martin W. , Johnson Sonia
Published: May 2008

Research on day care has tended to focus on the day hospitals rather than day centres. A substantial body of work has evaluated the success of the day hospital as an alternative to the acute admission ward (Herz et al, 1971; Creed et al, 1989). But many day hospitals appear to have taken on long-term supports, the role envisaged for the day centres, as their principal function, rather than short-term treatment (Pryce, 1982; McGrath & Tantam, 1987): for example, Pryce draws attention to the accumulation of long-stay psychiatric day patients in a day hospital in South Glamorgan, where 67% of patients have been attending for between two and 17 years.
The purchaser-provider game: a user-friendly management workshop
Authors: Lock Toni , Guthrie Elspeth , McGrath Graeme , Margison Frank
Published: May 2008

Following the recent reorganisation of the health service, doctors have been advised to accept the challenge of involving themselves in general management, (Ross, 1991), and the need for additional training in management skills has been recognised (Higgins, 1989; CTC Working Party Report, 1990). Local trainers, however, often do not know what sort of management training is appropriate, nor how or when it should be introduced into an eight year specialist training agenda, and the current situation for many trainees may, therefore, be described as hit or miss (Lock, 1991). Trainees need also to learn to consider not only their immediate clinical responsibility to individual patients, but also the broader concepts of preventive and public health medicine and the principles of equity, efficiency, quality and efficacy which underly the purchaser-provider contractual process.
The Portsmouth Care Consortium
Authors: Bale Rod
Published: May 2008

The co-ordination of services for the long-term mentally ill in the community poses difficulties of organisation. Each country has its own health and social service structure which influences the development of such services. This paper outlines an approach to co-ordinating care in Portsmouth. The mental health services were well known in the ‘30s because of their community orientation due to the leadership of Thomas Beaton, the superintendent of St James' Hospital (Freeman, 1962). The city has a population of 210,000. Previous seaside holiday accommodation is now utilised for residential care homes for the elderly and the mentally ill.
Australia (Melbourne)
Authors: Ames David
Published: May 2008

Australia is a unique, geologically ancient island continent. Its flora and fauna are unlike those found anywhere else and the same may be said of its people, politics and health services. The population of 17.3 millions represents a multicultural mix, with an anglo-celtic core conflated by sustained post-war immigration from southern Europe, Turkey, southeast Asia and south America. One in five current Australians was born elsewhere, one in ten comes from a non-English speaking background, and a quarter of those born here have a parent who was born overseas. Aboriginals and Torres Strait Islanders form 1.4% of the total population. They have third world mortality figures but die of first world diseases, their life expectancy being 20 years less than that of other Australians. Two hundred and four years after what they see as the British invasion, their standard of living lags far behind all other socio-cultural groups in the country. Most members of the Aboriginal community do not live long enough to develop Alzheimer's disease, but it and other age-related diseases are emerging as the major determinants of health costs as Australia moves towards the 21st century.
Violence Management Special Interest Group
Authors: Stark Cameron , Kidd Brian
Published: May 2008

The first meeting of the Violence Management Special Interest Group on 25 February 1992 drew a mixed group of delegates from three of the 15 Scottish Health Boards, three Regional Social Work Departments and several Education Departments, as well as the Scottish Prison Service. The majority of those who attended were actively engaged in designing training programmes for public sector staff.
The future of services for the chronically mentally ill: a priority case?
Authors: Soni Som D. , Mahmood Rafeek F. , Shah Anant
Published: May 2008

Research into delivery of psychiatric care has shown that the chronic mentally ill (CMI) patients continue to pose major difficulties not only in terms of economic cost to patients, their families and the state but also in the ability of authorities to provide adequate facilities in the community. The latter is especially important now because of rapid discharge of patients into the community from long-stay wards of mental hospitals, often with little rehabilitative preparation and even less consideration of the effects of the environment into which they are relocated. Although follow-up in some cases has been of exceptionally high quality, a majority have filtered through the network into inadequate residence; this surely is unacceptable. The high prevalence of mental illness among the homeless and the difficulties of providing care for them by an inflexible health service have been highlighted by a recent report of the Royal College of Psychiatrists (Bhugra et al, 1991). This paper attempts to define the possible adverse consequences of the recent reorganisation of National Health Service (NHS) on the care of the chronic mentally ill.
Towards sectorised psychiatric care–what do GPs think?
Authors: Dorkins Eluned
Published: May 2008

The last ten years have seen the development of sectorised psychiatric services across many areas of the country. The characteristic feature of such a service is that a given team is responsible for serving a population base defined either on geographical grounds or by general practice (Tyrer, 1985). However there has been little research on the impact of sectorisation (Tyrer et al, 1989).
‘The Last Resort’ – the influence of a television programme on referrals to a national unit for affective disorders
Authors: Hodgkiss A. D. , Malizia A. L. , Bridges P. K.
Published: May 2008

On 28 March 1990 a BBC television programme in the ‘QED’ series was broadcast entitled ‘The Last Resort’. It sympathetically showed the life of a woman with a treatment resistant affective disorder and later presented some aspects of her treatment at this unit, including a stereotactic subcaudate tractotomy (SST) operation. As a result of this programme a number of patients wrote to us and this report compares referrals arising in this way with a sample of referrals to the unit through the usual channels.
Child psychiatry and child sexual abuse
Authors: (Convenor) Danya Glaser
Published: May 2008

In the light of new contexts, a working group of the Child and Adolescent Specialist Section of the College has produced a comprehensive new document reviewing the current role of child and adolescent psychiatry in the field of child sexual abuse. There is also mention of the role of general and forensic psychiatry. The need for this review has arisen due to major changes in health and personal social service provision, the law, developments in clinical practice and new research findings.