bluuebunny/crossref_metadata_2025 huggingface dataset:
Mental state examinations by psychiatric trainees in a community NHS trust
Authors: Kareem Oladimeji S. , Ashby Ceri-Anne
Published: September 2002

Aims and Method

To investigate the recording of Mental State Examination (MSE) findings by psychiatric trainees as well as dating, timing and signing of entries into the clinical record. Data were collected from randomly selected case notes in three acute psychiatric units.

Results

There was an initial decline of MSE recording from 69% to 58% in the first re-audit. Introduction of a standardised format and involvement of consultant trainers in the supervision of MSE recording led to an improvement to 83% in the secondre-audit. Adherence to medico-legal standards also improved.

Clinical Implications

The introduction of an MSE format and consultant supervision of records improved the standard of MSE recording as well as basic medico-legal requirements by psychiatric trainees.
Benzodiazepines in schizophrenia
Authors: Paton Carol , Banham Stuart , Whitmore John
Published: September 2002

Aims and Method

We sought to determine the prevalence of long-term benzodiazepine prescribing in patients with schizophrenia occupying psychiatric rehabilitation beds. A cross-sectional survey was conducted in 11 National Health Service trusts.

Results

Almost10% of patients occupying rehabilitation beds had a diagnosis of schizophrenia and received long-term benzodiazepines in combination with one or more anti-psychotics.

Clinical Implications

Our results are consistent with those of other authors and show that benzodiazepines are frequently used inthe long-term in patients with schizophrenia despite a lack of open acknowledgement of this practice and a paucity of objective data to support its efficacy.
Encouraging the implementation of clinical standards into practice
Authors: Palmer Claire , Lelliott Paul
Published: September 2002

The articles by Geddes & Wessely (2000, this issue) and Lelliott (2000, this issue) describe the current evidence base and guidelines from which clinical standards can be developed in mental health. They highlight some of the issues and complexity surrounding the development of standards. It could be argued, however, that an even greater challenge lies in getting clinical standards used in routine practice.
Post-colonialism and mental health
Authors: Hickling Frederick W. , Hutchinson Gerrard
Published: September 2002

We were encouraged by the many, varied, responses to our paper on the roast breadfruit psychosis (Hickling & Hutchinson, 1999). We have no intention of defining or creating a new nosological entity. We are proposing the centrality of identity negotiation as a psychological process occurring when one is faced with the concrete reality of racism and social exclusion. This process of negotiation, if unsuccessful, is a mechanism through which psychopathology can result as defined within the rubric of psychiatry. Identity negotiation as a trigger for psychosis must not be confused with nosological definition. One of the by-products of empires has been the European propensity to believe that their nosological constructs are universal and can therefore be applied to the cultural behaviour of their former subjects. This becomes dangerous when nosological characterisation is synonymous with pathology and the need for treatment, again in ways that are determined and deemed appropriate by the colonial hegemony. The construction of semiotic equivalence of knowledge and cultural systems that are widely diverse is another demonstration of the moulding of otherness into terms and perceptions understandable to the European mind and is as such the sine qua non of the European colonial experience. The post-colonial challenge is to seek liberation from these mechanisms and so foster insight into the behaviour and thought processes of both the former colonisers and those people they colonised.
Afro-Saxon psychosis or cultural schizophrenia in African-Caribbeans?
Authors: Maharajh Hari D.
Published: September 2002

“Everybody in Miguel Street said that Man-man was mad, and so they left him alone, but I am not sure now that he was mad and I can think of many people much madder than Man-man was… That again was another mystery about Man-man. His accent, if you shut your eyes while he spoke, you would believe an Englishman – a good class Englishman who wasn't particular about grammar – was talking to you.” (Naipaul, 1959)
Suicide: a call-sheet audit – Data from SANELINE
Authors: Fakhoury Walid K. H.
Published: September 2002

Aims and Method

This is an audit of 10 359 calls made to the national mental health helpline SANELINE between January 1996 and June 1998 aiming at describing the profile of suicidal callers.

Results

More calls were by, or about, women. The most common age group for suicidal callers was 25–34 years, while those under 25 were least likely to call the helpline. Fifty-five per cent of all calls related to people suffering from depression, and 31% were for people with psychosis. The majority of sufferers who were planning suicide or were in the act of suicide at the time of the call were in contact with services, and almost three-fifths of sufferers reported problems with services.

Clinical Implications

There is an urgent need for innovative interventions targeting males and those under 25 years of age.
A survey of stress in psychiatrists working in the Wessex Region
Authors: Rathod Shanaya , Roy Leena , Ramsay Maureen , Das Mrigendra , Birtwistle Jon , Kingdon David
Published: September 2002

Aims and Methods

The study explored job-stress experienced by psychiatrists, its effect on their lives and the coping mechanisms used.

Results

The response rate was 62%. The younger group reported higher stress levels and used more positive coping strategies than the older groups. Female doctors were more likely to report being stressed. Aspects of the job experienced as most stressful include on-call duties and dealing with difficult and hostile relatives.

Clinical Implications

Anxietyand depressive symptoms are reported frequently in psychiatrists. Strategies to deal with the identified causes need to be put in place.
Complaints against psychiatrists
Authors: Barbenel David , Ikkos George
Published: September 2002

Psychiatrists need to maintain demonstrably good standards of practice. They are guided in this by clinical supervision and consultation, by Duties of a Doctor, (General Medical Council; GMC, (1995)) and by guidelines from the Royal College of Psychiatrists (Royal College of Psychiatrists, 1984). The ethical standards to which psychiatrists should adhere are made explicit in The Declaration of Madrid (World Psychiatric Association, 1997). Procedures exist to address poor practice and irresponsible conduct.It is important that psychiatrists actively support and participate in these.
Clinical Governance Support Service
Authors: Palmer Claire
Published: September 2002

The Clinical Governance Support Service (CGSS) was launched in February 1999 following an overwhelming response by mental health and learning disability services to the Royal College of Psychiatrists' Research Unit's experimental proposal to establish a support service for clinical governance.
Availability and acceptability of home treatment for acute psychiatric disorders
Authors: Owen Andrew J. , Sashidharan S. P. , Edwards Lyse J.
Published: September 2002

Aims and Methods

To ascertain current levels of access to home treatment for those with acute mental illness and future plans of trusts and purchasing authorities to provide such services. Also, to assess the attitudes of these organisations towards this form of treatment. A postal survey of all mental health trusts and purchasing authorities within the UK was carried out.

Results

One hundred and seventy-two trusts and 82 health authorities returned questionnaires, representing a response rate of 75% and 67% respectively. Only 27 (16%) of trusts provided home treatment but 58 (40%) had plans to do so. All health authorities and 97% of trusts were in favour of the principle of providing home treatment.

Clinical Implications

Despite the low levels of provision of home treatment trusts and health authorities were strongly in favourof it. There is likely to be a large increase in its availability over the next 12 months.
What you don't know won't hurt you
Authors: Smith Shubulade , Henderson Max
Published: September 2002

Aims and Method

Information given to patients about side-effects of their medication plays a key role in future adherence. It is possible that when antipsychotic medication is prescribed routinely, insufficient information is given to them. In order to investigate the amount of information doctors feel they need to give to patients when they are prescribing conventional antipsychotic medication, all the clinical doctors at a large mental health trust were surveyed by anonymous questionnaire.

Results

Overall, doctors said they gave large amounts of information to patients about possible side-effects of anti-psychotic drugs, but some side effects we discussed far more frequently than others.

Conclusions

The selectivity of information given to patients appears to reflect the doctors perception of what is important. This might not correlate with what the patient may wish to be told. Discussions with patients about side-effects may need to be more comprehensive than they currently are.
The NHS and Community Care Act 1990
Authors: Angunawela Indra I. , Barker Andrew , Nicholson Simon D.
Published: September 2002

Aims and Method

The Community Care Act came into effect in April 1993. In order to see what impact this would have on the discharge profile of dementia inpatients, prospective studies of inpatient discharges from a dementia assessment ward before the Act, and five and 41 months after the Act were conducted.

Results

The proportion of patients discharged to their own homes and to residential/nursing homecare remained unaffected by the Act. Duration of hospital stay increased after the Act in 1993 and 1996 (P=O.02) largely due to delays in placement into care homes. Placement delay was increased both in 1993 and 1996, but by 1996 the difference was no longer statistically significant. Duration of hospital stay was unaffected by the Act for those patients discharged to their own homes.

Clinical Implications

The new care management process by social services was found to be associated with delayed discharges for people with dementia requiring residential/nursing home placements, thus causing pressures on beds and hig her in-patient costs.
Provision of psychotherapy services for older people
Authors: Murphy Siobhan
Published: September 2002

Aims and Methods

A postal questionnaire was sent to 100 departments of psychotherapy within the UK in an attempt to gauge the use of psychotherapy services by patients in the third and fourth age.

Results

Eighty-seven per cent of respondents felt that the needs of this group for psychotherapy were not met as well as those of younger people in their catchment areas. This is most marked in people over 65 years of age who are infrequently referred to psychotherapy departments. Suggestions are made for improving services.

Clinical Implications

The psychotherapy needs of this group need to be considered in service planning. All professionals need educating about the availability and applicability of the psychotherapies for the older patient. Without additional resources it seems unlikely that the needs of this patient group will be met.
National Service Framework for Mental Health
Authors: Thornicroft Graham
Published: September 2002

The National Service Framework for Mental Health (NSF–MH) is a strategic blueprint for services for adults of working age for the next 10 years. It is both mandatory, in being a clear statement of what services must seek to achieve in relation to the given standards and performance indicators, and permissive, in that it allows considerable local flexibility to customise the services which need to be provided to fit the framework. This paper summarises the process by which the NSF was created, and its content, which became clear when it was published on 30 September 1999 (Department of Health, 1999).
Comparing general practitioners and specialist alcohol services in the management of alcohol withdrawal
Authors: Naik P. C. , Lawton J. , Brownell L. W.
Published: September 2002

Aims and Method

A postal questionnaire was used to compare the pharmacological management of alcohol withdrawal as carried out by a group of general practitioners and specialist alcohol services.

Results

General practitioners were significantly more likely to prescribe chlormethiazole, less likely to use B vitamins and less likely to admit patients with a history of withdrawal complications.

Clinical Implications

General practitioners need training in order to improve their management of alcohol withdrawal.
The role of the educational supervisor
Authors: Day Edward , Brown Nick
Published: September 2002

Aims and Methods

A postal questionnaire of all pre-membership psychiatric trainees in the West Midlands was used to investigate the role of the educational supervisor. The trainees were asked about their experience of educational supervision, and also asked to rank a number of possible roles for their supervisor in order of importance.

Results

A response rate of 70% was achieved. Trainees rated regular appraisal and assessment of skills and deficits as the most important role of the educational supervisor, but had only experienced this in 55% of their training posts thus far. Less than half of the respondents had developed a written educational plan with their educational supervisors, and trainees rated this the least important task of good educational supervision.

Clinical Implications

The results of this survey inform the training agenda for trainers, and emphasise the need to equip consultants with the skills to appraise their trainee's educational development.
Outcome of cosmetic surgery and ‘DIY’ surgery in patients with body dysmorphic disorder
Authors: Veale David
Published: September 2002

Aims and Method

Little is known about the outcome of cosmetic surgery in patients with body dysmorphic disorder (BDD). Self-reported outcome was collected on 25 patients with BDD who at the time of psychiatric assessment had reported that they had had cosmetic surgery in the past.

Results

Twenty-five patients with BDD had a total of 46 procedures. The worst outcome was found in those who had had rhinoplasty and those with repeated operations. Mammoplasty and pinnaplasty was associated with higher degrees of satisfaction. Nine patients with BDD, either in desperation at being turned down for cosmetic surgery or because they could not afford it, had performed their own ‘DIY’ surgery in which they attempted by their own hand to alter their appearance dramatically.

Clinical Implications

Cosmetic surgery cannot at present be recommended for patients with BDD. However, patients turned down for surgery or who cannot afford it, may try to alter their appearance by themselves. The study contains a selection bias of patients in favour of treatment failures in cosmetic surgery and prospective studies are required on BDD patients who obtain cosmetic surgery or dermatological treatment.
Partnership with probation hostels
Authors: Nadkarni Rajesh , Chipchase Barry , Fraser Kim
Published: September 2002

With every serious incident of violence involving a person with current or past mental health problems we hear the cry ‘community care has failed’. While an increase in resources for in-patient psychiatric care will be welcomed, the reality is that many individuals with mental health needs, some of whom commit criminal offences, will be living in the community. The probation hostels are an example of such an interface, and offer an opportunity for inter-agency working.
The treatment of shell-shock
Authors: Howorth Peter W.
Published: September 2002

“I had a sister first, then a brother, then another brother – he was the one that was killed – and the next brother, who was also in the army, went out, and he got shell–shock. Of course, they didn't understand anything about it at all in those days. He was put on light duty at first, and for, I should think, two–and–a–half years, we had the most terrible life with him. I don't mean because he could help it – he couldn't help it at all – and no doctor seemed to be able to do anything with him at all.

About five times a day, he'd say he was going to commit suicide. We knew he wouldn't, but he'd got to be watched, all the time, and he would wake up in the night, screaming – and my mother would go and sit with him – saying ‘Oh, I can't go back to it’ … It was absolutely terrifying when he woke up, screaming and screaming and screaming.” (Liddle Collection, Leeds University Library, further details available from author upon request)
Learning disability psychiatry – the future of services
Authors: O'Dwyer J. M.
Published: September 2002

Distinctions between mental illness and learning disability have existed since the last century (Pinel, 1801; Ireland, 1877). The conditions have been accepted as coexisting in the same individual since the beginning of this century (Kraepelin, 1902). More recent papers have investigated the frequency of their coexistence and concluded that most psychiatric disorders are more common in those with learning disability than the general population (Turner, 1989).
Profile of service users attending a voluntary mental health sector service
Authors: Hutchinson Gerard , Gilvarry Catherine , Fahy Thomas A.
Published: September 2002

Aims and Method

Very little research has been undertaken to characterise the service user groups served by the voluntary sector mental health services in Britain. In view of the high reported cases of dissatisfaction with the statutory mental health services in the population of Caribbean origin in Britain, we sought to compare the male service users attending a voluntary sector service in Brixton, South London with those attending a service run by the mental health hospital for that catchment area. The service users and their case workers were interviewed and their case notes reviewed to obtain demographic information such as employment and forensic history and contact with other services. They were also assessed using the Global Assessment of Functioning (GAF) and the Camberwell Assessment of Need (CAN).

Results

The service users attending the voluntary sector were significantly more disadvantaged in the areas of unemployment and contact with other health services particularly general practitioners. They had significantly lower scores on the GAF and had more unmet needs on the CAN, including numeracy and literacy skills. Both patient groups, however, reported problems with intimate relationships.

Clinical Implications

Service users attending voluntary sector services are likely to be more socially and materially deprived than their counterparts attending statutory services and specific strategies are required to assist these organisations in meeting the many needs of the service users.
A postal survey of the assessment procedure for personality disorder in forensic settings
Authors: Milton John
Published: September 2002

Aims and Method

A survey of 50 in-patient forensic health care and prison services in England, Wales and Scotland was employed to evaluate: (a) how severe personality disorder is assessed; and (b) how assessments compare with recommendations concerning standardised assessment by the Working Group on Psychopathic Disorder (Reed, 1994).

Results

Seventy per cent of services responded, of whom 40% formally assessed personality disorder. Fifty-four instruments were routinely employed. Assessments of personality structure and cognitive/emotional styles were more common than structured diagnostic instruments or ratings of interpersonal functioning. Of the assessment tools, 25.7% of services provided at least one suggested by Reed (1994).

Clinical Implications

A nationally agreed, focused repertoire of instruments should be encouraged within secure forensic settings offering assessments to individuals with severe personality disorder.
Changing minds: every family in the land
Authors: Crisp Arthur
Published: September 2002

It is likely that our propensity to categorise people, and then to distance ourselves from and discriminate against certain groups, has time honoured instinctive (Gilbert, 2000) as well as more recent intra-psychic (Hughes, 2000) and sociocultural origins. One campaign working party with members drawn from such fields as cultural anthropology, sociology, behavioural psychology, psychoanalysis, human biology and psychiatry is currently attempting to shed light on this complex matter. The aim is to be helpful to the main thrusts of the Campaign to reduce prejudice and discrimination.
A consultant-led group for in-patients in a medium secure unit
Authors: Lucas Philip
Published: September 2002

Aims and Method

The first 14 months of a consultantled weekly group for in-patients in a medium secure unit are described.

Results

The group's (voluntary) attendance averaged more than 60% of the team's patients over 50 sessions. The weekly attendance increased significantly in the second seven-month period compared with the first (mean numbers of patients (s.d.) 10.4 (0.6) v. 8.1 (0.8)). An eclectic approach, with supportive, educational and interpretive elements, evolved as most suitable for the heterogeneous group of patients involved.

Clinical Implications

The group represented a safe, efficient and practical way of responding to patients' wishes for consultant contact, information, support and also of observing the individual's mental state and ability to interact in a complex social setting.
National survey of training needs for evidence-based practices
Authors: Taylor Pam , Warner James
Published: September 2002

With the increasing importance of evidence-based medicine in psychiatry, the recent inclusion of a critical analysis paper in the MRCPsych Part II Examination and the current emphasis on clinical governance, it is now necessary for all psychiatrists to have some degree of training in evidence-based practices.
Community mental health team case-loads and diagnostic case-mix
Authors: Greenwood Nan , Chisholm Brock , Burns Tom , Harvey Kate
Published: September 2002

Aims and Method

Information concerning team staffing, keyworker case-loads, and keyworker diagnostic case-mix was collected from six community mental health teams caring for 1651 patients to establish the clinical burden across teams and professions.

Results

Team case-loads varied from 427 to 121, an average of 275 patients. Over half the patients were female, and psychotic disorders constituted 44% of the sample. The most common diagnoses were schizophrenia (28.6%) and depression (23.6%). Keyworker case-loads varied across both teams and professions, averaging 30 patients per full-time equivalent. Psychiatrists' case-loads were the largest. Diagnostic case-mix varied with profession. Community psychiatric nurses had the largest proportion of patients with psychosis (73.8%).

Clinical Implications

Multi-disciplinary community mental health teams have a shared view of appropriate work distribution. Consultant psychiatrists may underestimate the resources required by patients with non-psychotic disorders even in inner city areas.
Provision of a community pharmacist-run medication advice service at mental health resource centres
Authors: Ewan Marilyn A. , Greene Russell
Published: September 2002

Aims and Method

To assess what medication information long-term mentally ill patients required and acceptability of an advice service. Confidential consultations were offered by a community pharmacist at two mental health resource centres. The service was evaluated by patients and staff by questionnaire.

Results

Data were collected on 33 consultations (30 users; three attended twice). Mean duration of consultations was 14.9 minutes (range 5–45). Antipsychotics and antidepressants were most commonly prescribed and enquired about. Most drug enquiries concerned adverse drug reactions (n=24) and therapy choice (n=17). All patients and staff hoped the service would be fully implemented.

Clinical Implications

Community pharmacists represent an acceptable, but underutilised, information provision service. Such a service could be overseen by specialist psychiatric pharmacists. This study reflects patients' concerns about the use of antipsychotics and antidepressants and the need to address them. Further work is needed to determine the impact of the service on clinical outcome.
Investigation of the ‘cuff’ method for assessing seizure duration in electroconvulsive therapy
Authors: Wise M. E. Jan , Mackie Fiona , Zamar Antonios C. , Watson James P.
Published: September 2002

Aims and Method

Electroconvulsive therapy should be effectively monitored and seizure duration accurately ascertained. We observed the seizure duration in both lower and upper limbs using the Hamilton ‘cuff’ method.

Results

Thirty-nine seizures in 19 patients were observed. There were no statistically significant differences between cuffed and uncuffed limbs, nor between upper and lower limbs.

Clinical Implications

Alternatives to the Hamilton cuff method to observe seizure duration need to be considered.
A survey of training experiences and attitudes of higher specialist trainees in child and adolescent psychiatry
Authors: Smart Siobhan , Cottrell David
Published: September 2002

Aims and Method

Changes in higher specialist training in the UK have led to a revision of training guidelines in child and adolescent psychiatry. This survey studies trainees' experiences and attitudes in the light of these changes. A questionnaire covering training attitudes and experiences was distributed to all higher specialist trainees in child and adolescent psychiatry via their programme directors.

Results

Eighty-eight per cent of trainees responded. Although most training experiences are well provided, there are gaps in provision in specific areas, including research and teaching. Dissemination of information about aspects of training requires improvement and clearer feedback on training could be given.

Clinical Implications

The implications for training in child and adolescent psychiatry and higher specialist training in general are discussed.
Psychiatric training in Argentina's two major cities
Authors: Meehan Oscar L. , Insua Jorge
Published: September 2002

Argentina is the second largest country in Latin America. The country extends for about 2360 miles (3800 km) from north to south and is about 884 miles (1423 km) at its widest extension from east to west. Its population is around 35 million. Ninety-five per cent of the habitants are of European origin, more than 50% Italian, followed closely by Spanish and the rest Germans, Russians, Irish, English and other minorities from Eastern European and Arab countries.
Psychotic disorders and parenting - the relevance of patients' children for general adult psychiatric services
Authors: Howard Louise
Published: September 2002

Patients with psychotic disorders are often assumed to be sub-fertile, and when patients do have children, any child care concerns are usually passed on to social services. The children of patients with psychotic disorders may not, therefore, be of major concern to the responsible medical officer, and community mental health services have not been developed with families in mind. Routine statistics on psychiatric patient episodes do not include information on patients' children – a question covering this issue was included in the pilot draft of the Mental Health Minimum Data Set (approved for England by the Department of Health in September 1999), but was dropped because clinical professionals were reluctant to record this information, as they did not consider it relevant in this context (personal communication, G. Glover, 2000).
Psychotherapy by computer
Authors: Graham Candida , Franses Abigail , Kenwright Mark , Marks Isaac
Published: September 2002

Aims and Method

Computerised self-help psychotherapies are fast becoming part of psychiatric practice. The aim of the study was to assess potential user preferences for the delivery of self-help psychotherapy for obsessive-compulsive disorder (OCD) and phobic anxiety disorders. A postal survey was undertaken of enquirers responding to a teletext article on self-help psychotherapies for OCD and agoraphobia. Subjects were asked their preferences for the delivery of self-help services for anxiety disorders, their acceptance or refusal of general practitioner (GP) referrals for such therapy, and how much they would be willing to pay for such a service.

Results

Of 326 questionnaires sent out 113 completed questionnaires were returned (35%). Twenty-seven per cent of respondents did not wish to access such services via their GP, 91% wanted access via a computer system and respondents were willing to pay an average of $10 per computer session (range 0–100).

Clinical Implications

Computerised self-help psychotherapies for OCD, phobic anxiety disorders and depression are becoming part of everyday clinical practice. This may be the first survey directly asking potential users about their preferred access to self-help psychotherapies for anxiety disorders. A significant proportion of responders did not wish to go via their GP to receive therapy and the vast majority welcomed therapy delivered by some form of computer system.
First-person accounts of delusions
Authors: Stanton Biba , David Anthony S.
Published: September 2002

Aims and Method

In order to investigate cognitive aspects of the experience of delusions, including onset and recovery, autobiographical accounts of schizophrenia were reviewed.

Results

The sample was self-selected and biased towards women and highly-educated patients. The delusions described were usually gradual in onset and often occurred in the context of an odd or fearful mood, which was accompanied by distorted reasoning. Recovery was also gradual with an intermediate stage of reality-testing or fluctuation between belief and disbelief. Many patients retained residual aspects of delusional thinking after recovery. Most attributed their recovery to a combination of medication, psychotherapy, social support and personal coping strategies; some felt that their illness had enhanced their self-awareness or spirituality.

Clinical Implications

Further exploration of spontaneous coping strategies in recovery from delusions through personal accounts of illness would be valuable.
Service innovations: a mental health service for homeless children and families
Authors: Tischler Victoria , Cumella Stuart , Bellerby Tina , Vostanis Panos
Published: September 2002

Aims and Method

Description of the development of an outreach mental health service for homeless children and families, and presentation of referrals characteristics and management of 40 families.

Results

Families became homeless predominantly because of domestic and neighbourhood violence. They were usually referred to the team for assessment of parents and children, without specific mental health concerns. A range of mental health interventions was offered, as well as liaison with other agencies.

Clinical Implications

The development of such services requires coordination of different agencies working with children and their parents. Also, designated staff and resources, because of the potential conflict with generic services.
Distribution of case-load in community mental health teams
Authors: Tyrer Peter , Muderis Omar Al , Gulbrandsen David
Published: September 2002

Aims and Method

An audit project was carried out in a mental health trust in North-West London on two successive years to determine the average case-load size of defined severe mental illness for each professional discipline.

Results

The average case-load for non-consultants varied from 16 (for occupational therapists) through to 98 patients (for senior house officers). Community psychiatric nurses had an average case-load of 21 and consultants had an estimated average case-load of between 185 and 317 patients. The proportion of patients with severe mental illness ranged from 49% to 67%.

Clinical Implications

The case-loads of consultants in community health teams are too large to exercise the statutory duties of a responsible medical officer and, therefore, need revision.
Problem severity in people using alternative therapies for anxiety difficulties
Authors: Graham Candida , Franses Abigail , Kenwright Mark , Marks Isaac
Published: September 2002

Aims and Method

The use of alternative therapies by people with mental health problems seems to be rising. Are the people who access alternative therapies those with mild or more severe problems? A postal survey was undertaken of enquirers responding to a teletext article on self-help psychotherapies for obsessive–compulsive disorder and agoraphobia. Respondents were asked to rate the severity and duration of their problem and the therapies and services they had used.

Results

Of 326 questionnaires sent out, 113 (35%) completed questionnaires were returned. Seventeen (15%) respondents had sought no help for their anxiety problems, 76 (67%) had been treated by their general practitioner (GP), 62 (55%) by a psychiatrist or psychologist and 48 (42%) had used alternative therapies. People who had sought help from their GP did not rate their problems significantly more severe than those who had not sought treatment. Those who had been treated by a psychiatrist or psychologist and those who had used alternative therapies rated their problem as being significantly more severe than those who had not sought help for it.

Clinical Implications

In this selected sample it was the more severe anxiety sufferers who had used alternative therapies.
Survey of staff perceptions of illicit drug use among patients in a medium secure unit
Authors: Dolan Mairead , Kirwan Helen
Published: September 2002

Aims and Method

A survey of staff perceptions of illicit drug use among in-patients in a medium secure unit.

Results

Sixty per cent of staff were aware of drug misuse on the unit. While 82% commented on the potential adverse effects of illicit substances on patient psychopathology, 45% were also concerned about the negative impact on the staff–patient relationships. Most (82%) staff cite personal enjoyment as the main reason for drug-taking behaviour and perceive drug use on the unit as a form of antisocial behaviour. Less than one-third of staff were clear about the unit's policy for dealing with in-patient drug use and few have had adequate training in the management of patients with dual diagnoses. Strategies for dealing with drug misuse appear to focus on security rather than therapeutic issues.

Clinical Implications

Services need to provide adequate training for staff on the management of patients with comorbid substance misuse, introduce patient education programmes and develop and disseminate clear policies that emphasise both therapy and security.
The experience of being a guest medical inspector with the Prison Inspectorate
Authors: Birmingham Luke
Published: September 2002

Health care for prisoners suffering from mental disorders is a subject that not only has a direct impact on my clinical work as a forensic psychiatrist, but it is also a particular research interest of mine. Therefore, I was delighted when the opportunity arose to shadow Dr John Reed (Medical Inspector) for 3 days during a full, announced inspection of Leicester prison in October 1998. Since then I have been invited back as a guest medical inspector to assist with the inspection of two large prisons: HMP Liverpool and HMP Wandsworth (London).
A guide to the internet for psychotherapists
Authors: Tantum Digby
Published: September 2002

One of the best collections of links to USA psychotherapy sites is at Mental Health Directory (http://www.mental-health.net). In the UK, two good starting points are: the Centre for Psychotherapeutic Studies at the University of Sheffield (http://www.shef.ac.uk/-psysc/) and Chris Evans' website (http://www.psyctc.org/).
Do trainees have adequate access to computers and computer software?
Authors: Kotak Anita , Butler Rob
Published: September 2002

Aims and Method

To find out whether trainees have access to computers and computer software; to estimate the demand for more access and training; and to see whether requests for more computer access over a 2-year period led to change. A questionnaire was sent to trainees in November 1997, and again 2 years later.

Results

Only half of the senior house officers and three-quarters of specialist registrars said they had access to computers. For those with access, this tended to be for word processing and Medline. Only one-quarter had access to the internet. There was a strong demand for wider access and for more training. There was little change in the provision of computers and software over the 2-year period.

Conclusion

To take advantage of developments in technology, psychiatrists need to have access to computers. This survey suggests that trainees are not being adequately prepared for the future.
Mental health courts: a workable proposition?
Authors: Mikhail Sherine , Akinkunmi Akintunde , Poythress Norman
Published: September 2002

In the UK the notion of diverting people suffering from mental disorders from the criminal justice system to treatment within the health service is not new (Home Office, 1990), nor is the concept of a court-based psychiatric assessment and liaison service (Joseph & Potter, 1990; James & Hamilton, 1991; Joseph, 1992). Similarly, the concept of 'specialist'courts is not a novelty in the USA (Bean, 1998; Schwartz & Schwartz, 1998). We report on the first specialist mental health court in the USA and propose a modification of the current provision of psychiatric services to courts in England and Wales by combining elements of the mental health court with current court diversion practice.
The future (or not) of the medical member
Authors: Rooth Graham
Published: September 2002

The present role of the medical member combines considerable common sense strengths with a particular legal weakness. It reflects a compromise between the need to inform the judicial process with an appropriate level of medical expertise, and the risk that information could be presented to the tribunal without being open to challenge by the patient.

Concern over this perceived, but unresearched risk, is reflected in the Green Paper on the Reform of the Mental Health Act 1983 (Department of Health, 1999). Here the bold solution to a problem of uncertain significance is to remove the offending medical member.
Audit of in-patient prescription and administration records on acute psychogeriatric wards in a teaching hospital
Authors: Onalaja Oludemilade , Saffrey Ruth , Jones Elaine , Bentham Peter
Published: September 2002

AIMS and Method

An audit of in-patient prescription and administration records on acute psychogeriatric wards in a teaching hospital measured the extent of conformity to NHS trust drug policy and improvements following specific interventions. The audit also measured doctors' knowledge of the trust drug policy. Prescription cards of all patients present on the wards were re-audited after 12 months.

Results

The audit identified important shortcomings in prescription writing, recording and policy awareness. A targeted series of interventions resulted in significant improvements in some of these areas.

Clinical Implications

Continuous evaluation and feedback via audit can reduce omissions in prescription writing and recording.
The work of the College Research Unit during 2000
Authors: Goldberg David
Published: September 2002

One of my tasks as Acting Director of the College Research Unit (CRU) is to make its work better known to members of the College. While attentive readers of BJP and the Bulletin may have gained a flavour of our work, inevitably much never sees the light of day, as it takes the form of confidential reports to the organisations that commission the various projects that we undertake. The papers that have appeared that describe our work during 2000 are set out below and a list of books, which represent another form of output.
Media and the College
Authors: Khoosal D. I.
Published: September 2002

I became a Divisional Public Education Officer (DPEO) for the College's External Affairs Department in 1990. My first media training day was most informative. I learned how to disseminate information; how to inform journalists about issues pertinent on the day; and ways to challenge stigma. I learned that it was safest to assume that most journalists do not usually understand the complexity of mental health issues. The health correspondent for the BBC at the time showed how adequate preparation – making written information available in a helpful question and answer format – and development of personal relationships with journalists through understanding how they work, their deadlines, pressures, etc., are important factors in trying to do the job properly. I also learned the golden rule: never say anything off the record.
Web guide: journals on-line
Authors: Hicks Trevor , Briscoe Martin
Published: September 2002

Journals on-line

The British Journal of Psychiatry (BJP), Psychiatric Bulletin and Advances in Psychiatric Treatment have been available at www.rcpsych.org since May 2000 (Fig. 1). During the initial free trial period all users of the internet had access to the full content of these journals on-line. This period ended on 31 January 2001. Access to full text is now limited to subscribers only; but access to electronic tables of contents (eTOCs), abstracts and the ability to search full text will continue to be available. Individuals or institutions who subscribe to BJP in print or are Members of the College are now able to activate an on-line subscription and select a username and password by entering a subscriber number. The eTOC service allows anyone who registers his or her e-mail address to be notified via e-mail when new content goes on-line. Users may choose to receive any or all of the following: notification that a new issue of BJP is on-line; a complete eTOC for new issues; and special announcements from the College.
Inviting a statistician to join an evidence-based journal club
Authors: Swift G. , Crotty F. , Moran M. , McDonough C. M. , Moran A. , Casey P. R.
Published: September 2002

AIMS AND METHOD

In response to frequent cancellations, we recently changed the format of our journal club. We invited a statistician to attend and each meeting focused specifically on critical appraisal and statistical analysis. Active learning principles were used where every participant critically appraised an aspect of the paper presented at each meeting. The aim of this paper was to evaluate the impact of the new format on attendance and satisfaction levels. Attendance and satisfaction levels were measured in the 3 months before and the 3 months after the new format was introduced.

RESULTS

Average attendance increased from 10 to 15, with two psychologists and two trainees who did not work in the hospital starting to attend regularly. Satisfaction levels also increased significantly with respect to academic interest, enjoyment, usefulness and overall satisfaction.

CONCLUSION

Combining statistical expertise with principles of active learning has led to increased satisfaction levels among participants in our journal club.
Twenty-four hour crisis assessment and treatment teams: too radical for the UK?
Authors: Protheroe David , Carroll Andrew
Published: September 2002

In our special article (pp. 439–441, this issue) we have described the structure and function of a 24–hour crisis assessment and treatment team (CATT). Comprehensive, accessible, specialist, out of hours crisis services designed to facilitate community treatment are not new in the UK but they are not currently widespread. Services employing the CATT model have become widespread in Australasia and are considered to be a success there. In this paper we discuss some of the advantages of CATTs and some possible reasons why they are not more commonly employed in the UK.
Reconciling the information needs of clinicians, managers and commissioners – a pilot project
Authors: Broadbent Matthew
Published: September 2002

Aims and Method

Clinicians are often required, by managers, to provide information that does not appear relevant to clinical practice. Rooted in compromise, an outcome-based information model that supports practice and also provides information for managers was developed. A 9–month pilot project at three sites in South-East London took place to test the feasibility of this model in real clinical settings.

Results

Accurate data were reliably collected. Clinicians at participating sites agreed the model produced potentially useful information and, on condition that support is provided, continue to collect data voluntarily.

Clinical Implications

This is not an exclusively clinical model. However, because it also fulfils management needs there is a better chance that clinicians will get the support they need.
Cognitive–behavioural therapy: a survey of the training, practice and views of Scottish consultant psychiatrists
Authors: Le Fevre Peter David , Goldbeck Rainer
Published: September 2002

Aims and Method

A postal survey of all consultant psychiatrists employed by the NHS in Scotland was performed with the aim of determining the numbers and characteristics of consultant psychiatrists who have received training in cognitive–behavioural therapy (CBT). Additional aims were to ascertain the current practice of CBT, along with general attitudes towards practice and training issues.

Results

Nine per cent of consultant psychiatrists had received formal training in CBT. An additional 20% had received informal tuition with supervision of cases. For consultants appointed within the previous five years, 48% had received the recommended amount of supervised experience. In practice, consultants were unable to devote significant amounts of time to formal CBT but were actively using CBT techniques and supported the availability of training opportunities.

Clinical Implications

The survey suggests that the current Royal College of Psychiatrists' guidelines do not appear to have been fully implemented for the area surveyed. Further debate is needed to ascertain the exact form that training in CBT should take.
The forgotten children: children admitted to a county asylum between 1854 and 1900
Authors: Gingell Kate
Published: September 2002

Aims and Method

To assess the part that the 19th century asylums played in the development of the discipline of child psychiatry. Admissions to the Worcester County Asylum between the years 1854 and 1900 were screened to identify children aged 16 and under. An item sheet was used to record details of the admission.

Results

One-hundred and ninety-five children were admitted. Risk of suicide and dangerousness were routinely recorded, family history rarely. It was not possible to make retrospective diagnoses. The death rate was high and contact with the family was minimal post admission.

Clinical Implications

Children were treated exactly like the adult patients, and therefore asylums did not contribute significantly to the development of the discipline of child psychiatry.