bluuebunny/crossref_metadata_2025 huggingface dataset:
Working together for planning services in the post-Griffiths era
Authors: Birley J. L. T.
Published: May 2008

At the College's Autumn meeting in 1984, a joint British Psychological Society (BPS)/Royal College of Psychiatrists Conference took place on the theme ‘Psychiatrists and Psychologists—Co-operation or Confrontation’. This was reported in the Bulletins of the College (June 1985) and of the BPS. It was generally agreed to have been a success, but perhaps at the price of being over-polite. A ‘more focused and hard hitting’ meeting was suggested for the future.
The Bethlem and Maudsley Hospital item sheets (B-MIS)
Authors: Turk Jeremy , Loza Nasser F. , Kasinski Jan , Katz Randy , McGuffin Peter , Murray Robin
Published: May 2008

The Bethlem and Maudsley Hospital item sheets (B-MIS) are summaries in coded form which are completed for every patient admitted or readmitted to the joint hospitals. The Part 1 item sheet contains information which is included in the Part 1 case summary, as described inNotes on Eliciting and Recording Clinical Information, and is completed at the same time as the summary is prepared; that is, usually within a fortnight of the patient entering hospital. Similarly, the Part 2 item sheet contains information normally found in the discharge summary, and is completed at the same time that this summary is prepared; shortly after the patient has left hospital. The item sheets are restricted to pieces of information which can be readily coded by the registrar. Thus, of necessity, they concentrate on relatively ‘hard’ data.
Service evaluation in old age psychiatry: using the general practitioner's view
Authors: Gehlhaar Eric
Published: May 2008

Psychiatric services for the elderly are evolving rapidly. The Government has recently reiterated that this area needs special attention. The reasons for upheaval are well-known: the changing age structure of the population, the historical neglect of the elderly mentally ill and a growing emphasis on community-based approaches in place of traditional institutional solutions. In the London area and elsewhere, adjustment has been complicated by geographical transplantation from old suburban mental hospitals to locally situated units, often within district general hospitals. New specialist services also suffer from the effects of financial stringency and inadequate recruitment. These and other changes have ensured that the process of restructuring services has been difficult. Planners have had few precedents to fall back on, and have been heavily dependent on available guidelines. There has been comparatively little information available about how effectively services work in practice.
Psychiatry in the Commonwealth Caribbean
Authors: Hickling Frederick W.
Published: May 2008

Treatment of the mentally ill by the Aboriginal Awaraks of Jamaica and the other Caribbean islands was first described by a Spanish monk in 1540: ‘Lunatics’ who were called ‘mind riven’ were treated in the community with salvent herbs, which were blended with food and left to hang on fruit trees for those who wandered, and by the administration of unguents and lavings while singing. This record indicates that the mentally ill were treated by the indigenous Indians without restraints, and with rudimentary attempts at pharmacology and cultural therapies. But this enlightened but primitive mental health system was destroyed with the advent of the Spanish conquerors who, according to Las Casas, “in about eight to forty years have unjustly put to death about twelve million Indians without distinction of quality, sex or age”.
Community psychiatric nurses in primary care: consumer survey
Authors: Oyebode Femi , Gadd Elaine , Berry David , Lynes Mary , Lashley Patricia
Published: May 2008

There has been a dramatic increase in the numbers of community psychiatic nurses (CPNs) in the last decade; in the period 1980–1985 the number grew from 1667 to 2758, an overall increase of 65%. Traditionally, CPNs were based within psychiatric institutions. However, in the period 1980–1985 there was growth from 8% to 16.2% in the population of CPNs based in health care centres or General Practitioner (GP) surgeries. Some of the functions of CPNs is also changing, developing away from involvement with chronic psychiatric patients towards patients with minor disorders. CPNs have also argued that work in the community and in GP surgeries is synonymous with primary prevention.
Changing the Institution—Research in Action
Authors: Quarry Andrew , Rayner Rosemary
Published: May 2008

Large psychiatric hospitals are notoriously resistant to change. Their size and organisational complexity inevitably hinder their capacity to keep pace with trends. The serious consequences of a system that has ceased to adapt have been documented many times. Stereotyped routines and practices combine with rigid and bureaucratic management structures to produce the phenomenon of staff ‘burn out’, the “I've seen it all before and it doesn't work” syndrome.
The Use of the Remand Provisions in the 1983 Mental Health Act
Authors: Grounds Adrian
Published: May 2008

The 1983 Mental Health Act introduced new powers for courts to remand mentally disordered defendants to hospital. The provisions came into operation in October 1984, and were preceded by a Ministerial statement that the new arrangements were becoming available because the Government believed.
Multiprofessional care in forensic psychiatry
Authors: Griffin N. V.
Published: May 2008

The concept of multidisciplinary care has arisen from the recognition that there are many areas in medicine and psychiatry which require professional skills and expertise in addition to those possessed by doctors and nurses. The attitude of psychiatrists towards this development has varied from enthusiasm to alarm. Whereas the latter may be understandable in the face of recent publications which portray the profession as being under threat, Bennett (1988) has addressed these changes in a positive manner, and it is surely more responsible to regard the emergence of related professions as a source of assistance rather than hazard.
Confidential ‘phone-in’ for teenagers
Authors: Burnfield Alexander
Published: May 2008

Ocean Sound, an independent Hampshire radio station, broadcasts pop music on a channel known as ‘Power FM’. The presenter/producer of Power FM occasionally asks a guest ‘expert’ to talk briefly about a particular subject and then listeners are invited to phone directly for a confidential talk during the following hour. At the end of the allotted hour the ‘expert’ comes on the air again with some concluding remarks and additional information.
Psychiatry, traditional healers, and the vimbusa, in northern Malawi
Authors: Rands Gianetta
Published: May 2008

Last year I was fortunate enough to visit two GP friends running a district hospital in northern Malawi. As I had just taken Part 1 of the Membership Examination, they were intrigued to know my professional view of a condition called ‘the vimbusa’. In their experience, the vimbusa was a common complaint with a wide variety of presentations, none of which corresponded with disease entities they had learnt during their training. After a fascinating two weeks I was unable to categorise the vimbusa according to ICD-9, but the following essay summarises my attempts to understand this condition.
Multidisciplinary teams and line management
Authors: Soni Som D. , Steers Leonard , Warne Tony , Sang W. H.
Published: May 2008

Recent developments in psychiatry have required increased inter-disciplinary collaboration to ensure co-ordination of specialist skills. Simultaneously, changes in management structures of participating disciplines have produced vertically organised systems of management with multiple tiers often referred to as line management. The membership of multidisciplinary teams (MDTs) now comprises individuals at varying levels in management hierarchy and with different abilities to contribute to the decision making process. Managers usually impose attitudes, expectations and obligations on staff working in MDTs which are often major obstacles to effective teamwork by causing ambivalence and opposing loyalties leaving individual workers in invidious positions (Fagin, 1985). This paper reviews current thinking on multidisciplinary teams and present day management structures among disciplines in psychiatry and discusses the practical problems and areas of conflict resulting from their interaction in settings where MDTs are expected to operate.
Two decades of psychiatry in Zimbabwe: 1964–1984
Authors: Buchan Terry
Published: May 2008

The first Pan African Conference in 1961 made a number of recommendations to guide the development of psychiatric services in emergent African countries. The purpose of this paper is to show that the application of these recommendations, admittedly serendipitously at times, led to a considerable measure of success in Zimbabwe.
Mental health services: results of a survey of English district plans
Authors: Kingdon D.
Published: May 2008

In November 1987, I wrote to the ‘Planning Officer (Mental Health)’ of the 192 English Health Authorities requesting a copy of the section of their 1984 Strategic Plan dealing with mental health and any recent update. A checklist of information to be analysed was drawn up on the basis of an initial reading of the plans. This contained a substantial proportion of the elements for a comprehensive service listed by Hirsch (1988) and by MIND (1983). Replies were received from 137 (71%) of the health authorities. Of these, 127 (67%) sent planning documents, ten wrote saying that their plans were under review and therefore unavailable, or “meaningless”. Strategies were sent dated 1983 (2), 1984/5 (63), 1986 (11) and 1987/8 (45). Planning reports and Short Term Programmes were also sent which meant that four (3%) provided information updated to 1988, 74 (58%) to 1987, 16 (13%) to 1986, 17 (13%) to 1985, 15 (12%) to 1984, with one giving details relating to 1983 only.
Monitoring community care in York
Authors: Harborne Giles , Henderson Annette
Published: May 2008

Up to 37,000 chronic mentally ill and mentally handicapped patients have been discharged from long-stay hospitals over the past ten years and nobody knows for certain where most of them are. This is one of the findings of the 1986 Audit Commission into community care which prompted Sir Roy Griffiths (1988) to state in his report on community care that.
Patients' perceptions and knowledge of electroconvulsive therapy
Authors: Malcolm Katy
Published: May 2008

Most research on electroconvulsive therapy (ECT) has focused on technical aspects, such as indications for treatment, efficacy, side effects of treatment, and theories of mechanism of action. Little investigation has been made of the attitudes and experience of patients receiving ECT and less regarding patients' understanding and knowledge of this treatment. Earlier studies have looked at specific aspects of patients' perceptions of ECT, such as subjective side effects, (Gomez, 1975), or the effect of the media on attitudes towards ECT (Bird, 1979). Other studies have investigated these and related issues more comprehensively (Freeman & Kendell, 1980; Hughes et al, 1980). These studies were carried out some time after the ECT course had been completed; in some cases, over a year. It may be that patients' perception and knowledge of ECT are different before and after treatment. Attitudes and knowledge may also change or fade over time.
Working with survivors
Authors: Turner Stuart
Published: May 2008

As I walked into the waiting room, I remember being struck by his appearance. Although he was almost exactly my age, I saw an old, tired-looking, white-haired man, his face deeply lined and drawn. I wondered what I had to offer this survivor of torture. Would I be able to help him recover from such a dreadful trauma? How could anyone come to terms with an experience which seemed to threaten some of the most basic human needs?
Sketches from the history of psychiatry
Authors: Rollin Henry R.
Published: May 2008

On the night of 16/17 November 1988, fire destroyed a male ward at Friern Barnet Hospital in North London. Two patients died in the conflagration and one was injured.
The value of work in the 1980s
Authors: Shepherd Geoff
Published: May 2008

Mental health professionals seem to have a curiously ambivalent attitude towards work. On the one hand, it is generally accepted that the experience of unemployment is often associated with severe social and psychological distress. On the other, we seem reluctant to strive to provide work for those patients who have the greatest social and psychiatric disabilities and for whom work, in all its forms, may have the greatest benefit. I don't wish to speculate on the psychological roots of this ambivalence, although I suspect that it stems, at least in part, from the way in which we all feel about our own jobs. However, there are other reasons why the concept of work has always sat uneasily within the context of psychiatric services.
Psychiatry in Algeria
Authors: Al-Issa Ihsan
Published: May 2008

In recent years, there has been increasing interest in the development of psychiatry in the Arab countries. Several reports have dealt with psychiatric problems in Iraq, Kuwait and Saudi Arabia (Al-Issa & Al-Issa, 1970; Kline, 1963; Dubovsky, 1983). Two general reviews have also dealt with major psychiatric research in the Arab Middle East (El-Islam, 1982; Racy, 1970). However, the countries surveyed have been under British and American influence and tend to follow the Anglo-Saxon psychiatric model. Little attention has been given to North African Arab countries which follow the French and franco-phone approach to psychiatry.
What is the role of the consultant in the community?
Authors: Sims Andrew
Published: May 2008

What follows is concerned with the role of the consultant. To avoid stereotyping of gender or race, this consultant will henceforward be referred to as she and should be considered as of minority ethnic origin.
Nafsiyat: a psychotherapy centre for ethnic minorities
Authors: Acharyya Sourangshu , Moorhouse Sharon , Kareem Jafar , Littlewood Roland
Published: May 2008

Nafsiyat, a community based ‘intercultural therapy centre’, was set up in London in 1983 to provide psychotherapy for people from ethnic and cultural minority backgrounds.
Suicide trends in the South-East Thames Region
Authors: Bhugra Dinesh , Watson John
Published: May 2008

Suicide rates in the Eastbourne Health District have risen dramatically over the last ten years. The present study looks at some of the factors which may influence these rates and compares these with other health districts in the South East Thames Region. Suggestions for further research are made.
Doctors' attitudes to male homosexuality: a survey
Authors: Bhugra Dinesh
Published: May 2008

The topic of homosexuality has often aroused strong opinions among the public and professionals alike. In a study organised by the journal Modern Medicine in 1969, 17, 741 physicians in the USA responded to a questionnaire. Of those who stated their speciality, 8% were psychiatrists, 26% general practitioners and 10% general surgeons. Questions sought opinions on abortion, legalisation of marijuana, legalisation of homosexual practice and other topics; 92% of psychiatrists [n 2,041] were in favour of legalising homosexual practices. The three specialities least in favour were general practitioners 59% [n 6,927], general surgeons 59% [n 2,580] and orthopaedic surgeons 58% [n 731]. The sample was self-selected and this may have introduced a respondent bias. The data were collected nearly 20 years ago when homosexuality was still seen as a psychiatric illness in the American Psychiatric Association's Diagnostic and Statistical Manuals I and II.
The future of psychotherapy in the NHS
Authors: Obholzer Anton
Published: May 2008

Mental health services in general are at present receiving a bad press. Recent complaints focus on two main areas: the widespread prescription of tranquillising drugs, and the social consequences of the policy of community care. There is now serious concern, both among the public and in the profession, about the over-prescription of tranquillisers. The legal implications are serious. An article in the Journal of the Medical Defence Union was recently quoted in the Bulletin: “Dr Ashton's article is a timely reminder that the prescription of benzodiazepines is now a high profile activity for the psychiatrist that has been scrutinised much more closely than many of our other functions. It is well to be aware that one of the potential onlookers is a lawyer” (Tyrer, 1988).
High rate of Section 4 admissions: clinical implications and possible explanation
Authors: Puri Basant K. , Bermingham Donald F.
Published: May 2008

The Mental Health Commissioners recommend that whenever possible two doctors should be involved in the decision to admit a patient to hospital under the Mental Health Act (1983). That is, Sections 2 and 3 of the Act should always be used in preference to Section 4, where only one doctor is required. It further recommends that the use of Section 4 should be confined to emergencies when it is only possible to secure the attendance of one doctor.
QALYs in psychiatric care?
Authors: Wilkinson Greg , Croft-Jeffreys Caroline , Krekorian H. , McLees S. , Falloon Ian
Published: May 2008

In the form of economic evaluation known as cost-utility analysis, the consequences of health programmes are measured in time units adjusted by health utility weights (i.e., states of health valued relative to one another in terms of notional quality). The outcome of health programmes can then be expressed in terms of increased (or decreased) life expectancy and increased (or decreased) quality-of-life. This provides a device for evaluating health programmes that extend life at the expense of undesirable effects, or, that produce reduced morbidity rather than reduced mortality.
Prevalence of schizophrenia in a refuge for homeless men: a five year follow-up
Authors: Teesson Maree , Buhrich Neil
Published: May 2008

Until the mid 1950s, the management of persons suffering from chronic mental illness in Australia was the responsibility of the large mental hospital. With the advent of psychotropic drugs and concern about the ‘negative’ influence of the institutional environment on patients there was a shift to shorter but more frequent periods of hospital admission. As the pattern of shorter admissions increased, community services for the mentally ill were expanded in the early 1970s. Between 1950 and 1985 in the state of New South Wales, the numbers of patients in large mental hospitals decreased from 256 to 55 per 100 000 population. However, no special arrangements for accommodation, as distinct from treatment, were made for these ex-mental hospital patients. The decline in hospital numbers can be attributed to a general reduction in the length of hospital stays. Initially, there seemed to be no pressing need for extra accommodation in the community as the provision of social security benefits was adequate to allow patients without homes to afford basic accommodation, a situation different to that in the United States (Lamb, 1984).
Inter-agency collaboration in the closure of psychiatric hospitals
Authors: Nocon Andrew , Tomlinson Dylan
Published: May 2008

The needs of people with mental health problems transcend agency boundaries. Service-planning, however, has often been carried out within the confines of individual agencies. Although inter-agency collaboration has been an integral part of official policy since 1974 (DHSS, 1974), joint planning has often been limited to the allocation of centrally-earmarked joint finance (DHSS, 1976). In the ten years following the introduction of joint planning, few authorities prepared, let alone attempted to implement, any broader joint strategies.
The TAPS Project. 2: Challenges and pitfalls of community interviewing
Authors: Dayson David
Published: May 2008

From November 1987 until March 1990 I worked as a researcher with the TAPS project. So far this project's task has been to evaluate the reprovision of hospital services for the long-term mentally ill from two hospitals in the North East Thames Region (Team for the Assessment of Psychiatric Services, 1988). My work involved gathering clinical and social data from over 250 patients and their carers after they had spent a year out of hospital. Most of these patients were suffering from schizophrenia. The design and first results (Team for the Assessment of Psychiatric Services, 1990) provide an objective account of this research. In contrast, this paper intends to put forth a subjective view of some of the problems encountered while obtaining these data in the community. This situation faced the researcher with unique and challenging circumstances that are not normally discussed in the scientific presentation of follow-up data. Its aim is to pre-empt similar difficulties for other community reserarch by providing guidelines. I am going to cover three areas: arranging interviews, conducting them safely, and handling situations that necessitate stepping out of the interviewer role.
2. Mental handicap
Authors: Guthrie Elspeth , Black Dawn , Simpson Neill
Published: May 2008

This speciality is concerned with the psychiatry of patients whose development of intelligence has been impaired.
Athens and beyond: Soviet psychiatric abuse and the World Psychiatric Association
Authors: Bloch Sidney
Published: May 2008

The recent Eighth World Congress of the World Psychiatric Association (WPA), held between 12 and 19 October 1989 in Athens, was reminiscent of the previous World Congress in 1983 in Vienna, and the one before that in 1977 in Honolulu. Once again the issue of the Soviet political misuse of psychiatry reared its ugly head, and dominated the Association's proceedings. In 1977 the critical debate revolved around what position the WPA should adopt concerning the abuse. In a cliff-hanger vote, the WPA passed a resolution condemning the political misuse of psychiatry but explicitly citing the Soviet case (Bloch & Reddaway, 1984). In the absence of any improvement in the situation by the time of Vienna and in the virtual certainty that the Russians would have been expelled from the organisation, the Soviet Psychiatric Society resigned from its membership in January 1983. In order to forestall a precipitous and premature readmission, the Royal College of Psychiatrists proposed at the Vienna Congress that the Soviets would be welcomed back into the fold but only when they had demonstrated “sincere co-operation”, and when there had been concrete evidence of “amelioration” of the abuse.
Conflict: not caring for people
Authors: Whitehead Tony
Published: May 2008

The publication Caring for People: Community Care in the Next Decade and Beyond (DoH, 1989) sets out the Government's plans for community care and is the much awaited response of Government to Sir Roy Griffiths' report on community care. Many health districts have been doing all, if not more, than is recommended in the White Paper but this has been rather costly as far as the DSS funding is concerned. It should be remembered that the high cost of community care to the DSS was one major reason for Sir Roy being asked to investigate and report on such care.
Training psychiatrists for work in the East of Africa
Authors: Tantam Digby
Published: May 2008

There is growing interest in this country in developing training programmes suitable for overseas psychiatrists. The motive is partly one of self-interest. The implementation of current Government policy means that many departments will look to overseas visitors to fill their registrar positions in excess of their career registrar allocation.
What would Adolf Meyer have thought of the neo-Kraepelinian approach?
Authors: Double D. B.
Published: May 2008

Because of the problem of diagnostic unreliability in psychiatry, there has been a trend over recent years to create explicit diagnostic criteria, such as the Research Diagnostic Criteria and DSM–III. This movement has been called neo-Kraepelinian (Klerman, 1978) as it promotes many of the ideas associated with the views of Kraepelin, regarded as the founder of modern psychiatry. It favours a biological approach and arose partially as a response to attacks on the ‘medical model’ in psychiatry.
Career progression in psychiatry: perceptions and realities
Authors: Junaid Ola , Staines Jill
Published: May 2008

The guidelines on criteria necessary for promotion to senior registrar grade in psychiatry may be found in The Handbook for Inceptors and Trainees 1987. The criteria are essentially those in the 1980 edition, namely the need for possession of MRCPsych status and completion of at least three years general professional training approved by the College. Yet it is undeniable that in recent years eligible candidates have experienced much more difficulty in achieving appointment as a senior registrar. Indeed Holden (1988) comments that “dedicated clinical service and the qualification of MRCPsych is insufficient to guarantee a registrar success in his or her application for a senior registrar post”. In the increasingly competitive job market research experience, possession of publications, and management training have become valuable assets for prospective candidates. Our concern at the lack of pertinent career guidance for trainee psychiatrists prompted us to look at trainees' perceptions of requirements and at the provisions which exist in their training to enhance their career prospects.
A model of training for consultancy in psychiatry
Authors: Azuonye Ikechukwu Obialo
Published: May 2008

In the medical profession a consultant is a doctor who has attained the capacity for totally independent practice, otherwise known as clinical freedom. Consultants differ from other doctors in the important respect that they have full clinical responsibility (BMA, 1984). The work of the consultant may be audited by his peers, with his full participation, but may not be supervised by one (DoH, 1989a). Thus, whereas the consultant is accountable, administratively, to his employers, in the clinical area, he is not accountable to any other doctors or managers: he is accountable to the General Medical Council for his professional conduct, and, with respect to the diagnosis and treatment of illness, to the patients directly, the patients' relatives, and the law of the land.
Lucia di Lammermoor
Authors: Jones Mark
Published: May 2008

Some 40 years had passed since the death of Mozart, and Donizetti had made a name for himself with Anna Bolena and L'Elisir d'Amore. His music is certainly more fragile than Mozart's and his originality lies in his use of melody which is masterfully constructed to evoke humour, sentimentality and tragedy. In Lucia his musical canvass is, perhaps, the greatest he ever painted. Based on a story by Sir Walter Scott, it tells of the love of Lucia for Edgar of Ravenswood, who is the last of a rival household. In order that the Lammermoors' fortunes can be retrieved, Lucia's brother, Lord Henry Ashton, arranges for her to marry a politically influential figure, Lord Arturo Bucklaw. Ashton arranges that a forged paper indicating the infidelity of Lucia's lover is passed to her. She believes herself deserted and unwillingly consents to marriage with Bucklaw. On sealing the contract with her signature at the wedding, Edgar appears, having returned from France to claim his Lucia. Convinced that she has betrayed his love he damns her and throws the ring she gave him at her feet. The effect of this is to drive Lucia insane, she slays her husband and dies of her sorrows. Edgar waits to duel with Lord Ashton outside the castle. But Ashton flees, leaving Edgar in solitude. Edgar is then told by a procession of Lucia's death. He kills himself in sorrow.
The College Library
Authors: Floate Susan
Published: May 2008

A copy of the databaseCurrent Opinion in Psychiatryhas been installed on the Dell computer in the Library. The database provides information on current psychiatric literature as assessed by experts throughout the world who scan over 175 journals.
Stances towards euthanasia
Authors: Helme Tim
Published: May 2008

Active voluntary euthanasia may be defined as the deliberate taking of a patient's life, or the facilitation of his or her suicide, with the informed consent and at the express request of the patient. It may therefore be distinguished from passive euthanasia, when no positive step is taken to hasten death but when potentially life-saving measures are intentionally withheld, and also from non-voluntary euthanasia, when the patient is unable to participate in the decision, or is incapable of providing an adequately informed consent.
Sexual abuse of the mentally handicapped: difficulties in establishing prevalence
Authors: Buchanan Ann , Wilkins Robert
Published: May 2008

That adults with mental handicap∗ are particularly vulnerable to sexual exploitation is not new, although relatively unacknowledged or investigated. Indeed successive acts under the mental health legislation have sought to protect them, particularly those with severe mental handicap. With the growing awareness and identification of sexual abuse of children, and the growing knowledge of the long-term psychological effects (Jehu, 1989), which may be even more severe for people who have disabilities (Kennedy, 1990; Sinason, 1989), it has been acknowledged that not only are the mentally handicapped particularly vulnerable to abuse (Benedict et al, 1990), but the problem may well be seriously underestimated by those working in management positions (Brown & Craft, 1989). While it is recognised that the mentally handicapped have rights and need to express their sexuality, they also have the right not to be exploited or abused. We therefore need to know more about the numbers, indicators and circumstances where this group may be sexually abused and to develop policies, systems and training to protect them (Brown & Craft, 1989). This pilot study was a step in this process.
Chengdu (China)
Authors: Xiang Kang , Wang Yu
Published: May 2008

In this personal review we discuss the contemporary issues in Chinese psychiatry, the main themes in recent Chinese literature, and current psychiatric practice in China.
Training implications of the NHS and community care reforms: the myths and the realities
Authors: Lock Toni , Castle David
Published: May 2008

The NHS and community care reforms have implications for trainee psychiatrists, but many consultants are unable to instruct trainees in these areas.
The viewpoint of the elderly psychiatric patient
Authors: Semple Margaret M. , McLennan Jane M. , Ballinger Brian R.
Published: May 2008

There is now an increasing emphasis on the views of the consumers of health care, but little is known of psychiatric patients' opinions on their care and treatment. This may be due to an assumption that their reports are unreliable. Much of the research in this area has been carried out in the USA, although there have been reports from the UK and elsewhere (Freeman & Kendall, Hansson et al, 1985; Lazare et al, 1975; McIntyre et al, 1989; Weinstein, 1981).
Liaison psychiatry and Gulf casualties
Authors: Stevens David G.
Published: May 2008

This article describes the response of some RAF and RN mental health personnel and civilian mental health teams to the challenge of dealing with the psychological needs of wounded Servicemen. The preparation for war casualties could be seen as a useful exercise for future conflicts.
Supervision for work with overdose and deliberate self harm patients — a psychodynamic approach
Authors: Finch Emily , Ramsay Rosalind
Published: May 2008

The anxiety of staff working alone with overdose and deliberate self harm patients can be high, and demands more recognition. In assessing and treating such patients, staff often feel that they are being required to take responsibility for someone's future in the face of an enactment of extreme despair. This article looks at one way to deal with such anxiety.
The rise and fall of a community service for the ‘compulsory’ treatment of opiate addicted offenders
Authors: Mendelson Eric F. , Mason Stephen P.
Published: May 2008

The compulsory treatment of addicts has always attracted controversy and even generates strong emotional responses from workers in the field. But the few projects which have been mounted have yielded results no less encouraging than voluntary approaches and in some instances report greater success. These schemes have already been subject to an international comparison (Webster, 1986).
‘Teaching the teachers' — a survey of trainees’ teaching experience
Authors: Bramble David J.
Published: May 2008

With a view to stimulating discussion on the subject of trainee's attitudes towards, and experience of teaching, at an informal meeting of members of the Association of University Teachers of Psychiatry held in Leicester last year, a survey of Trent Region Psychiatric Senior Registrars, as well as delegates to the first College Trainees' Conference (held at Warwick University), was undertaken.
The structure of work environments in psychiatric rehabilitation
Authors: Mills Nigel
Published: May 2008

There is now an extensive literature describing the value of work for people with a psychiatric disability (Shepherd, 1989; Bennett, 1970; Wing & Brown, 1970; Pilling, 1988). Apart from financial gain the benefits of work can include social contacts and support; social status and identity; ‘normal’ non-patient roles; a means of structuring and occupying one's time; a sense of personal achievement and mastery and a criterion of recovery from illness (Shepherd, 1984). However, for many people with a long-term psychiatric disability the range of opportunity for work is often very limited, usually consisting of subcontract packing or assembly work. The provision of this repetitive and simple work satisfies a basic occupational need. However to a large extent it neglects the fulfilment of broader psychological and social needs. People with a vulnerability to experience periods of major mental disorder usually have more than just an occupational need; they also need to be in an environment which can provide the conditions that will actively assist in the promotion of a state of positive mental health.
Working for patients: will it work in practice?
Authors: Fisher Nigel R. , Turner Stuart R. , Pugh Robert
Published: May 2008

The College has described the White Paper, Working for Patients (Department of Health, 1989a), as “an artist's impression” (Royal College of Psychiatrists, 1989) with the lack of detail obscuring the full implications of the proposals. Some of this detail is now available in the form of a series of working papers. In fact these papers may raise more questions than they answer, and in some cases would seem to be inconsistent with pre-existing Government policy – especially that concerned with the care of the mentally ill in the community.
Patients in Broadmoor Hospital from the South Western region: an audit of transfer procedures
Authors: Smith Jeanette , Donovan Martin , Gordon Harvey
Published: May 2008

Broadmoor Hospital is one of the three special hospitals covering England and Wales. It provides approximately 500 beds for mentally disordered patients who on account of their dangerous, violent or criminal propensities constitute a grave and immediate danger to the public, requiring treatment in conditions of special security (Section 4, National Health Service Act, 1977). It is generally recognised, however, that there are patients in special hospitals no longer requiring treatment in conditions of maximum security. These patients could probably be more appropriately cared for elsewhere if the facilities existed in general psychiatric hospitals or the community. However, special hospital consultants frequently encounter significant obstacles when attempting to transfer patients to local hospitals. Dell (1980) highlighted this problem, suggesting that 16% of special hospital patients were waiting to leave, following the agreement of the DHSS and the Home Office to their transfer. This delay appeared to be due to hospitals not wanting to accept patients who might prove to be difficult or dangerous. At the time of this current study (March 1990) these difficulties in transferring patients were particularly relevant as two of the special hospitals, Broadmoor and Ashworth (Park Lane and Moss Side) were full for male patients and therefore closed to male admissions, despite a continuing demand for beds.
Audit and action in relation to drug prescribing for psychiatric patients
Authors: Schnieden Vivienne , Mealham Pat , Greenberg Maurice
Published: May 2008

A pilot study in Bloomsbury established that the majority of patients were dissatisfied with the information given about medication. Consequently a medication group was set up to which all patients were invited to discuss issues about medication. It emerged that many patients believed they had not been adequately informed about the medication they were receiving, or possible side effects, and would have liked to receive written information. It was therefore decided to review professionals' and patients' satisfaction with the information provided and to test whether leaflets improved patients' satisfaction.
Setting up a new regional child and family psychiatry unit: the involvement of referrers
Authors: Park Michelle , Langa Arturo , Likierman Helen , Evered Christopher
Published: May 2008

The North West Thames Regional Health Authority rationalised its in-patient service in 1989 to fund an eight-bedded five day unit for children under 13 years of age at Collingham Gardens. Riverside Health Authority's District Child Psychiatric Day Unit was also relocated to provide ten places primarily for pre-adolescent children. The unit is staffed by a multidisciplinary team of child workers, nurses, occupational therapists, psychologists, psychiatrists, teachers, and a psychotherapist, social worker and speech therapist.
Whither the disturbed patient: a study of regional secure unit referrals from two health districts
Authors: Lodge George J.
Published: May 2008

Roundway Hospital provides all rehabilitation and continuing care (rehab) beds for the Swindon Health District (Swindon), population 245,000; the Wiltshire sector of the Bath Health District (Wilts) population 200,000; and the Bath City sector of the Bath Health District (Bath), population 85,000.
5. Forensic psychiatry
Authors: Black Dawn , Guthrie Elspeth , Snowden Peter
Published: May 2008

Forensic psychiatry is a relatively new subspeciality concerned with giving advice on, and with the assessment and treatment of, mentally abnormal offenders. The forensic psychiatrist works at the interface between psychiatry and the law.
Scottish Action on Dementia: a new response to an old problem
Authors: Christie A. B.
Published: May 2008

Scottish Action on Dementia had its origins in informal meetings of individuals drawn from a variety of health care professions with a shared concern about the inadequacies of provision for dementia sufferers in Scotland in the mid 1980s. At the heart of these concerns lay the absence of any effective response to two major documents – the Timbury Report and SHAPE (Scottish Hospital Authorities Plans for the Eighties). Both accorded the highest priority to care of the elderly, particularly those suffering from mental illness, and had been accepted by all the principal parties concerned as the blueprint for health care policies in Scotland in the 1980s. The sober realities of 1985 prompted the founding members of Scottish Action on Dementia (SAD) to set themselves up as a multidisciplinary forum with three principal functions – to promote public education and awareness of dementia and its implications for sufferers, families and society at large; to act as an independent pressure group; and to monitor activities in the field of dementia care with a view to promoting and maintaining high standards. Five years later these objectives remain unchanged.
Confidentiality and the examining psychiatrist
Authors: McHale J. V.
Published: May 2008

The dilemma of the medical practitioner as to when to break confidence and when to keep silent has again attracted the attention of the courts recently in the case of R v Crozier (The Guardian, 1990).
Beginnings: The Bethel at Norwich
Authors: Winston Mark
Published: May 2008

In the centre of Norwich stands a red brick building which has a rare place in psychiatry. Its history began on 12 December 1712 when a lease on a small piece of waste ground was granted by the Corporation of the City of Norwich to four men. The men were acting as trustees for an elderly widow, and the deed specified the purpose of the lease: it was to build a house, or houses for “the benefit and use of such as are lunatics.” The term of the lease was 1,000 years at an annual rent of one peppercorn. The widow was one Mary Chapman. Born in 1647, she was the daughter of Thomas Mann, Mayor of the city and one of the richest and most influential men in Norwich. It is thought that she grew up close to the city's Bridewell, where many difficult lunatics would have been housed, and she is known to have had immediate experience of mental illness in her own, and her husband's families. In 1682 she married a widowed cleric, Samuel Chapman, some years her senior and the vicar of a local parish. Together they made plans for the Bethel but in 1700 she was widowed and left childless. Despite this she continued to develop her charitable project. The final choice of name, Bethel, or house of God, was her husband's.
Reading about … medical audit
Authors: Daly Oscar E.
Published: May 2008

The volume of literature on medical audit and the broader field of quality assurance is expanding rapidly. Medical audit is now a requirement for all medical practitioners; therefore, to perform it, they need to know something about it. There is a multitude of articles written in the journals, especially the British Medical Journal and the Journal of the Royal Society of Medicine. However, in this paper I intend concentrating on some of the many books pertaining to this field which have been published recently.
Jury service and ex-psychiatric patients
Authors: Maden Tony
Published: May 2008

The Matthew Trust has argued that ex-offenders and ex-patients of the special hospitals should not be allowed to do jury service until they have had at least ten years without offending or have been out of an institution for at least ten years. Mr Peter Thompson, Director of the Matthew Trust, argues that this period is necessary, in order to overcome the effects of institutionalisation and adjust to life in the community. The ex-offender or patient is held to be under such psychological pressure during this ten years, largely as a result of society's prejudices, that he would be unable to perform objectively on a jury.
‘Elderly graduates’ and a hospital closure programme: the experience of the Camberwell Resettlement Team
Authors: Holloway Frank
Published: May 2008

The closure of Britain's large psychiatric hospitals, long foreseen, is now rapidly becoming a reality. Surprisingly little is known about the process and outcome of the relocation of long-stay hospital residents. One area of particular concern is the fate of ‘elderly graduate’ patients, who are by convention defined as long-stay patients aged over 65 years who came into continuous psychiatric contact before the age of 65. (More cynically they might be defined as those elderly patients whom our colleagues specialising in the psychiatry of the elderly choose not to take over). This paper documents the experience of a specialist resettlement team working within a declining mental hospital attempting to place ‘elderly graduate’ hospital residents into community provision.
Mental handicap and the new long stay
Authors: Dickinson M. J. , Singh I.
Published: May 2008

For almost 20 years planning for the mentally ill and mentally handicapped has focused on a shift of care from hospital to community, the advantages and difficulties of this process generating much discussion and interest. The hospital population of the mentally handicapped is currently at the forefront of this change, planning impetus now being propelled by alterations in funding with budgets being transferred from NHS to local and social services. One consequence is the closure, or planned closure, of large mental handicap hospitals situated at the periphery of urban centres, with residents being moved to small group homes and hostels within the towns and cities the hospitals once served. The change should prove beneficial for a majority of residents although the process continues to generate debate.
Why isn't guardianship more popular in Scotland?
Authors: Weatherhead Anne E.
Published: May 2008

Guardianship can offer a measure of control and support in the community to individuals suffering from any type of mental disorder, be it mental illness or mental handicap, yet there were only 14 new guardianship cases in Scotland in 1989, compared with 3,604 episodes of detention under the Mental Health (Scotland) Act 1984 (MWC Annual Report 1989), and out of an estimated total of mentally disordered people in Scotland of more than half a million (Titterton, personal communication).
The assessment of parenting: some interactional considerations
Authors: Reder Peter , Lucey Clare
Published: May 2008

Psychiatrists are frequently invited to give expert opinions to Courts about children's emotional welfare, their parents' capacity to care for them and issues of placement and access. Previous child abuse/neglect may have been suspected or confirmed or the parents might suffer from psychiatric symptoms. Assessment may be required of parents' mental state with a guide to prognosis, but, in addition, factors in parent–child relationships will be crucial to overall assessments of parenting.
The future for psychiatry
Authors: Reed John
Published: May 2008

Policy for mental health services in England is based on two straightforward principles. These are, first that care should be provided as locally to where a person lives as is reasonably possible, and secondly that treatment should be available in the least restrictive conditions that are compatible with the safety of the patient, of those looking after him and of the public at large. I make no apology for reviewing the history of policy and practice; it is not possible to understand the mental health services that we are trying to achieve for the future without understanding how the service has developed over the years. I shall use the mental illness service as an example – similar considerations apply to the mental handicap services.
Sir Robert Armstrong-Jones
Authors: Wallis Geoffrey
Published: May 2008

Sir Robert Armstrong-Jones was President of the Medico-Psychological Association in 1906.
Police referrals — a crisis intervention approach
Authors: Morgan Janice , Cordingly John
Published: May 2008

Recently, concern has been expressed by mental health professionals, MIND, and the police regarding the management of Section 136 referrals, which at present varies according to the local psychiatric services available. In the majority of London Metropolitan Boroughs a person deemed to be in need of care and control is taken first to a police station where the necessary documentation is completed and then transported, often a considerable distance, to a mental hospital for the purpose of assessment. This can result in lengthy delays in a police cell for the patient, time-consuming negotiations with hospitals for the police, and problems completing the assessment procedure due to lack of availability of social workers. The importance of considering alternatives, particularly with the move towards community care, has been stressed.
The right stuff? a prospective controlled trial of trainees' research
Authors: Lewis Shôn
Published: May 2008

“One fine day, after he had joined a fighter squadron, it would dawn on the young pilot exactly how the losers in the great fraternal competition were now being left behind.” (Tom Wolfe)