bluuebunny/crossref_metadata_2025_split huggingface dataset:
The NHS and Community Care Act, 1990
Authors: Thornicroft Graham 
Published: October 2008

This is the first in a series of articles to be published serially in the Psychiatric Bulletin on recent government policy and legislation. Each article will describe a different piece of legislation and place it in its international perspective, highlighting how it will affect individual psychiatric practice, users of mental health services and the working relationship with purchasers and managers. The articles are aimed at all practising psychiatrists and those in training who wish to familiarise themselves with the important recent legislation that is having a profound effect on the practice of psychiatry in the UK. The legislation that will be covered includes the NHS and Community Care Act, The Health of the Nation community care plans and mental illness specific grant, the care programme approach, discharge and aftercare planning procedures, NHS trusts, fundholding and commissioning general practitioners and the purchaser provider split. There will be a summarising article to reflect common themes and trends. The series was commissioned by Dr Sara Davies and Dr Jeanette Smith, Trainee Editors at the Psychiatric Bulletin.The National Health Service and Community Care Act, 1990, enacts some provisions contained in the Working for Patients and Caring for People White Papers. The former measures were introduced immediately in 1990 and contain, for example, the legal basis for NHS trusts and fund-holding GPs. Most of the community care sections of the Act were delayed in their implementation until April 1993. The key element is allocating the main coordinating responsibility as ‘lead agency’ to local social service authorities; they are charged with conducting ‘needs assessments’ on clients presenting with problems. Whether, however, there is a legal obligation upon social services departments to provide care for people with unmet needs to not yet dear.
Depression: counting the costs
Authors: Haddad Peter M. 
Published: October 2008

The Merck Essay Prize was inaugurated in 1993. All trainee psychiatrists (senior house officers, registrars or senior registrars) in the United Kingdom and Republic of Ireland were eligible to submit an essay on the topic: ‘Depression: Counting the Costs’. The winning essay by Dr Peter Haddad is printed here. The runners-up in Joint second place were Dr J. Bray, Lecturer, University of Leicester (Leicester General Hospital) and Dr R. Bullock, Senior Registrar, St Mary Abbots Hospital, London.Depressive illness is the commonest form of mental disorder in the community. Its effects are far-reaching and include psychological suffering and social disruption for affected individuals and their families, increased mortality, and direct and indirect financial costs for society. Only about half of all cases of depression are recognised by doctors and not all of these receive effective treatment. The costs of depression could be reduced if detection and treatment were improved. Addressing this is a major challenge for psychiatric services.
Deliberate self-harm: service development in Kettering
Authors: Gordon Catherine , Blewett Andrew 
Published: October 2008

Services for deliberate self-harm patients in the general hospital are unsatisfactory in many respects. A survey of activity and quality in a district general hospital confirmed recent trends observed elsewhere and highlights areas in which service provision can be improved.High rates of deliberate self-harm (DSH) are a public health problem. A study in Oxford showed rising rates among young women during the late 1980s, and a threefold increase in the proportion due to paracetamol poisoning between 1976 and 1990 (Hawton & Fagg, 1992). A multicentre European study found a trend of increasing peak age, a declining female to male ratio, and unexplained differences between regions (Platt, 1992). In the year following DSH, 9% repeat (Hawton & Fagg, 1992); and suicide rates reach 1.1 to 1.3% of patients in the three years following an episode of DSH (Owens et al. 1991).
Failed discharges from the psychogeriatric ward
Authors: Too Judy , Gardner Justin , Savla Navin 
Published: October 2008

‘Failed discharge’ was used as a measure of service efficacy on a psychogeriatric unit. Thirty-eight failed discharges from hospital were compared with 38 controls. Failed discharge was associated with a diagnosis of depression and a greater number of previous admissions. Possible underlying causes are discussed.In the current NHS climate, it is increasingly important to measure the outcome of medical care. In psychiatry, the most appropriate methodology is not clear-cut (Garden & Oyebode, 1989). Tailed discharge’, or readmission to hospital within a short period of discharge, has been advocated as a possible outcome measure (Jones, 1991). This point prevalence study, of patients under 65 years, yielded a ‘failed discharge’ rate of 27%. Recurrence of original symptoms, poor treatment compliance and failure of follow-up arrangements emerged as important factors.
Time to amend Section 135
Authors: Cutajar Peter , Hampson Michele 
Published: October 2008

Section 135 of the Mental Health Act (1983) allows a Justice of the Peace, on information provided on oath by an approved social worker, to issue a warrant allowing any constable named in the warrant to enter, if need be by force, any premises in which there is reasonable cause to suspect that a person believed to be suffering from a mental disorder:
(a)has been, or is being, ill-treated, neglected or kept otherwise than under proper control: or(b)being unable to care for himself, is living alone in any such place, and, if thought fit, to remove him to a place of safety.
Reports prepared for Mental Health Review Tribunals and Managers' Reviews
Authors: Davison Phil , de Albeniz Alberto Perez 
Published: October 2008

Little advice is offered in the literature for the novice report writer, despite the gravity of the situation, for example, a patient appealing against detention. Section 20, which renews the authority for detention after periods of 6 months or a year, is a useful reminder for clinicians, as it outlines the components that must be present in order for detention to continue.This audit established guidelines for the completion of reports for Mental Health Review Tribunals and Managers' Reviews. A structure and list of ‘features to be included’ was compiled. This was used to rate the standard of reports prepared in the Warneford Hospital between 1991–1993. Following peer consultation within the hospital, the guidelines were considered acceptable and useful. At re-audit after 8 months the standard of reports had improved in most respects.
Locked ward patients 25 years on
Authors: Feakins Martin 
Published: October 2008

Aims and methodA retrospective case note study of 43 patients who were residents of a locked ward in 1970, augmented by a cross-section of the ward's current residents was undertaken.ResultsThe study established a profile of the 43 patients in 1970 and determined their outcomes. A brief comparison of the use of medication then and now was also undertaken.Clinical implicationsThis view of the past aimed to provide a prospective on why and how the field has changed, and to facilitate planning for the future.
Primary health care service for long-stay psychiatric in-patients
Authors: Fisher Nigel , Roberts Judy 
Published: October 2008

Aims and methodA retrospective review of the activity of a general practitioner employed specifically to provide a primary health care service to the residents of an ‘old long-stay’ psychiatric ward was undertaken.ResultsAll but one patient had a chronic physical health problem requiring active management. Presenting pathology covered all organ systems. The review indicated that these health problems had not previously been satisfactorily managed by psychiatrists. This service was acceptable to and valued by patients.Clinical implicationsThe success of the service was only achieved by dedicating specific resources to meet primary health care needs. The extent to which this model could be extended to ‘new long-stay’ populations located in dispersed hospital hostels is less certain.
Satisfaction of ottenders and non-attenders with their treatments at psychiatric out-patient clinics
Authors: Killaspy Helen , Gledhill Julia , Banerjee Sube 
Published: October 2008

Aims and methodNon-attendance at psychiatric outpatient appointments has a substantial financial cost, and may also have clinical significance. To prevent non-attendance and formulate effective responses, its determinants need to be understood. Patient dissatisfaction with services has been suggested as a reason for non-attendance, we therefore investigated the role of patient satisfaction in attendance at psychiatric out-patients appointments. All patients booked for adult psychiatric out-patient follow-up appointments in a three-month period were studied using a brief, self-report questionnaire.ResultsSixty-three per cent (340/538) of offenders and 54% (118/219) of non-attenders responded. Responders expressed high levels of satisfaction with their treatment (92% offenders, 91% non-attenders) and with the service (96% attenders 92% non-attenders). Despite adequate statistical power, there were no statistically significant differences in satisfaction between the two groups.Clinical implicationsIn conclusion, patient satisfaction with psychiatric out-patient care was reported to be relatively high and did not seem to be an important determinant of non-attendance. Further work is needed to determine the impact of variables such as relapse and social disorganisation on attendance.
Mental health review tribunal medical reports
Authors: Ismail Khalida , Smith Shubulade , Maden Tony 
Published: October 2008

Aims and methodMedical reports submitted to mental health review tribunals should be of a clinically acceptable standard. We examined 100 medical reports to assess whether they stated the four criteria for detention under Section 3 of the Mental Health Act 1983. We compared the standard of reports according to the seniority, qualifications and speciality of the doctor, and with the outcome from the tribunal.ResultsThe majority of the reports were written by junior doctors and did not fulfil the criteria laid down by the Mental Health Act 1983. Consultant and forensic psychiatry status were associated with completed reports.Clinical implicationsThis study was performed in one hospital only but highlights the ongoing need to review and improve the workings of the Mental Health Act before reform is considered.
Provision for people with anxiety disorder by a community health care trust
Authors: Middleton Hugh , Ball Lisa , Blore David , Dunn Helen , Foster Margaret , Hart Barbara , Majid Ifti , Rajan Peter 
Published: October 2008

Aims and methodProvision for patients with loosely defined anxiety disorders has been reviewed. During a two-week period. 66 of the 69 adult mental health practitioners working in a modestly sized community health care trust surveyed all patients with anxiety disorder currently under their care.ResultsThese practitioners were seeing a total of 758 patients who fitted a loose definition of anxiety disorder. A further 134 patients had been treated in anxiety management groups during the preceding year. Disparate treatments were being used, reflecting idiosyncratic approaches to this otherwise homeogenous group of patients.Clinical implicationsLess than one-tenth of the estimated population of anxiety disorder patients were receiving specialised treatment. Among those that were, choices of treatment were arbitrarily determined and idiosyncratic. It was clear that the management of these patients does not fulfill the requirements of ‘evidence-based practice’.
Death certification in a psychiatric hospital
Authors: Salib Emad 
Published: October 2008

Aims and methodA retrospective review of death certificates issued at a large psychiatric hospital in North Cheshire during the 1980s and 1990s.ResultsDementia, which was the recorded clinical diagnosis in 78% of all deceased, was reported in 31% of death certificates, while other psychiatric disorders (22% of all deceased) appeared in only 2% of certificates. Autopsy appears to have very little or no value in improving the quality of death certificates in psychiatry.Clinical implicationsThe onus is on the clinicians to produce adequate death certificates. Recording chronic conditions present at death, such as dementia and other psychiatric disorders, in addition to those directly causing or contributing to death would improve the epidemiological value of death certificates.
Lamotrigine in bipolar affective disorder
Authors: Duncan Denise , McConnell Harry W. , Taylor David 
Published: October 2008

Aims and methodThe study aimed to assess the available data on the use of lamotrigine as a mood stabilising agent. We reviewed all published and unpublished data available to us through a Medline search from 1987–1998 and from our own files, which include reference materials presented at conferences as well as published reports.ResultsMost of the data found were derived from case reports or open trials. We could find no published double-blind, placebo-controlled studies. The data from initial open trials suggest that lamotrigine may be effective in bipolar disorder, but futher data are required before specific treatment recommendations can be made.Clinical implicationsAt this early stage, there are too few data to recommend lamotrigine for first or second line therapy in bipolar disorder. However, initial reports are very promising and this agent may eventually be unequivocally shown to be useful in treating mania, hypomania, depression, rapid cycling and mixed affective states in people with bipolar disorder.
Rationale behind psychiatrists' choice of drug
Authors: Dickson-Mulinga John 
Published: October 2008

Aims and methodThe study investigated the reasons that influence medical staffs' choice of a specific drug over another given the same clinical situation, by use of a questionnaire-based survey. The study population was 88 clinicians of various ranks, at psychiatry units in National Health Service university and district general hospitals In Greater Manchester. Responses in the factors: personal experience, scientific evidence, influence from colleagues, economic consideration, influence by drug representatives, ward or unit policy and other in choice of prescription, were the main outcome measures.ResultsOf the 546 responses generated by the 88 clinicians, 263 (48.2%) were for personal experience as the most important influence on choice of prescription. Scientific evidence was the second most important factor with 117 (21.4%) responses. Economic consideration and influence by drug representatives were least important. This trend held for all ranks except for registrars, where scientific evidence was as important as personal experience.Clinical implicationsAs prescribers, clinicians trust mostly in their own personal experience. This may not be unique to psychiatrists. An understanding of how clinicians gain ‘personal experience’ could be important in improving rational prescribing.
Assessing the physical health of psychiatric patients
Authors: Osborn David P. J. , Warner James P. 
Published: October 2008

Aims and methodMost medical diagnoses are made from the physical history alone. In the psychiatric literature, physical assessment usually focuses on examination rather than history. We aimed to ascertain the relative importance that trainee psychiatrists attach to the physical history and examination, and to investigate their actual method of physical assessment. The relative weight that trainees attach to physical history and examination was assessed with a postal questionnaire. Their actual practice was evaluated by reviewing a selection of case notes from patients under their care.ResultsTrainees weighted the physical examination as more important than the history in theoretical terms (P=0.02). They also indicated that they attached more importance to examination in their own practice (P=0.03). On review of the case notes, 34 (71%) of inpatients had been physically examined, but only one (2%) had evidence of a physical history.Clinical implicationsIt appears that many psychiatric trainees do not adhere to the basic medical principle of taking a physical history on which to base a physical examination. ‘Blind’ examinations are unlikely to yield medical diagnoses. These findings have implications for our patients' health and psychiatric training.
Psychotherapy on a shoestring: improving training using existing resources
Authors: Davies Stephen Paul 
Published: October 2008

Aims and methodThis article aims to describe qualitatively attempts in one NHS trust to improve psychotherapy training for psychiatry trainees, according to the Royal College of Psychiatrists' Guidelines, using existing multi-disciplinary resources.ResultsTraining opportunities in a wide range of interventions were identified. A psychotherapy supervision group was established, and a psychotherapy training post was introduced for a trial period. The costs and benefits are discussed.Clinical implicationsSubstantial improvements in psychotherapy training can be made using existing resources, even in the absence of a consultant psychotherapist. Flexibility and coordination are required.
Specialist assessment clinic for pervasive developmental disorders
Authors: Falls Niall 
Published: October 2008

Aims and methodThe Joint Committee on Higher Psychiatric Training lists the ability to carry out a thorough clinical assessment including physical and mental state examination, as one of the essential core skills in child and adolescent psychiatry. Experience of the assessment of comparatively rare disorders may depend upon the organisation of regional services, as well as good working relationships between teams willing to involve the trainee.ResultsThis paper describes a six-month attachment to the first multi-disciplinary Specialist Assessment Clinic for Pervasive Developmental Disorders to be created in Northern Ireland. Assessments are multi-dimensional and multi-professional. Attachment to this specialist clinic has become a valuable resource, with demand exceeding availability of places.Clinical implicationsThe pervasive developmental disorders are characterised by onset before 36 months, qualitative impairments in social interaction and communication (both verbal and non-verbal), and a pattern of repetitive or stereotyped activities or interests (DSM-IV). Diagnostic criteria for these disorders have broadened since the introduction of DSM-IV and ICD–10. For example, both have now agreed the validity of Asperger's syndrome, featuring difficulties in social interaction, restricted and repetitive areas of interest, without clinically significant impairment of intelligence or language development.
The psychotherapy department and the community mental health team: bridges and boundaries
Authors: Holmes Jeremy 
Published: October 2008

Aims and methodThe aim of the study was to clarify the role of psychotherapy departments in relation to a general psychiatric service, and in particular community mental health teams (CMHTs). Literature reviews of therapeutic activities in CMHTs and of psychotherapy delivery methods were undertaken. The implications of the National Health Service Executive document on Psychotherapy Services in England was considered, based on experience of the psychotherapy-general psychiatry interfaces in North Devon and Bristol.ResultsPsychological therapies are an integral part of psychiatric treatment provided in CMHTs, but are often delivered without careful assessment training or supervision. Psychotherapy departments contain expertise in the range of psychological therapies, but are sometimes perceived as remote from everyday psychiatric practice. Ways in which the divide between general psychiatry and psychotherapy might be bridged are suggested. A multi-disciplinary psychological treatment unit can offer specialist resources for the assessment and treatment of complex cases, especially those with personality disorders; psychological interventions in psychosis; and brief focused therapies for neurotic disorders unresponsive to drugs.Clinical ImplicationsConsultation and liaison with the CMHT should become a key element in the work of a psychological treatment unit, and structured therapies under supervision similarly central to the work of CMHTs.
Patients' knowledge of their lithium therapy
Authors: Anderson J. , Sowerbutts K. 
Published: October 2008

Aims and methodUsing a semi-structured questionnaire, we surveyed the patients attending an out-patient affective disorders clinic, enquiring about their knowledge of their lithium therapy.ResultsThe response rate was 68%. In general, the level of knowledge relating to their own treatment was good, however we were able to identify particular areas of deficiency in their theoretical knowledge.Clinical implicationsThe only factor we could identify which had a significant effect on patients' level of knowledge was having received education on lithium in more than one form.
Medication refusal among patients treated in a community mental health rehabilitation service
Authors: Macpherson Rob , Alexander Minh , Jerrom W. 
Published: October 2008

Aims and methodThis study aimed to examine medication refusal and its associated variables in a representative sample of patients on the Gloucester rehabilitation service case register. One hundred and seventy-four of 199 patients on the Gloucester rehabilitation register were surveyed. Insight cognitive function, knowledge of treatment, psychopathology and patient satisfaction were independently rated.ResultsThirty-five per cent of patients had refused treatment in the past month. Negative attitudes to treatment and historical indices of non-compliance were associated, identifying a consistent core of patients at continuing risk of refusal. However of refusers, 84% were persuaded within one month to take treatment, mostly by their community keyworker. Treatment refusal was associated with diagnosis of affective disorder, higher Brief Psychiatric Rating Scale score and failure to use a dosett dispenser, but not with insight cognitive function, satisfaction with treatment, knowledge of treatment, a range of illness and demographic factors or any particular treatment type.Clinical implicationsDrug refusal was evidently mostly managed by community keyworkers, and without recourse to the Mental Health Act. Simple techniques such as the use of dosett dispenser may be valuable. Problems of communicating with the severely mentally ill about their long-term treatment were discussed.
Model of forensic psychiatric community care
Authors: Whittle Mary C. , Scally Mark D. 
Published: October 2008

Aims and methodThe paper describes the establishment of a specialist forensic team providing an integrated model of forensic community psychiatric care.ResultsA description is provided of the problems encountered in setting up and running the service and of the ways in which those problems were managed.Clinical implicationsThe integrated model has the advantage of minimising stigma, providing support and education for staff and enabling forensic expenditure to be provided for a wider group of patients and staff than would otherwise be possible.