We conducted a telephone survey of medium secure units in England and Wales to determine the distribution of women patients.

The survey identified 1836 medium secure beds, housing 342 women patients. Women in the NHS were housed primarily in mixed-gender units (170 women, 94%). Most NHS beds in single-gender units were for men (56 beds), whereas most private sector beds in single-gender units were for women (79 beds).

Increased awareness of the often inappropriateness of services for women in mixed-gender units has led to units deciding not to admit women patients and, inadvertently, more single-gender beds for men in NHS units than for women. The NHS units have to rely on private sector units to provide beds in single-gender units for women, perhaps at the expense of effective continuity of care.

To establish prevalence of domestic violence among female psychiatric patients, including risk factors, health professional attention and acceptability of routine enquiry. Participants were 70 adult women in an inner-city community mental health team who received questionnaire and case-note review. Main outcome measures were: lifetime/point prevalence of domestic violence; attitudes to routine enquiry; past disclosure and recording in psychiatric records; clinical and demographic risk factors.

Lifetime prevalence was 60% for physical violence from partners, 27% during pregnancy and 40% receiving injuries. Point prevalence was not reported, as an insufficient number of participants were currently in a relationship. As many as 82% regarded routine enquiry as acceptable, but only 24% had ever been questioned. Logistic regression analysis showed prediction by presence of children, previous overdose, and experience of sexual abuse.

Domestic violence in female psychiatric patients is common but undetected. Enquiry should be routine, but would require staff training.

To identify the prevalence and patterns of substance misuse in patients with schizophrenia in a catchment population in Dublin, and to compare this with that of a control group from general practice. Ninety-nine patients and 75 controls were interviewed using a semi-structured technique. Urine samples were obtained from all patients and controls were analysed for illicit substances.

Prevalence of illicit substance and alcohol misuse was similar among patients (illicit substances, 45%; alcohol, 33%) and controls (illicit substances, 43%; alcohol, 25%). Patterns of substance misuse were similar, apart from ecstasy, which was used more commonly by controls. Discrepancies were found between histories of drug use and urinalysis.

Illicit substance misuse in patients with schizophrenia may mirror usage in the general population, rates of misuse reflecting cultural factors rather than illness and patterns of misuse reflecting geographical variations in the availability of drugs. A combination of screening methods is more effective than the use of a single source of information.

The aim of the study is to improve patient safety by identifying factors influencing gatekeeping decisions by crisis resolution and home treatment teams. A theoretical sampling method was used to recruit clinicians. Semi-structured interviews to elicit various aspects of clinical decision-making were carried out. The transcripts were thematically analysed using a grounded theory approach.

Patient needs (safety and treatment) was the primary driver behind decisions. The research also revealed that information gathered was processed using heuristics. We identified five key themes (anxiety, weighting, agenda, resource and experience), which were constructed into an acronym ‘AWARE’.

AWARE provides a framework to make explicit drivers for decision-making that are often implicit. Incorporating these drivers into reflective practice will help staff be more mindful of undue influences and result in improved clinical decisions.

None.

To obtain a prioritised list of psychiatrists' concerns relating to in-patient child and adolescent mental health services. Four-hundred and fifty-four members of the child and adolescent faculty of the Royal College of Psychiatrists were asked to list their main concerns.

Two-hundred and seventy-four members responded. The most reported themes included lack of emergency beds; lack of services for severe or high-risk cases; lack of beds in general; poor liaison with patients' local services; lack of specialist services; and poor geographic distribution of services.

The range of themes identified from this survey have served to focus the National In-patient Child and Adolescent Psychiatry Study (NICAPS) and several design changes have been made to NICAPS as a result.

Despite extensive evidence that attention-deficit hyperactivity disorder (ADHD) and developmental coordination disorder commonly present as overlapping disorders, it is not clear whether clinicians routinely enquire about movement difficulties when assessing children with suspected ADHD. We describe a survey that examines knowledge and practice of child and adolescent psychiatrists (n=107) and paediatricians (n=51) in this area.

Results show that 67.3% of child and adolescent psychiatrists compared with 15.7% of paediatricians claimed to have poor or very poor knowledge of developmental coordination disorder, and 28% compared with 5.9% respectively reported that they never or only occasionally ask about motor difficulties.

Child and adolescent psychiatrists should consider routine screening for developmental coordination disorder when assessing for ADHD. Further training in assessment of developmental coordination disorder is recommended to facilitate this.

We conducted a questionnaire study to establish the incidence, specialist staff availability, treatment provision and socio-demographic profile of patients with first-episode psychosis referred to all adult and child and adolescent community mental health teams in south and west London.

All 39 teams completed the questionnaire, identifying 295 cases of first-episode psychosis (annual incidence 21/100 000/year) referred in the year 2000. Teams manage to engage most patients with first-episode psychosis. A total of 73% of cases of first-episode psychosis were on some form of Care Programme Approach. However, many teams did not have adequately trained staff to provide psychosocial interventions. Even where such staff were available, care was focused mainly on monitoring medication and risk assessment, with only half the teams providing psycho-educational programmes and only a quarter offering individual cognitive–behavioural therapy to those with first-episode psychosis.

Establishing early intervention services nationwide will require significant new resources, including specialist trained staff, which could prove difficult to provide in inner-city areas. Rather than a single, uniform service model, several models of early intervention services based on locally determined need might be more realistic and appropriate, and also allow research into their relative efficacy.

With increasing numbers of students and falling numbers of individuals receiving electroconvulsive therapy (ECT) it has been difficult to timetable all students to witness ECT, and it has been suggested that this experience may be dispensed with. However, we wondered how the experience of witnessing ECT might enhance students' knowledge and, just as importantly, challenge negative perceptions of ECT. We surveyed students' attitudes and knowledge at the beginning and the end of their 8-week attachment in psychiatry.

There appears to be a clear benefit in terms of knowledge and positive attitudinal change for students who both witness ECT and receive a lecture on the subject.

Direct observation of ECT can challenge and affect attitudes in ways a lecture may not. Any changes to the provision of ECT teaching for medical students, including replacing witnessing ECT, needs to be carefully developed and assessed.

The aim of the study was to obtain numbers of adult patients with attention-deficit hyperactivity disorder (ADHD) on consultant adult and adolescent psychiatrists' case-loads. A brief semi-structured confidential postal questionnaire was sent to 1947 consultant psychiatrists in England and Wales.

There were 1030 consultants who responded (52.9%), which clearly indicates that there is an increasing demand and need for a service, and the resources, to treat adult ADHD. Only 197 consultants offered a service for adults with ADHD. Adult ADHD is more commonly diagnosed in males (n=995, 73%), and the total number of patients with a diagnosis of adult ADHD was 1345. Most patients were aged 18–25 years (n=209, 54%). The most commonly prescribed stimulant medication was methylphenidate (n=251, 55%).

There is a clear need to improve services and funding for adults with ADHD. The study shows there are already services available for adult ADHD patients in some areas of the country. However, more research is needed to establish the prevalence of adult ADHD in England and Wales.

Mental health services have changed the way they operate during the COVID-19 pandemic. We investigated the challenges and innovations reported by staff working in services for people with intellectual disability and/or autism in National Health Service (NHS) and non-NHS sectors, and in in-patient and community settings.

Data were drawn from 648 staff who participated in a UK-wide online survey. Issues around infection risk and mitigation were more important to those working in the NHS and in-patient settings. Community staff were more likely to express concern about the practicalities of a rapid shift to remote working and engaging patients remotely. Qualitative data revealed support for maintaining remote staff working and remote service provision post-pandemic.

Given the current emphasis on community support for people with intellectual disability and/or autism, the focus of research and clinical practice should be the development of accessible and effective models of remote service provision.