A cross-sectional study to ascertain levels of personal and perceived public mental illness stigma in a university student population and the association between the respective levels of stigma and help-seeking intention. An adaptation of the Discrimination-Devaluation scale was used.

A total of 735 students participated in the study (response rate 77%). There were higher mean perceived public stigma levels than personal stigma levels. Perceived public stigma was not significantly associated with future non-help-seeking intention (odds ratio (OR) = 0.871, P = 0.428). Personal stigma was significantly associated with a decreased likelihood of future help-seeking intention (OR = 1.44, P = 0.043). Being younger than 25, having no history of or treatment for mental illness and having no personal contact with someone with a history of mental illness were all associated with higher personal stigma levels.

This study indicates that personal stigma as distinct from perceived public stigma is a significant barrier to mental health utilisation for a student population and future stigma reduction campaigns could strategically focus on this.

This survey is the first UK study of trainee psychiatrists' experiences of patient suicide. One hundred and three senior and specialist registrars in psychiatry working in Scotland completed the questionnaire, representing an 81% response rate.

Almost half (47%) had experienced suicide of a patient in their care or otherwise known to them (e.g. through on-call experiences). Although only 28% recalled previous training on issues to consider following a suicide, all of these doctors found this to be of value. Many reported that patient suicide had a deleterious impact on their personal and professional lives. The most valuable supports were informal, and the trainees' consultants appeared particularly well placed to offer support and advice.

Many trainee psychiatrists experience the suicide of a patient. Such experiences have potential for adverse effects on doctors' professional practice and personal life. Greater availability of training in this area would allow trainees to be better prepared for such an event. Trainees' consultants have a pivotal role to play in providing appropriate advice and support after a patient suicide.

The aim of this study was to determine the attitudes of medical students in the UK towards different specialties as career options and to ascertain the position of psychiatry among these specialties. Students belonging to a London medical school completed a questionnaire.

Among the 301 students who completed the survey, psychiatry was the least popular clinical specialty. The study revealed that the students had a number of misconceptions about psychiatry. A family history of mental illness was significantly associated with choosing psychiatry as a career.

Considering the unpopularity of the specialty, it is likely that recruitment of psychiatrists will continue to be a major problem for the foreseeable future. Measures need to be taken to dispel the misconceptions about psychiatry.

The aim of this survey was to examine staff views on smoking at work in a large psychiatric hospital. A postal questionnaire was sent to all clinical staff (n=1471) asking about their smoking habits and attitudes to smoking at work.

The response rate was 40.7%. Overall, 22.0% of respondents were smokers, with unqualified nursing staff having the highest rate (31.0%). The majority of staff did not favour a total ban on smoking by staff, patients or visitors. Smoking habit and profession influenced responses. Smokers and nurses were more permissive in their attitude towards smoking on wards than non-smokers and psychiatrists.

Implementation of the government's recommendations on tobacco control in psychiatric units is likely to require considerable preparatory work with staff to ensure full compliance.

To explore what young people who self-harm think about online self-harm discussion forums. SharpTalk was set up to facilitate shared learning between health professionals and young people who self-harm. We extracted themes and illustrative statements from the online discussion and asked participants to rate statements.

Of 77 young people who participated in the forum, 47 completed the questionnaire. They said they learned more about mental health issues from online discussion forums than from information sites, found it easier to talk about self-harm to strangers than to family or friends, and preferred to talk online than face-to-face or on the telephone. They valued the anonymity the forums provided and reported feeling more able to disclose and less likely to be judged online than in ‘real life’.

Mental health professionals should be aware of the value of anonymous online discussion forums for some young people who self-harm, so that they can talk about them and assess their use with their patients.

This study aimed to identify predictors of symptom severity for post-traumatic stress disorder (PTSD) and depression in asylum seekers and refugees referred to a specialised mental health centre. Trauma exposure (number and domain of event), refugee status and severity of PTSD and depression were assessed in 688 refugees.

Symptom severity of PTSD and depression was significantly associated with lack of refugee status and accumulation of traumatic events. Four domains of traumatic events (human rights abuse, lack of necessities, traumatic loss, and separation from others) were not uniquely associated with symptom severity. All factors taken together explained 11% of variance in PTSD and depression.

To account for multiple predictors of symptom severity including multiple traumatic events, treatment for traumatised refugees may need to be multimodal and enable the processing of multiple traumatic memories within a reasonable time-frame.

We surveyed the usage and perceived utility of standardised risk measures in 29 forensic medium secure units (a 62% response rate).

The most common instruments were Historical Clinical Risk–20 (HCR–20) and Psychopathy Checklist – revised (PCL–R); both were rated highly for utility. the Risk Matrix 2000 (RM2000), Sex Offender Risk Appraisal Guide (SORAG) and Static-99 were the most common sex offender assessments, but the Sexual Violence Risks–20 (SVR–20) was rated more positively for its use of dynamic factors and relevance to treatment.

Most medium secure units use structured risk assessments and staff view them positively. As HCR–20 and PCL–R/PCL–SV (Psychopathy Checklist – Screening Version) are so widely used they should be the first choices considered by other services.

We undertook a postal questionnaire survey of all consultant psychiatrists working in Scotland to examine whether psychiatrists themselves may contribute to the misunderstandings surrounding schizophrenia by avoiding discussion of the diagnosis with their patients.

Two-hundred and forty-six (76%) responded. Ninety-five per cent thought the consultant psychiatrist was the most appropriate person to tell a patient their diagnosis of schizophrenia, although only 59% reported doing so in the first established episode of schizophrenia, rising to 89% for recurrent schizophrenia. Fifteen per cent would not use the term ‘schizophrenia’ and a variety of confusing terminology was reported. Over 95% reported telling patients they had mood disorders or anxiety, under 50% that they had dementia or personality disorders.

Greater openness by psychiatrists about the diagnosis of schizophrenia may be an essential first step in reducing stigma.

We used an online questionnaire to investigate medical students' perceptions of the apparent hierarchy between specialties, whether they have witnessed disparaging comments (‘badmouthing’ or ‘bashing’) against other specialists and whether this has had an effect on their career choice.

In total, 960 students from 13 medical schools completed the questionnaire; they ranked medical specialties according to the level of badmouthing and answered questions on their experience of specialty bashing. Psychiatry and general practice attracted the greatest number of negative comments, which were made by academic staff, doctors and students. Twenty-seven per cent of students had changed their career choice as a direct result of bashing and a further 25.5% stated they were more likely to change their specialty choice. Although 80.5% of students condemned badmouthing as unprofessional, 71.5% believed that it is a routine part of practising medicine.

Bashing of psychiatry represents another form of stigmatisation that needs to be challenged in medical schools. It not only has an impact on recruitment into the specialty, but also has the wider effect of stigmatising people with mental health disorders.

To understand the benefits and limitations of using psychological formulations for patients with severe mental illness, a qualitative study of staff views was conducted, based on semi-structured interviews with 25 staff working in a high-dependency rehabilitation service.

Participants believed that formulations benefited care planning, staff–patient relationships, staff satisfaction and teamworking, through increasing understanding of patients, bringing together staff with different views and encouraging more creative thinking. They particularly valued meeting together to develop the formulations. Some staff accepted formulations as tentative and provisional, whereas others regarded them as statements of conviction.

The study suggests that using psychological formulations in the care of psychiatric patients may well be valuable, but needs further exploration.

We aimed to find out how patients on clozapine felt about clozapine treatment. A structured questionnaire was given to 1284 consecutive patients attending 27 clozapine clinics in the UK.

The response rate was 44.4% (570 forms returned). This cohort of responders to the questionnaire consisted, for the most part, of Caucasian males who had been taking clozapine for more than 2 years. Respondents expressed largely favourable views on clozapine treatment. For example, 86.1% claimed to feel better on clozapine and 88.6% claimed to prefer to remain on clozapine than to change to another drug. Many patients stated that they disliked having to undergo blood testing, but a large majority (87.0%) felt that the advantages of clozapine outweighed disadvantages. All other responses supported this overall favourable view of clozapine therapy.

Patients stabilised on clozapine are largely content with their treatment. These results suggest that clozapine is effective as assessed by patients' own standards and that adherence to therapy is likely to be good.

The Transitions of Care from Child and Adolescent Mental Health Services to Adult Mental Health Services (TRACK) study was a multistage, multicentre study of adolescents' transitions between child and adult mental health services undertaken in England. We conducted a secondary analysis of the TRACK study data to investigate healthcare provision for young people (n = 64) with ongoing mental health needs, who were not transferred from child and adolescent mental health services (CAMHS) to adult mental health services mental health services (AMHS).

The most common outcomes were discharge to a general practitioner (GP; n =29) and ongoing care with CAMHS (n = 13), with little indication of use of third-sector organisations. Most of these young people had emotional/neurotic disorders (n = 31, 48.4%) and neurodevelopmental disorders (n = 15, 23.4%).

GPs and CAMHS are left with the responsibility for the continuing care of young people for whom no adult mental health service could be identified. GPs may not be able to offer the skilled ongoing care that these young people need. Equally, the inability to move them decreases the capacity of CAMHS to respond to new referrals and may leave some young people with only minimal support.

Death of patients by suicide can have powerful effects on psychiatrists. We report the findings of a survey completed by 174 psychiatrists on the effects of patient suicide on their emotional well-being and clinical practice, and the support and resources they felt would be helpful.

The death of a patient by suicide usually had a major effect on respondents. Clinical practice was often negatively affected, and over a quarter of respondents considered a change of career path as a result. There were some gender differences in responses, with women reporting more sense of responsibility for the deaths and a greater effect on their clinical confidence. Desired support included a senior suicide lead clinician, support during formal post-suicide processes, opportunity for reflection on practice, information about resources to support families and help communicating with families and friends of the deceased.

We aimed to establish current practice in the risk assessment of harm to others within general adult psychiatry and review risk assessment documentation in use. Consultants working across 66 randomly selected trusts across England were surveyed. A qualitative analysis of risk assessment documentation was carried out.

Data were obtained from 45 trusts (68%). Consultants reported that 30 (67%) of the trusts had standardised forms for risk assessment. Forty-one forms were subjected to content analysis. Wide variation was found in the methods used to identify risk factors and in approaches to quantifying risk.

Current risk assessment practice is highly variable, indicating a lack of consensus about suitable methods.

A health needs assessment was undertaken to evaluate current provision and to help inform the future development of services for people under the age of 65 years with dementia in Leeds.

The prevalence rate for early onset dementia in Leeds was found to be 42 per 100 000 aged 30–64 years, and 78 per 100 000 aged 45–64 years. Four main gateways for specialist investigation and care were identified and 38 referral pathways were identified in total. Carers had difficulties accessing information and services and they, along with the patients, valued, in particular, both the coordinated service provided by the specialist early onset dementia team and the dedicated day care facility available in Leeds.

Younger people with dementia can have very different needs to older people. The prevalence rate and the experiences of carers and patients clearly justifies the existence and further development of a specialist early onset dementia service. Such a service should provide a single gateway to coordinated service provision and ensure continuity of care. It should provide sufferers and carers with information, advice and expertise.