The climate change emergency is also a mental healthcare emergency. We seek to provide a framework for what mental health professionals and organisations should do to make their practice more sustainable.

There are ethical, legal and organisational imperatives to make mental healthcare more sustainable. Mental healthcare must be refocused with an emphasis on prevention, building social capital and community resilience. Patients must be empowered to manage their own mental health. Efficiencies should be found within the system. Low-carbon ways to deliver care must be found, measured and improved upon. Greater adaptability needs to be built into the system to mitigate the impact of climate change. Sustainability should be integrated into training programmes, and good examples of practice shared and celebrated.

Mental health organisations and individuals must act now to prevent and adapt for the climate and ecological emergency. Sustainable practice is also good practice.

To explore attitudes and perceptions towards workplace-based assessment (WPBA) among psychiatric trainers in Wales and to compare them with those of trainees. To identify current problems and report recommendations made by survey respondents to streamline and successfully implement WPBA. An anonymous questionnaire-based cross-sectional online survey was conducted involving consultant psychiatrists in Wales and the results compared with a previous survey of specialty registrars.

In total, 104 of 164 consultants participated (63%), compared with 81 of 88 trainees (92%). Both surveys highlighted numerous problems and negative attitudes towards WPBA. Compared with widespread dissatisfaction among trainees, trainers appear more diverse in their opinions, although considerable numbers are dissatisfied with the new competency-based system.

Negative attitudes harboured by many trainees and trainers constitute a significant hurdle to the effective implementation of WPBA and undermine its efficacy as a tool intended to improve training. Specific measures with the potential to address various shortcomings are discussed, with a view to improving WPBA and rendering it more acceptable to both trainees and trainers – and thus facilitate improvement of training.

This study considered patients admitted to hospital following deliberate self-poisoning. The characteristics of the patients and the outcomes of assessments by trainee psychiatrists and a mental health nurse were compared.

There were no significant differences in the outcome of 68 assessments performed by a trainee psychiatrist and 77 by a mental health nurse. The nurse assessment service was well-received by the poisons unit, a medical ward specialising in overdose treatment, and trainee psychiatrists.

Psychosocial assessments following self-poisoning can be provided by appropriately trained and supervised mental health nurses. The introduction of a nurse-led service should enhance relationships with the local poisons unit and reduce the workload of junior doctors without compromising their training needs.

To assess the usefulness of the electronic patient record, we used the search engine Clinical Record Interactive Search (CRIS) to scan all acute admissions during 2008 for possible substance use disorders. In addition, screening interviews were undertaken with 75 in-patients, and documentation in their files was compared with results of screening interviews.

Of 839 acute admissions during 2008, 47% of males and 29% of females had reference to a substance misuse problem in their file. Documentation was unsystematic and inconsistent and mostly occurred in progress notes rather than in structured questionnaires. Screening interviews and manual review of files of 75 current in-patients confirmed that substance use disorders were common, but poorly documented.

The study highlights the power of search engines in scanning electronic clinical records, but also identified the limitations of unsystematic documentation in research and practice. Mental health staff were reluctant to diagnose or rate severity of substance misuse problems.

This study investigates patient satisfaction and levels of hope after receiving treatment from a home treatment team. It studies whether distributing questionnaires during the last visit increases the response rate, and explores whether patient satisfaction and levels of hope are associated with particular elements of the care received.

Patients who answered the questionnaire tended to be satisfied. When forms were distributed during the last visit, the response rate increased to at least 64%. People with negative views were more likely to return the form by post. Patient satisfaction and levels of hope were associated with most elements of received care, and the resolution of problems was predictive of both satisfaction and increased hope in logistic regression.

The distribution of service evaluation questionnaires during the last visit increased the response rate considerably. This study suggests that in order to improve services, it is important to focus on whether patients think their problems have been resolved.

To discuss the service offered by an in-patient neuropsychiatric brain injury rehabilitation unit. To examine the demographic details of patients admitted to the unit. To find the commonest reasons for referral.

The notes of 78 patients admitted to the unit, over a two-year period, were examined. Seventy-three per cent were male and the mean age was 45 years. Seventy-five per cent of admissions had a severe brain injury. Two-thirds of the patients were admitted within six months of their injury. The most common reasons for referral were memory difficulties (n=61), verbal aggression (n=31) and temper control(n=25).

In-patient neuropsychiatric brain injury rehabilitation units offer management of patients referred with a wide range of cognitive, behavioural, functional and physical problems.

A trust-wide audit of antipsychotic prescription was conducted in order to investigate the prevalence of high-dose treatment in a population with schizophrenia and assess compliance with Royal College of Psychiatrists' guidelines on the use of high doses. Details of antipsychotic medication were recorded and in cases of high-dose treatment compliance with the College's guidelines was assessed.

Sixteen out of 361 patients (4%) were receiving high-dose medication. At re-audit this figure fell to four patients (1%). High-dose treatment comprised of a combined depot and oral medication in most cases. There was poor compliance with the College's guidelines.

The study stresses the importance of monitoring patients on high-dose antipsychotics, particularly when taken in combination.

This study describes a survey of in-patients with personality disorder admitted to a specialist personality disorder unit, in terms of their knowledge and understanding of their diagnosis, and the subsequent development of a psychoeducational programme.

Overall, patients had a poor knowledge and understanding of their diagnosis. Most had not had their diagnosis explained to them, and if they had, they had not retained the information. Consequently a structured psychoeducational programme was developed, incorporating diagnostic information obtained at the pre-admission assessment.

Diagnostic information for those with personality disorder, even when it is available, is not transmitted to patients. Imparting this information through a psychoeducational programme is one way in which the therapeutic relationship between patient and clinician can be strengthened.

To elucidate and describe current neuropsychiatry service provision in the UK. A questionnaire was developed and posted to members of the Royal College of Psychiatrists who had expressed an interest in neuropsychiatry. the responses were tabulated and analysed using descriptive statistics and SPSS version 11.0 for Windows. the neuropsychiatry services provided, sources of referrals, setting of the services and funding streams are described.

Out of 251 respondents, 70 reported providing a neuropsychiatry service, 21 having been principally appointed as neuropsychiatrists.

Neuropsychiatry services in the UK are currently based in a few regional centres, representing a patchy and inadequate service provision.