We report the results of a clinical audit of patients' reactions to two types of talking therapy groups facilitated by assistant psychologists and psychology graduates on three acute wards. Patients' experiences of problem-solving and interpersonal group formats were explored via focus groups and structured interviews with 29 group participants.

Both group formats generated high satisfaction ratings, with benefits related mostly to generic factors.

Adequately trained and supported assistant psychologists and psychology graduates can provide supportive talking groups that patients find helpful.

The aim of this study was to evaluate the predictive validity of the HCR–20 risk assessment instrument for the case-load of an inner-city community forensic team. File review and an interview with the keyworker for each patient were used to compile the information, and the author completed the HCR–20 for all patients. Cases were followed up for an average of 2.5 years to collect information on recidivism.

The risk profile for this sample was comparable to published North American studies. Patients who were subsequently charged with or convicted of violent offences all scored highly on the HCR–20.

The HCR–20 appears to be a useful instrument for stratifying risk within community forensic samples; this finding has implications for intensity of treatment and supervision. However, the data also suggest that services need to target criminogenic variables more effectively.

To evaluate a psychosocial intervention for patients treated with antipsychotics with body mass index (BMI) > 25. A total of 44 patients (mean age (s.e.) 37.6 (1.2); 28 female, 16 male) received dietary and exercise advice with motivational interviewing. Weight and BMI were measured at baseline and monthly thereafter. Patients were offered weight monitoring for 1 year.

Overall mean weight loss was 3.1 kg (mean 3.22%). Modal (range) weight change was 74.2 (719.2 kg to +8.7 kg).

Overall weight loss was not significant after 355.7 (32.5) (mean, s.e.) days. Determinants of response remain unclear. Avoiding weight gain in the first instance is critical. Further research will explore determinants of antipsychotic-induced weight gain and prevention strategies.

In 1999, child and adolescent mental health (CAMH) in-patient provision was unevenly distributed across England. A repeat of a1999 bed count survey was conducted in 2006 to determine whether change had occurred in response to government policy.

Total bed numbers in England were found to have increased by 284; 69% of the increase is due to the independent sector, whose market share has risen from 25% in 1999 to 36% in 2006. Regions with the highest number of beds in 1999 have increased bed numbers more than areas with the lowest number of beds in1999 (8.3 v. 3.6 beds per million population). In units that admit only children under the age of 14, there has been a 30% reduction in beds available (123 to 86).

Inequity in provision of CAMH inpatient services has increased despite government policy to the contrary. We speculate that this might be partly due to fragmented and local commissioning, and the effects of market forces operating as a result of increasing privatisation.

To examine the use of specialist psychiatric beds for people with learning disability, created following the closure of a long-stay institution. Admission and discharge data were examined, including history of previous institutional admission, diagnosis at discharge and number of subsequent readmissions.

Out of 348 admission episodes, 59 were accounted for by 40 patients who were previously resident in the long-stay institution. Most admissions were for new patients from the community. Over time, admissions to the specialist unit decreased when occupancy reached and persisted at 100%, coinciding with a significant rise in admissions of adults with learning disability to general adult psychiatric wards.

Resettlement after closure of long-stay learning disability institutions has not been accompanied by a high readmission rate for former residents, but neither has there been a decreasing need for psychiatric beds for those with learning disability and severe psychiatric disturbance. Most of these admissions are for people with learning disability who are relatively new to the service. There has been a persistent problem with full occupancy of these beds, which reflects delayed discharges indicating a lack of community resources and an increasing demand for admission.

Tackling discrimination, stigma and inequalities in mental health is a major UK government objective yet people with intellectual disabilities continue to suffer serious stigma and discrimination. The project aimed to determine the effect of viewing a picture of a person with intellectual disability on stigmatised attitudes. The 20-point Attitude to Mental Illness Questionnaire (AMIQ) was used and a representative panel of members of the general public were randomised to complete the questionnaire either with (experimental) or without (control) looking at a picture of a man with Down syndrome. Six months later the same experiment was performed with the groups crossed over.

Results were received for 360 participants (response rate 87–93%). The sequence (control or experimental) had no significant effect on the outcome. The mean AMIQ score in the control groups was 1.56 (s.d. = 2.85, s.e. = 0.21, n =186) and in the experiment group (after looking at the pictures) was 2.43 (s.d. = 2.59, s.e. = 0.12, n = 174; median difference 1, P = 0.0016 Mann-Whitney U-test; effect size 0.23).

Looking at a picture of a man with Down syndrome significantly reduces reported stigmatised attitudes.

To audit the quality of medical recommendations for detention under the Mental Health Act 1983, Section 2 and 3. The recommendations were tested against a gold standard based on the statutory criteria. Two cycles were completed, the first containing 214 recommendations, the second 202. Relevant education took place after the first cycle.

The percentage of medical recommendations containing clear statements of why each of the statutory criteria was met increased in the second cycle. It reached 87% for mental disorder; 87% for nature and/or degree; 75% for why community treatment was not possible; 64% for why detention was in the interests of health; 60% for safety; 55% for protection of others; and 70% why informal admission was not possible.

Doctors, scrutineers and approved mental health practitioners welcomed clear guidance about what is expected in a medical recommendation for detention and endorsed the gold standard described. Armed with a better understanding of what is expected and a template to follow, there was an improvement in the reasons given for detention.

To assess the extent of user involvement in care planning, from the users' perspective. Fifty Care Programme Approach (CPA) meetings across five consultant teams were included using quota sampling. Data concerning user involvement was collected by direct observation, semi-structured interviews with users and keyworkers and a review of CPA documentation.

User involvement in needs assessment and decision-making was poor, as was knowledge of care planning and information provision to users.

Limited resources and conflict resulting from the more containing aspects of the CPA remain obstacles for user involvement. Possible improvements include user led needs assessment, information pack provision and limiting attendance at CPA meetings.

New variant Creutzfeldt–Jakob disease is a novel prion disease of humans that may be causally linked to bovine spongiform encephalopathy. Psychiatric symptoms occur in the early stages of the illness and may be difficult to distinguish from the symptoms of more common psychiatric disorders. Cases of new variant Creutzfeldt–Jakob disease are identified through the national surveillance system. Information on psychiatric features has been obtained by review of case notes and, in the majority of cases, by interview of relatives by a member of the surveillance staff.

Thirty-five cases of new variant Creutzfeldt–Jakob disease have been identified in the UK and detailed information on the clinical features and investigations is currently available in 33 of these cases. All but one of the cases exhibited prominent early psychiatric symptomatology, but the diagnosis of an underlying neurological disease was not possible in the majority of cases until the development of neurological symptoms and signs. Early indications of an underlying neurological disorder included cognitive impairment, persistent sensory symptoms or limb pain and, in a minority, gait imbalance, dysarthria or visual symptoms. Limited evidence suggests that investigations such as electroencephalogram or brain imaging are unlikely to provde useful diagnostic information during the ‘psychiatric’ phase of the illness.

The early recognition of an underlying neurological disorder may be impossible in the early psychiatric phase of new variant Creutzfeldt–Jakob disease, but the suspicion of this diagnosis may be raised by the occurrence of associated neurological symptoms. The development of early diagnostic markers is an important objective.

To examine patients' views on the quality of care they received before, during and after electroconvulsive therapy (ECT), a questionnaire was completed by 389 patients who had received ECT at ECT Accreditation Service (ECTAS) member clinics.

The nine key standards set by ECTAS relating to quality of patient care were rated as having been met by 65% or more respondents. Most patients found staff friendly and reassuring and often commented on how this had helped reduce their anxiety prior to ECT. Patients were less positive about standards relating to being introduced to staff prior to ECT, and the quality of the waiting and post-recovery areas.

Patient views are important indicators of quality of care and should be used to improve ECT practice. Anxiety about ECT is helped by supportive and caring staff. Improvements could be made to practices related to waiting for and recovering from ECT.