A postal survey was sent to all consultants in the psychiatry of learning disability from four English regions. Their views on job satisfaction, their core roles and the management re-structuring of services were elicited.

The proportion agreeing or strongly agreeing with each management option was 79% for integrated mental health–learning disability trusts, 61% for specialist learning disability trusts, 47% for care trusts, 10% for primary care trusts and 5% for social services. Only 34% felt consulted or able to influence the process of change and only 33% were satisfied with the current management changes within their trust but 67% were satisfied overall with their jobs.

Management from integrated mental health–learning disability trusts is the most preferred option for psychiatrists in learning disability. A large number of consultants, though otherwise satisfied with their jobs, feel excluded or unable to influence the current changes in management structures. A model of integrated service provision in line with the government's learning disability strategy is presented.

The relationship between homophobia (varying from actual and perceived to internalised) and measures of well-being is well documented. A study in Athens, Greece and London, UK attempted to examine this relationship in two cities with potentially different levels of homophobia. One-hundred and eighty-eight men who have sex with men (MSM) living in London and 173 MSM living in Athens completed a survey investigating their views on their sexuality, perceptions of local homophobia and their identity evaluation in terms of global self-esteem.

The results confirmed a negative association between homophobia and self-esteem within each city sample. However, Athens MSM, despite perceiving significantly higher levels of local homophobia than London MSM, did not differ on most indicators of internalised homophobia and scored higher on global self-esteem than London MSM. The city context had a significant impact on the relationship.

The findings are discussed in relation to the implications they pose for mental health professionals dealing with MSM from communities experiencing variable societal stigmatisation and its effect on a positive sense of self.

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.

The routine monitoring of blood glucose indices for all patients on atypical antipsychotics in 2004 in a rural adult psychiatric sector was examined. Pragmatic and practical standards were based on consensus expert opinion, National Institute for Clinical Excellence and prescribing guidelines.

The audit was completed on 60 atypical antipsychotic prescriptions. Testing of blood glucose prior to the initiation or change of an atypical antipsychotic was largely followed, with an overall adherence rate of 82%. However, there were large differences in testing between in-patient and community settings. Routine yearly monitoring in the community was inadequate, with an adherence rate of 63%.

There is a welcome emphasis on the physical health of those with severe and enduring mental illness. New initiatives, including prescribing guidelines, the care programme approach and primary care registers, offer the opportunity to develop consistency and coordination between primary and secondary care in the routine monitoring of psychiatric treatments and physical health in these patients.

A questionnaire survey of general adult psychiatric consultants and specialist registrars in the West Midlands was conducted to examine attitudes towards New Ways of Working (NWW) for psychiatrists; these were measured using a 5-point Likert scale. Participants were also asked about their own experiences of NWW. the data were analysed using Mann–Whitney U-test.

The response rate was 31.2%. Attitudes were generally negative, particularly regarding the effect on patient care, the erosion of the professional role of the consultant and effect on quality of work life. the attitudes of those who did not have any direct experience of working to the NWW models were more negative than those who had direct experience of NWW.

There are significant concerns about NWW among consultants and specialist registrars. There is a need for further debate and research with regard to the proposals.

A survey of 50 in-patient forensic health care and prison services in England, Wales and Scotland was employed to evaluate: (a) how severe personality disorder is assessed; and (b) how assessments compare with recommendations concerning standardised assessment by the Working Group on Psychopathic Disorder (Reed, 1994).

Seventy per cent of services responded, of whom 40% formally assessed personality disorder. Fifty-four instruments were routinely employed. Assessments of personality structure and cognitive/emotional styles were more common than structured diagnostic instruments or ratings of interpersonal functioning. Of the assessment tools, 25.7% of services provided at least one suggested by Reed (1994).

A nationally agreed, focused repertoire of instruments should be encouraged within secure forensic settings offering assessments to individuals with severe personality disorder.

To investigate the effectiveness of the Women's Service crisis house in Croydon we performed an observational study prospectively measuring functioning, symptom severity and unmet needs before and after admission. Use of mainstream mental health services was also measured.

Women using the service had high use of mainstream mental health services, with 137 out of 269 (51%) requiring admission to a mainstream acute ward in the 4 years studied. The service was effective with an improvement in Global Assessment of Functioning scores from a median of 48 on admission to 67 on discharge (P<0.001).

The women's crisis house was effective in providing for women who required high levels of mainstream mental health services, suggesting that it provides a valuable alternative to standard in-patient care.

We conducted a questionnaire survey of all 120 health authorities and boards responsible for the commissioning of services for the assessment and treatment of transsexual people in England, Scotland and Wales, in order to identify the nature of the input offered and assess conformity to current international standards of care.

Eighty-two per cent of the commissioning authorities responded and confirmed that most health authorities/boards provide a full service for the treatment of transsexuals, although this would be delivered at a local level in only 20% of cases. However, 11 commissioning authorities gave confused and inaccurate responses and three other health authorities appear to hold views on the commissioning of these specialist services that are not in keeping with the current legal situation and a recent High Court ruling, which establishes the right of transsexual people to NHS assessment and treatment.

There are discrepancies in prioritisation and provision of clinical services for this group that are not standard across Great Britain.