To examine treatment response in traumatised refugees, we compared routine outcome monitoring data (Harvard Trauma Questionnaire) of two refugee populations with those of individuals experiencing profession-related trauma who were treated at a specialised psychotrauma institute.

Asylum seekers/temporary refugees (n = 21) and resettled refugees (n = 169) showed significantly lower post-traumatic stress disorder (PTSD) symptom reduction between intake and 1 year after intake than did a comparison group of non-refugees (n = 37), but the interaction effect was clinically small (partial η2 = 0.03). Refugees who had more severe symptoms at intake showed significantly greater symptom reduction after 1 year.

Therapists and refugee patients should have realistic expectations about response to treatment as usual. Additional treatment focusing on improving quality of life may be needed for refugees whose PTSD symptom severity remains high. At the same time, novel approaches may be developed to boost treatment response in refugee patients with low responsiveness.

Dialectical behaviour therapy (DBT) is associated with particularly high drop-out rates in the National Health Service (NHS). This paper seeks to investigate the characteristics of patients with borderline personality disorder dropping out from DBT and the role of care coordination in this phenomenon. Data for the 102 patients receiving DBT in east London, 58% of whom had dropped out of treatment prematurely, were analysed.

In a multivariable analysis, a history of care coordination was the only variable significantly correlated with drop out: 88% of patients with a history of care coordination dropped out prematurely compared with 52% of patients without such history.

The experience of comprehensive care within the care programme approach, particularly care coordination at the start of DBT, affects the retention of patients in DBT. Further qualitative research is required to understand how care coordination and DBT drop out are related, which could lead to changes in how the therapy is delivered in the UK and influence decisions regarding the use of care coordination with patients with borderline personality disorder.

We surveyed all psychiatric services in the six northeast strategic health authorities to determine how the provision of liaison psychiatry services related to College recommendations and the size of the general hospital trusts served.

Thirty-six (100%) services provided usable data, 8% of general hospital trusts had no liaison psychiatry service, 41% of teams were not multidisciplinary with their only staff being nurses, only 38% of services had dedicated consultant psychiatry time and only a quarter met the recommended minimum standard of 0.5 whole-time equivalents. No teams contained clinical psychologists. Disorder-specific out-patient clinic provision was idiosyncratic.

There is a lack of rational planning of liaison psychiatry services and as a result, many services are not needs-based and do not comply with College recommendations. One indication of this is the lack of multidisciplinary teams.

The use of alternative therapies by people with mental health problems seems to be rising. Are the people who access alternative therapies those with mild or more severe problems? A postal survey was undertaken of enquirers responding to a teletext article on self-help psychotherapies for obsessive–compulsive disorder and agoraphobia. Respondents were asked to rate the severity and duration of their problem and the therapies and services they had used.

Of 326 questionnaires sent out, 113 (35%) completed questionnaires were returned. Seventeen (15%) respondents had sought no help for their anxiety problems, 76 (67%) had been treated by their general practitioner (GP), 62 (55%) by a psychiatrist or psychologist and 48 (42%) had used alternative therapies. People who had sought help from their GP did not rate their problems significantly more severe than those who had not sought treatment. Those who had been treated by a psychiatrist or psychologist and those who had used alternative therapies rated their problem as being significantly more severe than those who had not sought help for it.

In this selected sample it was the more severe anxiety sufferers who had used alternative therapies.

An increasing number of mental health trusts in the UK are replacing the geographically sectorised model of service delivery with a functional one. We conducted a qualitative study of staff perception concerning this reorganisation in our Trust, to inform effective change management locally and elsewhere.

Perceived benefits were quick decision-making, positive risk management and improvement in clinical leadership. Dedicated consultant time would lead to improvements in junior doctor training. Concerns included lack of continuity of care, disagreement between teams and de-skilling of staff. Communication was seen as the key to overcoming these difficulties.

Detailed communication from management about the practicalities and reasons for change could facilitate effective transition.

This study examined the frequency of seclusion intervention and factors associated with its use in the acute general adult psychiatric ward serving the Southland area of New Zealand. Details of the use of seclusion and relevant demographic data were collected over a 12-month period in 2007–2008.

During the study period there were 30 seclusion episodes involving 23 patients. The median duration of seclusion was 17 hours. The duration of seclusion was found to be inversely related to the treatment received during the period of isolation. Most patients under seclusion had a diagnosis of psychosis, and the nature of this was directly related to the Mental Health Act order applied.

The duration of seclusion in this study is long but compares with a similar study from elsewhere in New Zealand. The duration of treatment while in seclusion could be reduced if optimal treatment is given.