There are validated tools for structured professional judgement of risk of violence, but few for risk of suicide. The Suicide Risk Assessment and Management Manual (S-RAMM) is a new structured professional judgement tool closely modelled on the HCR-20. This is the first validation study for the S-RAMM. We measured inter-rater reliability, internal consistency, concurrent validity with another validated risk instrument (HCR-20) and with a measure of psychopathology (PANSS). We tested whether the tool could distinguish between groups of patients clinically assessed as at varying levels of risk of suicide or self harm.

Two researchers jointly interviewed 25 current in-patients for inter-rater reliability (Cohen's kappa) and internal consistency (Cronbach's alpha) and interviewed 81 of 83 current in-patients to assess whether the mean scores for different wards were significantly different (using ANOVA). Two other researchers made independent ratings of the HCR-20 and PANSS.

Inter-rater reliability was acceptable for all items (Cohen's kappa >0.5 for all but three items) and all sub-scale and total scores (Spearman correlations all >0.8). Internal consistency was high, (Cronbach's alpha all sub-scales >0.6). Scores stratified significantly with high scores for admission and intensive care units and progressively lower scores in rehabilitation and predischarge units. The HCR-20 historical and S-RAMM background scores did not correlate but the dynamic sub-scales correlated significantly. PANSS scores also correlated significantly with S-RAMM scores.

The S-RAMM has better than minimum acceptable characteristics for use as a clinical or research tool. Prospective studies of sensitivity and specificity are now required.

Dialectical behaviour therapy (DBT) is a recommended treatment of patients with borderline personality disorder, yet there are few descriptions of the approach in public community mental health settings where the majority of such patients present. This study describes the development and evaluation of a DBT programme in an Irish setting.

The DBT programme was run over a six month period. Participants were assessed at baseline and post intervention with the following instruments: The Structured Clinical Interview for DSM III R personality disorders (SCID II), the clinical Outcomes in Routine Evaluation (CORE) and the symptom checklist 90 Revised (SCL-90-Revised). Inpatient bed usage was determined from case note review.

Outcome data was available for eight subjects. Significant improvement (p < 0.005) was seen on all CORE subscales. SCL-90-R showed significant improvement (p < 0.05) on the global severity index and on the positive symptom distress index. A decrease in self harming behaviour was found. Subjects' inpatient bed days dropped from a mean of 58 in the year pre intervention to a mean of four days in the year post intervention. A novel finding was that 43% of subjects who originally fulfilled criteria for avoidant personality disorder no longer did so post intervention.

The study found that DBT can be applied in a community mental health setting with benefits similar to more specialist settings. Significant difficulties were encountered in implementing the programme. The clinical implications are that specialist psychotherapy services need to be an integral part of psychiatric services to achieve better outcomes for patients with borderline personality disorder.

To describe the characteristics and progress of the first 50 patients with severe and enduring mental illness who accessed inpatient rehabilitation services in Dublin North East Mental Health Service between 2001 and 2006.

Retrospective collection of data on the first 50 inpatients from case notes and staff interviews. Data included demographics, psychiatric history, results of rehabilitation interventions and assessment tools. The results were compiled and analysed using descriptive statistics.

Fifty patients were identified. The majority were male (68%) with a diagnosis of paranoid schizophrenia (60%). The levels of co-morbid alcohol and drug misuse were 40% and 30% respectively. Histories of verbal/physical aggression were found in 92% and impulsive behaviour in 70%. The majority of patients had a past history of being detained under the Mental Treatment Act (1945). High levels of co-morbid physical health problems were identified. New long-stay (NLS) patients showed a trend towards requiring the shortest admissions prior to being ready for discharge to lower levels of support.

One third of patients moved on to reside at lower support levels and accessed vocational training programmes following active inpatient rehabilitation interventions. However, there remained a cohort of patients who required prolonged inpatient admissions due to their high levels of disability. This study further highlights the need to ensure that a range of rehabilitation services from inpatient to supported community placement are provided to meet the needs of patients with severe and enduring mental illness with complex needs.

The aim of this study was to determine the extent of knowledge that family members of intellectually disabled individuals had in relation to their siblings' psychiatric illness. All siblings lived in residential intellectually disabled housing.

We evaluated on three occasions (before providing information about their sibling's psychiatric illness and treatment, and one and six months after providing this information) the families' understanding of their siblings' psychiatric illness.

Initially families had a poor knowledge of their siblings' psychiatric illness and treatment, but this improved markedly after information was provided by a medical practitioner. This was a short-term effect, as at six months, families understanding had disimproved although not to pre-consultation levels.

The provision of information to family members pertaining to their siblings' psychiatric diagnosis and treatment should be incorporated into the routine treatment of intellectually disabled individuals with a psychiatric illness.

To explore whether (direct) referrals from GPs to two Community Mental Health Team (CMHT) clinical psychologists differed from those received from both ‘Psychiatric’ (eg. consultant psychiatrists) and ‘Other’ sources.

The two psychologists retrospectively examined and coded the case files of all clients who attended them during a 12-month period. The six measures used were diagnostic prevalence and groups, co-morbidity, chronicity, previous hospital admission and CMHT contact Separate cross-tabulations and chi squared tests were conducted for the various dependent variables to profile differences across the three referral sources.

There was no difference in prevalence of Axis I disorders, co-morbidity and chronicity of disorders between ‘GP’ and ‘Psychiatric’ referrals to the two CMHT psychologists. However, although low in number, there were more eating and psychotic disorders among the ‘Psychiatric’ referrals, and more of these referrals had previous hospital admission and CMHT contact.

‘GP’ referrals were similar to ‘Psychiatric’ referrals on some measures but differed on others. Hence, as to whether an ‘open access’ model of (direct) referral to CMHT clinical psychologists lowers the clinical threshold for referrals depends on which measures are deemed most critical. Consistently applying a composite index of referral ‘severity’ could prevent the former.