A survey was undertaken to ascertain if doctors working in psychiatry knew when to perform electrocardiograms (ECGs) prior to and during psychiatric treatments where indicated, and to investigate the training, confidence and ability of doctors in ECG interpretation. Half had received no training in the indications for performing an ECG. Opinion differed widely as to when to perform an ECG, with 54% stating an ECG was required before treatment with pimozide and only 19% and 11% stating ECGs were required during the course of treatment with pimozide and high dose antipsychotic medication respectively.

Ability in ECG interpretation correlated negatively with time spent in psychiatry but no correlation existed between grade and ability to identify an ECG as normal or abnormal.

Many psychiatric hospitals in the UK have closed. Factors influencing staff morale around the time of a hospital closure will affect the functioning of that institution. This study surveyed staff anxieties, attitudes and expectations in a major psychiatric hospital three weeks prior to its closure. We found evidence of widespread denial despite energetic dissemination of information. There were also significant differences between staff groups. Our findings will have implications for the management of future hospital closures.

“We have to get it into our heads that a hospital is like a shell, a framework to contain certain processes, and when the processes are superseded, the shell must, most probably, be scrapped and the framework dismantled” (Enoch Powell, 1961).

Little is known of the facilities available nationally to treat the most disturbed patients. A postal survey sent to all pharmacists in the UK known to have a special interest in psychiatry identified 110 psychiatric intensive care units. They varied in size from four to 30 beds, with the small units having low and the larger units very high occupancy levels. Many units accepted a mixture of informal patients directly from the community, detained patients and referrals from the prison service. Medical cover was variable, multidisciplinary team-working poor, and the existence of written policies unsatisfactory. Staff often felt undervalued with little control over admissions and discharges. There is currently no national or local support network for these units.

Constant observation is used in psychiatric practice mainly to prevent acutely III in-patients from self-harm. All in-patients in a psychiatric hospital and a general hospital psychiatric unit who had been on constant observation over a 6 month period were identified (13 patients). These patients and their primary nurses were interviewed using different questionnaires. Most patients felt they had benefited from being on constant observation, but disliked the intrusion on their privacy. The nurses agreed that it had helped most patients, but a significant number of nurses found it frustrating and stressful. Our results suggest a need for an information sheet to be given to patients placed on constant observation; that the period on constant observation should be reduced where possible, and that support should be provided for the nurses involved.

The Royal College of Psychiatrists launched a five year campaign in 1992 to better inform health practitioners and the public about depression. A questionnaire survey of Sheffield general practitoners (GPs) to assess the impact of the Defeat Depression Campaign on their knowledge and clinical management of depression was carried out in May 1994, half way through the campaign. Overall, 75% of GPs who responded indicated that the Defeat Depression Campaign had had little or no impact on their clinical practice. It would appear that at its mid-point the Defeat Depression Campaign failed to achieve its main goals in relation to educating GPs about depression and its management.

With the recent establishment by the College of ‘Affiliate’ status for non-member psychiatrists and continuing professional development (CPD) for ‘non-training’ grades, we though it timely to open a debate on the role, status and needs of staff grade doctors in psychiatry. Many of the issues that need to be addressed are common to staff doctors in all specialities. Following a brief description of the grade and how it is being used at present we will focus on education needs and career progression, drawing on recent debate in the medical literature and our own experience as staff grade psychiatrists in the West of Scotland.

The weekly educational supervision sessions between consultant psychiatrists and their trainees have emerged as a central pillar of psychiatric training. The College has set out, in various Statements on Approval of Training Schemes for General Professional Training for the MRCPsych, what it expects of these sessions: they should happen weekly, be devoted entirely to the needs of the trainee, and be applied to the development of the trainee's clinical skills as opposed to academic knowledge.

This paper discusses a training opportunity based on an adaptation of the Infant Observation method. This is a much shorter module, of ten weekly visits.

We describe three training components: (a) an opportunity to learn directly about child development and to become familiar with children's verbal and nonverbal communications; (b) a direct experience of the emotional impact and strength of primitive feelings, both in the children and in the trainees themselves, and (c) learning to be a ‘non-participant’ observer. We believe that the ability to observe without intervention is extremely important in the development of clinical skids. We suggest that this is the cornerstone of the method and that it may have a wider application to the training of those in the caring professions, including psychiatrists, nurses and social workers.

This paper discusses a pilot teaching programme on cultural aspects of psychiatry undertaken as part of the academic programme of the Department of Psychiatry, Cambridge University. The aim of the programme was to stimulate thinking about psychiatric phenomena in a different, more culturally aware perspective. Feedback was collected from participants through an evaluation questionnaire following the series. More practical and experiential teaching of cultural psychiatry is needed.

Health professionals are increasingly expected to take a share in the management of risk in a systematic manner. At its most blunt, clinical risk management is defined as the identification and planned response to negative events that occur during the provision of clinical care and can lead to litigation, the cost of this to the NHS is rapidly rising (Vincent & Clements, 1995). There are, of course, much broader risks to any healthcare organisation, and the approach to risk management in any organisation needs to be systematic. At the start of the process the development of a list of clinical and non-clinical areas in which failures might occur can be overwhelming to clinicians and support staff alike. Rigorous prioritisation of the process is essential, and for practitioners the first rule of sound clinical risk management is common sense.

A repeat audit of referrals to the CAT Clinic of Guy's Hospital is reported. Changes in training and supervision of therapists instituted since earlier audits are believed to have contributed to a lower drop-out rate and a higher attendance for follow-up. Mean score reductions on three questionnaires are significant and consistent in the three cohorts. Some characteristics of samples of patients who dropped out and failed to attend for follow up are described.

There is an identified need for more psychiatrists who have been trained in cognitive-behavioural therapy (CBT). The Royal College of Psychiatrists' guidelines for psychotherapy training recommend that all psychiatric trainees receive CBT training. This paper describes a brief programme of CBT training for psychiatric senior house officers (SHO) which demonstrates a viable model achieving limited training objectives.

The Glasgow Media Group has published the first major study in this country on media coverage of mental health (Philo, 1996). This research examines both the content of press, television and films and how these relate to public beliefs about mental illness. It involved an extensive content analysis plus a series of focus group interviews. The results show clearly that ill-informed beliefs on, for example, the association of schizophrenia with violence can be traced directly to media accounts.

Trainspotting, the “best British film of the decade”, arrived on 23 February 1996. Such were the expectations of the film (1996) that the face of its narrator-hero Renton (Ewan McGregor) appeared that month on the front cover of two influential London-based film magazines, Premiere and Sight and Sound. One year after its release, the film stands as both a critical and commercial success. The total Box Office receipts for Ireland, at IR £800 000 in the first 3 months, were comparable to a major Hollywood blockbuster. The film was still being screened 10 months later in Dublin's north inner city, the heartland of Dublin's heroin epidemic. Given its subject-matter, it is important to examine both the film itself, and its points of contact with the realities of drug addiction. In this respect, three questions suggest themselves: is the film showing anything new (representation), is it doing anything new (technique), and what is the film saying (ideology)?