We set out to ascertain how common this is for psychiatric trainees in South Thames and the effects it has, if any. An anonymous postal questionnaire was circulated to 400 trainees.

Of the 400 trainees, 203 (51%) responded and 109 (54%) of the respondents had had one or more patient suicide and 168 suicides were reported.We judged the effect of the suicide on the doctor to be moderate or severe in 126 (75%) of the 168 suicide events.

Patient suicide must have a higher profile in training. Formal systems need to be created to provide support and education in this area.

Services were compared for the management of deliberate self-harm with existing national guidance. A postal survey was sent to all clinical directors of adult psychiatry at all NHS trusts assessing adult patients admitted to general hospital following deliberate self-harm in England.

Responses were received from 129 (65%) trusts.Thirty per cent of trusts do not use secondary psychiatric services for psycho-social assessment following deliberate self-harm; 52% have designated self-harm liaison staff and 69% of general hospitals have a ward to which most cases of deliberate selfharm are admitted. However, only 18% have staff with psychiatric experience. In 82% of trusts training is provided for junior psychiatrists at induction but in only 56% are observed-assessments undertaken. Forty-two per cent of the trusts have a deliberate self-harm services planning group.

Standards for deliberate self-harm services fall substantially below existing national guidelines, particularly in the areas of planning and training.

Nationally, a variety of community care projects are being developed to replace institution-based care. We describe an innovative system of providing mental health care in Southport, combining an extended day service with short-term hospital admission – the partial hospitalisation philosophy.

During the first year of operation 438 assessments took place with 27% of patients being admitted to a crisis bed and a further 25% supported via attendance at the unit.Twelve per cent needed in-patient admission and 10% were deemed not to require any involvement of the mental health service.

The use of short-stay admission coupled with extended day care and crisis line support can provide a viable alternative to admission to the acute ward.

This study describes residents in seven care homes, reviews their usage of mental health services and evaluates cost implications of psychiatric health care provision.

The patients are predominantly male with multiple diagnoses who are receiving psychiatric health care, but in general lack structured rehabilitation services. Forty-seven per cent of the residents moved into the trust catchment area in order to occupy the placement.The cost associated with the provision of differing models of out-patients care varies considerably.

These vulnerable residents are costing the mental health service relatively little, although the total cost to society is higher.This study points to the necessity of multiagency planning for 'new long-stay' patients.

Mental health day centres have been little researched. We carried out a 1-week census at the four day centres run by a London borough.

The centres catered for a g roup with long-standing mental health problems, mostly under community mental health team care. A surprising number were suffering from physical ill health. They attended the centres primarily for social reasons or to participate in creative groups such as music and art.Very few were concurrently attending day hospitals.

Further work is essential to understand the distinction between NHS day hospitals and Social Services day centres in terms of utilisation and client group.This client group's needs, particularly for physical health care, require urgent attention.