Our aim was to explore attitudes of in-patient mental health staff to smoking and the smoking ban. A questionnaire was distributed to staff (n=450) working at National Health Service psychiatric units in three different locations.

We obtained 308 responses, at a response rate of 68.4%. Staff were generally less permissive towards smoking in mental health units when compared with previous studies. However, most (78.9%) feared that service users' states would deteriorate if they were not allowed to smoke.

We found small but noticeable change in staff attitudes following initial reforms in smoking policy. However, there is a need for further significant change in staff attitudes to facilitate implementation of a total smoking ban from July 2008.

To explore the experiences and attitudes of psychiatrists to a new electronic patient records system. A questionnaire was emailed to 115 psychiatrists across the South London & Maudsley National Health Service Foundation Trust.

The total response rate was 66% (senior house officers 75%, specialist registrars 57%, consultants 56%). Technical problems, difficulty with patient confidentiality, administrative burden and impact on clinical work were identified as concerns. However, psychiatrists recognised the potential benefits and the majority did not wish to return to using paper records.

Electronic patient records are rapidly being integrated into the daily practice of psychiatrists. More administrative assistance and specific training should be provided to support clinicians who use this system.

To capture the local primary care experience of first-episode psychosis before developing a local early intervention in psychosis service. A survey of Northamptonshire general practitioners (GPs) using a confidential questionnaire was carried out.

Out of 284 GPs, 123 (43%) responded. General practitioners are unlikely to start treatment before referring to a specialist service: 63 GPs (51% of responders) start treatment in 10% or less of individuals with first-episode psychosis and 19 (15.5%) GPs start treatment in 75% or more before referring them to psychiatric service; 42 GPs (34%) refer those who request/accept a referral and 66 GPs (53%) refer all even if they refuse. Overall, 92 GPs (74%) agreed that an early intervention in psychosis service is needed and 77 (63%) GPs welcome having a mental health clinic in their surgery.

Individuals are more likely to accept referral to a psychiatric service if offered than to ask for it. People disengaging, stigma, the service being difficult to access/inappropriate and carers' lack of knowledge about mental illness are the likely causes for delayed referral.

To describe the mentoring scheme for consultant child psychiatrists in Scotland and discuss findings of a qualitative questionnaire survey of all eligible consultants' use and satisfaction with the scheme.

All 21 respondents who had used the mentoring scheme thought it had been of great help. A third of respondents appointed since the start of the scheme had not used it. This could be because the consultants were not aware of the scheme, there were not enough mentors or mentoring was not included in consultants' job plans.

Formal mentoring is strongly recommended for all newly appointed consultants. Written recognition within job plans for both mentoring and being mentored would support mentoring arrangements.

Reaching into the community to treat people with anxiety and depressive disorders raises the spectre of wrongful use of scarce resources at best, and of disease mongering at worst. We recruited for an internet-based treatment for social phobia.

Applications were received from 789 people, and 205 were rejected because of severe depression or suicidal thoughts. Many were excluded because they had another disorder or were in treatment. Some dropped out, only 7 were subthreshold cases and 291 people with social phobia were treated.

Despite easy access to clinicians, the burden of untreated serious mental disorder in the community remains considerable.

To assess whether postal questionnaires, used as a local initiative, were useful in identifying carer depression allowing early support for community-dwelling carers of older adults with mental health needs. the Geriatric Depression Scale and a questionnaire collecting information on the carer's circumstances were sent to carers of consecutive patients routinely referred to a community mental health team for older adults in south London. Rates of carer depression between postal questionnaire responders and non-responders were compared.

The response rate to the postal questionnaires (33%) was similar to that observed in other postal studies; 42% of responders had depression compared with only 4.6% of non-responders.

Pre-contact postal questionnaires may present a simple method of enhancing early detection of carer depression for minimal economic outlay.

The aim of this study was to explore older users' and carers' views of attending out-patient clinics for older adults. A questionnaire was designed to be distributed to all patients attending out-patient clinics for a period of 1 month in January 2007.

The response rate for returning the completed questionnaire was 71%, and 95% of these respondents were satisfied with their overall experience of attending out-patient clinics. Although satisfaction levels were high with every aspect of out-patient clinics, 49% preferred the hypothetical option of being seen at home.

The role of psychiatric out-patient departments for older adults merits further research, comparing cost and user/carer acceptability with home or general practitioner surgery-based treatment.

Recent guidelines on perinatal mental health highlight the need to predict, detect and prevent mental illness in childbearing women, but there are a limited number of studies in this field. This study describes the characteristics of 277 service users newly referred to a specialist community perinatal mental health service over 1 year, and discusses the implications for effective management of mental illness related to childbearing.

The most common diagnosis was affective disorder (51%), of which 8% had bipolar affective disorder. Almost three in five women had previous non-pregnancy-related psychiatric contact and a fourth had previous ante/postnatal psychiatric contact. More than half were on medication at conception, most commonly antidepressants (43%).

This study highlights the opportunities for identifying women at high risk of postnatal mental illness and the need for adequate pregnancy planning advice for women taking psychotropic medication.

There is insufficient research into the relationship between ethnicity and appeals against detention under mental health legislation. We sought to identify rates and success of appeals in different ethnic groups through a retrospective analysis of all detentions under the Mental Health Act 1983 over 1 year.

We found high rates of appeals overall, with substantial differences between ethnic groups (36 (39%) White British compared with 71 (63%) Black Caribbean (P = 0.0001) and 21 (68%) White Irish (P = 0.01) individuals (Yates corrected chi-squared)). Success rates on appeal were very low in all groups.

There are significant ethnic differences in appeals against detention under the Mental Health Act.

To assess circumstances and frequency of use, opinions and suggestions for improvement from psychiatrists in a teaching hospital on UK Psychiatric Pharmacy Group patient information leaflets for psychotropic drugs. We also sought information from psychiatrists regarding use of alternate sources of information provision for their patients on psychotropic drugs. A questionnaire was designed, piloted and distributed.

Sixty-one psychiatrists were approached, of whom 49 (80%) responded. the most common indications for use were when initiating a new treatment and when information is sought by the individual or their carers. the most common reason for not using these leaflets was lack of awareness of their existence. Although 33 (67%) responders were of the opinion that these leaflets were useful for patients, only a small proportion was using them frequently.

Our study suggested increasing awareness among psychiatrists to encourage the use of patient information leaflets. Various other themes to improve their use also emerged including easy accessibility to the patient information leaflets, modification in the content and structure, and recording the provision of patient information leaflets in the case records.

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.

We sought to develop and introduce annual physical health checks and offer lifestyle advice for out-patients diagnosed with schizophrenia or bipolar disorder in two semi-rural areas in the north-east of Scotland. the results for the first year of the clinics are presented.

Seventy-eight patients were invited to the clinics in the first year. Attendance rates varied from 76% in one centre to 38% in the other; 75 individual significant physical health problems were identified and highlighted to the patient and their general practitioner.

The high attendance rate in one half of the catchment area demonstrates the potential for physical health screening for this vulnerable group of patients. the identification of significant levels of previously undiagnosed physical morbidity offers opportunity for intervention. Several innovative lifestyle interventions arose from the project and have been maintained.

To assess the number of cocaine-dependent clients attending a typical addiction clinic, using urine drug testing for screening and a structured clinical interview for diagnostic assessment.

Of the 419 clients whose urine records were analysed, 38 were regular users of cocaine (9.1%), with at least half of their urine samples positive for cocaine in a 12-week period; 84.2% of these regular users of cocaine satisfied the criteria for cocaine dependence (7.7% of the total number of those attending the clinic).

Publicly funded addiction treatment centres in Ireland are mostly designed for the treatment of opiate addiction. There is, however, a significant problem of concomitant cocaine dependence in these centres. Increased availability of psychological/behavioural treatment programmes with proven efficacy in cocaine addiction may help improve overall treatment outcome.

Multidisciplinary activities of community mental health teams in Ireland are understudied. We explored symptom profile and multidisciplinary team contacts in a complete sector population (n = 504).

The frequency of attendance was greater in individuals with severe mental illness (P<0.001) and correlated with total Health of the Nation Outcome Scale (HoNOS) scores (P<0.001) and with the sub-scales for social disability (P<0.001) and symptoms (P<0.01). Sixty-two per cent of individuals were receiving shared care and were more likely to have severe mental illness (P<0.001) and higher total HoNOS scores (P<0.001). Frequency of attendance correlated with total HoNOS scores and subscale scores for social impairment and symptoms.

Frequency of service attendance and activities of multidisciplinary team members vary with symptom profile of service attenders but are focused towards individuals with more severe illness and greater problems identified by the HoNOS.

Stigmatised attitudes among the general public towards people with mental illness are one of the main factors delaying such people from seeking treatment, hindering their recovery and rehabilitation. Our aim was to devise a simple motivational interviewing technique to reduce stigmatised attitudes towards people with schizophrenia and substance misuse. We conducted a randomised paired-design trial of 100 adults subjected to a 10 min motivational interview to reduce their stigmatised attitudes; we used the Attitudes to Mental Illness Questionnaire (AMIQ) to measure the effect of the various procedures on stigmatised attitudes.

A small improvement in stigma scores was observed in attitudes towards people with alcoholism but not towards those with schizophrenia.

A brief intervention involving motivational interviewing can be used to challenge the stigma of mental disorders.

To describe a group of prisoners who required transfer to mental health units from two London prisons. Data were collected from prison clinical records.

Overall, 149 patient-prisoners were transferred over a 17-month period. Around a quarter were not previously known to services. the aggregate wait was 36.5 years (averaging between 93 and 102 days per prisoner) and the total saving to the National Health Service (NHS) has been estimated at £6.759 million.

Both prisons manage a large number of prisoners with untreated psychosis. While in prison, they save the NHS considerable sums of money, but transfer delays prevent timely treatment and could now be legally challenged.