A cross-sectional survey of the use of the Mental Health (Scotland) Act 1984 in a defined urban area. Patients initially detained under civil sections (Sections 24, 25, 26 and 18) between 1 April 1997 and 31 March 1998 were identified using the hospital information system and a hand search of section papers.

There were 283 detentions involving 204 patients that lasted a median of 6 days. A total of 98% of patients were initially detained on a 72-hour ‘emergency section’. A total of 61% had non-organic psychotic disorders (172/283). Less than half of detentions were during the working week. Consent was usually provided by the mental health officer or relatives, but was not provided for 11% of detentions. Patients detained after admission were more likely to be detained for a longer period (29 v. 3 days) and to have their detention extended over 72 hours (64% v. 41%) compared with those detained in the community.

This paper provides information on some of the gaps identified by recent reviews of mental health legislation in Scotland and discusses the possible impact of the changes proposed by the Millan Committee. The workload of general adult consultant psychiatrists is likely to increase and the proportion of patients detained without consent could also increase. The study supports the differentiation of patients detained after admission from those detained in the community, as the patterns of detention are different.

To study whether psychiatry received differing treatment in newspapers than the other medical specialities, and whether tabloids were more negative in their coverage of general medicine and psychiatry than broadsheets. We conducted a survey of all headlines in all daily newspapers in the Dutch-speaking part of Belgium over a one-month period and judged whether the content was essentially positive, neutral or negative.

There was no significant difference between articles on general medicine and psychiatry with respect to the tone of the article. Whereas negative articles about medicine focused on both doctor and patient to the same extent, negative articles on psychiatry tended more often to describe the patient. Broadsheets published more negative than positive articles, while tabloids published an equal proportion of negative and positive articles.

There appears to be no difference in tone with respect to articles on general medicine and psychiatry, respectively. Nevertheless, the fact that negative articles on psychiatry tend to focus more exclusively on the patient points towards continuing stigmatisation of the psychiatric patient. Finally, broadsheets tend to be more negative in covering both general medicine and psychiatry, which contrasts with earlier findings.

The use of illegal drugs is becoming increasingly common and presents particular problems in pregnancy. There is strong evidence to suggest that improvements in obstetric and neonatal outcomes can be made by attempts to treat the substance misuse problem, although this group may have limited engagement with traditional medical services. We conducted a retrospective case note review of a specialist ‘mother and baby team’ within a drug misuse treatment service to determine whether it had achieved its original service aims.

There was a high level of engagement with the service, with the majority of cases staying in contact for over 20 weeks. The average dose of methadone fell during the course of the pregnancies, and at the time of delivery, only 20 of the 80 cases (25%) still in contact with the service had urine tests that were positive for heroin. A significant number of women managed to completely detoxify from all drugs by the point of delivery, in contrast with previous studies conducted with this patient population.

This study demonstrates that the specialist service for pregnant drug users has been effective in engaging those misusing drugs in treatment, leading to significant improvements in key outcome measures.

We conducted a postal questionnaire survey of the practice of rapid tranquillisation among 215 consultant psychiatrists in the West of Scotland, before and after the withdrawal of droperidol by the manufacturer.

One hundred and eighty questionnaires (84% of those sent) were returned. Droperidol had been used extensively, often combined with lorazepam, for rapid tranquillisation. The main replacement suggested for droperidol was haloperidol. About half of the respondents to our survey chose to comment on the withdrawal of droperidol. More than half of the comments were unfavourable, including lack of an adequate replacement and lack of consultation with the psychiatric profession.

The abrupt withdrawal of droperidol, partly for commercial reasons, was regrettable. There was no time for an adequate evaluation of possible replacement medications and a lack of consultation with the profession regarding the impact on clinical care.

All 208 consultant members of the Faculty for the Psychiatry of Learning Disability were contacted and asked to complete a questionnaire to provide qualitative and quantitative information about their work and experiences.

One hundred and thirty-six consultants responded, giving a 64% response rate. They reported a wide range of clinical, academic and management skills, with 72 having registration in other specialities. Insufficient in-patient provision and problems with discharge were cited by 85% of respondents. There was a wide disparity in the provision of mental health services for children and adolescents with learning disabilities and 12 areas reported no services from any source. Although most respondents showed satisfaction with clinical work and professional relationships, there were many concerns about management, commissioning and planning of services.

Consultant psychiatrists in the field of learning disability are a broadly skilled group of clinicians with a wide range of responsibilities and areas of expertise, but many are working in services that they see as under-resourced and poorly managed, planned and commissioned. Overall levels of satisfaction are good, particularly in relation to clinical work, peer support and study/academic work.

A number of relevant professional bodies were invited to state their views on the responsibilities of consultant child psychiatrists within multi-disciplinary teams in order to ascertain whether there was any consensus on the issue.

Little consensus or clarity emerged, save for agreement on child psychiatrists' expertise with medical matters. Only medical organisations believed in a notion of the consultant holding ultimate responsibility, although definition of this remained elusive.

Consultants may need to seek clarity about their clinical and legal responsibilities from their employing Trust. However, there are many other dimensions to responsibility which have relevance for the training of child psychiatrists.

We conducted the first systematic territory-wide survey of electroconvulsive therapy (ECT) practice and utilisation in Hong Kong. All public ECT services were evaluated with a postal questionnaire, a visit and observations of ECT administration. All private ECT practitioners were surveyed using a postal questionnaire.

Most practice areas at the public ECT services in Hong Kong complied with College guidelines. However, a few private practitioners were still using outdated ECT machines. The number of ECT courses completed in 1998 was 0.34 per 10 000 population, which was much lower than the rate of ECT use in Western countries.

We obtained basic information on ECT services in Hong Kong and on areas requiring immediate attention.

To devise a protocol, reflecting best practice, for obtaining second opinions in child and adolescent psychiatry through discussion with consultants in child and adolescent psychiatry within the Yorkshire region at their quarterly meetings.

The major pressure for second opinions falls upon the Academic Unit of Child and Adolescent Mental Health and on the in-patient units. Other consultants who are considered to have specialist expertise in certain areas may also receive referrals for second opinions. Both consultants requesting and offering second opinions considered a protocol for obtaining them would be helpful to their practice.

An agreed protocol between consultants in child and adolescent psychiatry within a region ensures that young people with complex problems have access to second opinions on their diagnosis and management by consultants who can be recommended to referrers by other consultants. The network of consultants ensures such opinions are not requested excessively and that ‘rogue’ opinions without therapeutic follow-up are avoided.

The National Service Framework sets standards to improve the treatment of mental health on a national level, and requires the development of localised shared care protocols. We aimed to develop a shared care protocol for use in local National Health Service (NHS) services, based on best practice guidelines and local consensus. A systematic literature search used three databases and the advice of a clinical expert. Articles satisfying the search inclusion criteria were retrieved and appraised. Clinical recommendations from well-designed regional and national documents relevant to all aspects of the management of psychotic illness in primary care were compared and contrasted by a facilitated group involving primary and secondary care clinicians who drafted the final recommendations. A multi-agency steering group guided the work.

Twenty-two articles were retrieved, of which nine reached the criteria for inclusion. The protocol provided a comprehensive range of recommendations regarding detection, assessment, management, referral and shared working with local mental health services.

Using local clinical consensus to resolve uncertainty about conflicting clinical recommendations from a series of well-designed guidelines was an effective method for adapting clinical guidelines to local circumstances.

Young people attending the Maudsley obsessive–compulsive disorder (OCD) children's clinic had expressed an interest in meeting other similar young people with OCD. A group was set up comprising 6-weekly sessions focusing on psycho-education and support.

Seven young people (mean age: 14 years 4 months; age range: 11 years 11 months to 16 years 6 months) took part. Feedback questionnaires showed that all the participants found the group helpful and enjoy-able. They felt less isolated and more confident about dealing with OCD.

Establishment of groups may be a valuable way of increasing awareness and knowledge on aspects of OCD, as well as providing much-needed psycho-social support to patients.

In order to establish whether there is consistency in the management of sexual assault allegations in a psychiatric in-patient unit, and to assess quality of data recording, a manual search of 177 case notes included in an audit project, carried out between October 1997 and May 1999 was carried out. Each recorded allegation was noted on a standard form.

There was little consistency between cases, and data recording was patchy.

There is no accurate method of recording or monitoring alleged sexual assault in the trust studied. In spite of a policy document, these cases are dealt with ad hoc.