A survey of people with schizophrenia in an inner-city general practice was undertaken to identify levels of social disability, service receipt and patterns of care received. Contacts with general practitioners, psychiatrists, community psychiatric nurses and social workers were quantified, and the nature of the contacts assessed. Overall social disability for the group was marked (mean Health of the Nation Outcome Scales (HoNOS) rating 55.5). There was a correlation coefficient of +0.899 between the numbers of agencies involved and the overall HoNOS scores suggesting appropriate targeting of care. While there were few differences in the HoNOS ratings of the various contact subsets, there were significant differences in the extent of agencies contact with patients, the greatest number of contacts being in general practice. Limited information sharing, the absence of a formal shared care plan and sectorisation of services are thought to obstruct more effective general practice involvement in care.

A widespread perception exists that attendance at child psychiatry clinics is especially poor. The reported rate of non-attendance at a child psychiatry outpatient clinic is 61%. However, other child health clinics also suffer a high rate of non-attendance. In this paper we examine the hypothesis that rates of non-attendance are higher in child psychiatry than In other child health out-patient clinics.

Thirteen per cent of referrals of ex-servicemen to a military psychiatric centre for the treatment of combat-related post-traumatic stress disorder (PTSD) in a 12-month period have proved to be factitious. A simple classification of factitious combat-related PTSD into those with no military service and those with military service but with false claims of combat is described. The possible causes of this behaviour are discussed and a guide to the detection of factitious claims for psychiatrists without military experience is given.

Long waiting lists are a common problem in child and adolescent mental health services. We describe how referrals to the service in York are considered and allocated by a multi-disciplinary team. The criteria for allocation to different professionals and specialist teams are described and data representing a snapshot of referrals and response rate over a three-month period presented, showing that most referrals are seen within two months. We postulate that consideration of referrals in this way is an effective and efficient way of running a service.

Twenty-four patients in the Gloucester rehabilitation service were considered suitable for clozapine treatment between January 1993 and May 1996. Five patients consistently refused to start clozapine and four patients (21%) discontinued clozapine, usually due to side-effects. Eight patients showed ‘some positive response’ and seven ‘good positive response’, of the 15 still taking clozapine. High rates of side-effects, but low readmission rates were found in this group. Putative reasons for the low discontinuation rates and apparent success of clozapine treatment in Gloucester include the wide experience engendered in the single consultant-led rehabilitation team, and the better coordinated, uniform approach to managing problems through the Clozapine Clinic.

Those who attempt suicide by jumping often have a history of major psychiatric disorder, are left with a high level of physical and psychological morbidity and have a poor outcome. Services are failing this group in that national statistics may underestimate its size, and even when patients are in contact and are symptomatic and expressing suicidal intent before the incident many go on to jump. Care in hospital and preparation for follow up is uncoordinated.

The Bethlem Royal and Maudsley Hospitals Item Sheet system for registering clinical data generated by psychiatric assessments is long established, with a proven track record as an instrument of scientific research. However, its use has not spread beyond the originating institution, despite being available in the public domain for many years. To address this problem we have designed a modified version of the Item Sheet. The new system has been simplified and improved to facilitate the use of this research aid in child guidance clinics and similar settings.

This study surveyed north-west consultant psychiatrists regarding their clinical electroconvulsive therapy (ECT) practice. A postal questionnaire was sent to all consultants identified by contacting north-west hospitals. Most respondents were in favour of using ECT, primarily for depressive psychosis. Bilateral ECT, twice weekly, was the preferred means of administration. Practice was similar overall to Pippard and Ellam's findings in their national survey. Prior to the latest College ECT guidelines, there had been little change in clinical ECT practice in the north-west since Pippard and Ellam's national survey.

The Care Programme Approach and its accompanying register were introduced in response to difficulties encountered in a young adult population. This paper describes the use of the register by an old age psychiatry service who do not routinely accept ‘graduate’ patients. Few patients had a diagnosis of dementia and most had psychiatric histories in excess of 10 years.

In recent years the psychiatric users' movement has become more prominent and powerful. In this article aspects of the movement and some of the resultant challenges to psychiatrists are described. Psychiatrists are often regarded by users as resistant to its development. The author argues that psychiatrists may benefit from a creative engagement with this process of change.

Ninety-six successive acute psychiatric admissions were assessed with regard to dress, level of hygiene, the presence of tattoos, bodily piercing/decoration and surface marks of self-harm. These features were also examined in relation to ICD–10 category diagnosis. One-third were described as ‘dishevelled’, 21% ‘unclean’, 7% had multiple pierced ears and 3% other pierced body parts. Sixteen per cent had tattoos, rising to 34% in the F10–19 (substance misuse) category, and 15% had scars of self-harm. People with schizophrenia and related disorders were more likely to present in an unclean state. Those with personality disorders were no more likely to bear the scars of self-harm, tattoos or body piercing.

This survey evaluates current views of non-medical professionals on the style of court report writing. A random sample of 120 solicitors who worked in the criminal field in London participated in this survey. The usable return was 72%. Up to 76% favoured changes in standards of report writing because of problems concerning clarity of style and use of jargon. The majority objected to reports being prepared by non-consultant psychiatrists.

Services for adolescents who overdose remain variable in the UK despite College guidelines. The problem is significant in terms of the demand placed on services, the level of distress it represents and the high eventual mortality rate. This study was undertaken to gain an understanding of the local picture with a view to improving service provision. The study revealed a high level of psychiatric morbidity, considerable drug and alcohol misuse and paracetamol as the most commonly taken substance. The findings supported Hawton's classification into three distinct groups, confirming it as a simple but useful system. This may provide a means of screening adolescents who overdose to improve service delivery to those most in need within the resources available. The possible role of the primary child and adolescent mental health worker is discussed.

All personnel within one UK emergency service who had been identified during a six-month period as having been on sick leave for eight consecutive weeks or more were identified. Those consenting were interviewed once using both a semi-structured questionnaire and standardised instruments. There were three main objectives: to discover the nature of the presenting problem in terms of illness or injury, the extent to which psychological problems presented and the relative importance of general and/or traumatic stressors. The resulting sample of 17 people accounted for 2–3% of the workforce. Fifteen agreed to take part and 13 to full interview. of the 14 who completed the Hilton Drinking Behaviour Questionnaire 10 exceeded the threshold consistent with problem drinking. The reason for sick leave in all these cases was recorded as physical injury only.