To examine the pathways and outcomes of in-patient care in our locality before crisis teams were introduced details of all emergency referrals to psychiatry were recorded and all admissions to hospital were assessed within 24 h of admission and discharge.

Over a 6-month period, 88% (n=1852) of calls to the duty psychiatrist occurred between 09.00 and 01.00 h. Referrals from accident and emergency and general practice represented the majority of calls (80%); 40% of patients were admitted. Highest admission rates were for patients who were psychotic, suicidal or depressed. Admission led to improvement in all symptoms.

In-patient care is a valuable resource for stabilising patients who are acutely ill. Routine monitoring of unscheduled activity can inform service delivery.

We questioned 141 senior house officers (SHOs) across three training schemes in order to ascertain the awareness and achievement of psychotherapy requirements as recommended by the College. A structured questionnaire was used and administered either in person or over the telephone to all SHOs. Of all the trainees surveyed, 32 were eligible for MRCPsych part II.

Only 9% of the SHOs eligible for MRCPsych part II were able to meet the requirements. Less than a third of all trainees were aware of the College guidelines.

Trainees face a number of practical problems in meeting the College guidelines. Psychotherapy training for basic specialist trainees is in need of urgent review and steps need to be taken to ensure that SHOs are gaining basic psychotherapeutic skills.