A survey of 100 completed Regional Secure Unit (RSU) in-patient episodes shows that most patients are young, male, short-stay and suffering from chronic psychotic disorders. Substance abuse is prevalent, and many currently face serious charges. A significant minority of patients had previously been admitted to the Unit, especially those admitted directly from the community. Nearly half of all discharges were directly into community placements, and nearly as many remained under the care of the forensic service. Despite the sampling frame, it is clear that a few ‘long-stay’ patients contribute disproportionately to overall bed occupancy, so that beds for acute admissions may be blocked. Further, ‘parallel care’ is operating to a significant degree in this service, with the inevitable accumulation of patients who will continue to require future in-patient care. These two factors in particular suggest that the ability of the RSU to fulfil its basic functions may become increasingly compromised, particularly with respect to emergency requirements for medium secure beds at the district level.

This paper examines the use of Section 17 trial leave from local psychiatric units to regional secure units in order to facilitate the return of patients to local services when higher security is no longer necessary. The current national shortage of medium secure beds is exacerbated by such patients when general psychiatric services are unwilling to have them back. Experience from the regional secure units in the old South Western Region has shown beneficial effects of the use of Section 17 trial leave in this way.

Newly appointed consultants in general adult and old age psychiatry were asked to rate how well their senior registrar (SR) training had prepared them for their first year's work as consultants. Training in 39 specific skills was assessed, 14 were rated poorly. In general terms SR training appeared satisfactory in four areas (clinical skills, teaching, research, working with groups) but deficient in three areas (general management, personal management, information technology). SR study days, courses, consultant supervision and ‘hands-on’ experience are all potential ways of improving training in these areas. Audit is necessary to ensure such changes are effective.

Literature giving a ‘behind-the-scenes' view of community-based research is, at best, sparse. Most authors present only the finished product leaving others with the task of forever re-inventing the wheel. This paper provides a light-hearted account of the bittersweet experience of conducting a survey of community attitudes to mental illness. The survey was part of a controlled trial of an educational campaign for neighbours of residential facilities for mentally ill people. It involved Interviewing members of the local community in their own homes. The paper highlights common pitfalls and gives practical advice for the novice researcher.

The need for psychiatrists to be residential when on call is questionable, To determine whether becoming non-residential resulted in duty doctors being unable to provide the same quality of care in dealing with psychiatric or medical emergencies, a prospective study was carried out logging calls received by the duty doctor before and after transition from a residential to a non-residential on-call system. Outcome showed that requiring doctors to be resident did not seem Justified.

A questionnaire was sent to a random sample of 339 psychiatrists on the Royal College mailing list, enquiring about their practice of screening and risk disclosure in patients at risk of tardive dyskinesia. The response rate was 70%. There was wide variation in the rate of informing patients of the risk. Over half of the respondents felt that knowledge about tardive dyskinesia would reduce compliance, a view which predicted a low rate of informing patients. There was support for the issuing of clinical practice guidelines by the College. Psychiatrists need further education about tardive dyskinesia.

It is a common belief among staff in Nottingham's acute psychiatric services that the Rehabilitation and Community Care Services (RCCS) are slow to respond to referrals leading to blocking of acute beds. In response to this the authors examined ‘bedblocking’ while RCCS responded to referrals of acute in-patients and long stays of existing RCCS patients admitted to acute wards during exacerbations of their illness.

The Section of Old Age Psychiatry has compiled an informal register of old age psychiatrists using regional representatives as informants. This has been found to have a number of uses, but has also aroused concerns.

The Urgent Assessment Service (UAS) was set up to provide community based urgent psychiatric assessment to a range of referrers. The work of the service was assessed over a six month period. Results show that it was popular with a broad range of medical and non-medical professionals. Patients generally presented with depression or psychotic illnesses and those referred from non-medical sources were more likely to be suffering from schizophrenia and assessed as being at least as unwell as those referred by GPs and hospital based doctors. Rates or referral to hospital services were low with the vast majority of patients being referred back to their general practitioner after initial assessment and treatment.

A descriptive study of a psychiatric probation clinic based in South Wales is presented. Over a three year period, 100 probation clients were assessed by forensic psychiatrists at the request of the Probation Services in South Wales. The majority of these clients were mentally disordered, with common diagnoses being personality disorder (35%), substance misuse (11%), schizophrenia (10%) and post-traumatic stress disorder (9%). The non-attendance rates for these clients was 0% for the first and 13.3% for subsequent appointments. Psychiatric probation clinics seem to be analogous to general psychiatric clinics based in Primary Care.

A postal survey was conducted among doctors practising psychiatry in the Mersey Region to ascertain attitudes, beliefs and practice with regard to psychotherapy, achieving a response rate of over 60%. There was a surprising absence of very strong feelings for or against psychotherapy which was not seen as a powerful treatment modality. There was little knowledge of the facilities provided by the regional service, and no general support for their expansion. The role of training in psychotherapy and its significance in light of guidelines for general trainees ore discussed. A need is recognised for greater awareness and contact between psychiatrists and the psychotherapy service.

Speech and language therapy is a small profession. It only reached its golden jubilee year in 1995 and misleadingly, remains for many highly associated with the elocution training in which the profession had its genesis. In the last few years the greatest developments have been in the area of cognitive neuropsychological and functional (pragmatic) models for the assessment and management of language and communication. It is the premise of this article that speech and language therapists are likely to prove flexible and valuable members of the multidisciplinary team, with the ability to contribute a further dimension to care planning – that of specific clinical input to the wide range of language, speech and communication impairments associated with the major mental illnesses (Gravell & France, 1991).

A consumer satisfaction survey of patients with learning disabilities and mental health needs attending outpatient psychiatry clinics was performed using a questionnaire administered by their carer. Sixty completed questionnaires were returned and the results were analysed to determine whether demographic or service variables were correlated with the degree of satisfaction. Younger patients living independently or with their family and those who were not prescribed psychotropic medication were more satisfied. The service variables associated with increased satisfaction were comfortable waiting areas, punctuality and good communication with the doctors.

The consensus statement by the Royal College of Psychiatrists recommended that patients on high dose antipsychotic medication receive regular electro-cardiographic monitoring to identify prolongation of the QT interval. A survey of trainee psychiatrists in three hospitals investigated the accuracy with which trainees could identify this abnormality and found only 20% could do so.

The first 18 months of operation of a team providing high intensity case management is presented. A key-worker/co-worker system was adopted, with regular team meetings to review the progress of all clients. Low case-loads (10 clients per case manager) enabled the team to carry out detailed assessments of need, offer assertive outreach and crisis intervention and coordinate complex packages of community care. The case management team provided an accessible and effective service. However, not all patients appeared to benefit and the intensive nature of the work was very demanding on staff.

Since the Health of the Nation government document (Department of Health, 1992) set the target for the reduction of suicide in the severely mentally ill by 33% by the year 2000 it has become necessary to collect the suicide data for this population of patients at district and national level. There are a range of problems concerning the definition and identification of patients with severe mental illness as well as problems concerning the compilation of suicide data for this population at district level.

Non-attendance rates are high in child psychiatry clinics. This potential waste of resources is coming under increasing scrutiny within the NHS. This study shows that therapists themselves are good at predicting who will attend and who will not. The family's previous attendance rate is the most reliable predictor. Why then is not more use made of this information when organising clinics? Ways are suggested how attendance rates might be improved.

The psychiatric treatment decisions made by two multidisciplinary psychogeriatric teams in 100 new referrals were compared with those made by a group of psychiatrists following independent formal research assessments. There was satisfactory agreement between the team and research decisions with regard to psychiatric hospital admission, antidepressant treatment and neuroleptic treatment. Agreement was less good for psychological treatments.

The quality of lithium monitoring in a health district serving a population of 450 000 was studied over a period of a year. The following instances of poor monitoring were found: too frequent monitoring in stabilised patients, and failure to take action when lithium values fell below 0.3 mmol/l or rose above 1.0 mmol/l. Ways of improving the standard of monitoring are considered.

The views of referring general practitioners (GPs) on a psychogeriatric service were obtained through a questionnaire. Most GPs were satisfied with the service. A number of GPs wanted faster responses to referrals, telephone discussions after initial psychogeriatric assessments and more communication with consultants. In response to these findings, secretarial staff was increased and telephone discussions with referring GPs are to follow initial assessments of all urgent and emergency referrals.