A trust-wide survey of all in-patients to estimate the prevalence of likely deprivation of liberty and to investigate how two different approaches to measuring deprivation might affect the number identified.

A notable difference in the results was detected when comparing the two methods. One survey method identified deprivation of liberty factors in 84% of informal incapacitous patients, whereas a different approach that weighed up the factors in accordance with the UK government's interpretation of the case law detected only 11% as potential cases.

To be usefully implemented, the deprivation of liberty safeguards require an accurate method of assessment in order to target those the process is designed to protect. This survey demonstrates the difficulties in defining deprivation of liberty and highlights the issue of how it is best measured.

Although alcohol is reported as commonly associated with self-harm, there is nothing in the literature that bases the association on validated screening tools. We sought to discern the different types of alcohol use as discriminated by the Alcohol Use Disorders Identification Test (AUDIT). Completed AUDITs from a 2-year period were analysed, all relating to people who had presented to a district general hospital in Northumberland following self-harm.

The proportion of dependent, harmful and hazardous drinkers identified using AUDIT was many times higher than previously estimated in similar studies that had not used a validated alcohol screening tool.

The routine use of an alcohol screening tool should be part of any standard psychosocial assessment of self-harm, to guide appropriate interventions for problematic alcohol use that might otherwise be overlooked.

Several national anti-stigma campaigns have been devised in the UK, including the current Time to Change campaign in England. Our aim was to assess whether the campaign promotional materials were likely to have any effect on public attitudes towards mental illness. Postcards, leaflets and bookmarks promoting the campaign were posted to 250 participants recruited from a representative panel of members of the public. Two weeks later a questionnaire was sent to assess the impact the campaign materials had.

The response rate was 78%. Only 23% of participants recognised the Time to Change logo after 2 weeks and only 20% correctly reported that one in four people were affected by mental health problems when presented with five alternative responses. Almost as many participants thought the campaign was promoting a British political party rather than discrimination against mental illness.

A single exposure to Time to Change campaign materials is unlikely to be effective. The title of the campaign is likely to be confused with political campaigning in Britain.

Clinical audit methodology was used to compare the treatment of alcohol misusers at risk of Wernicke's encephalopathy in an acute medical setting, and to assess the impact of providing information about best practice to prescribing doctors. All patients prescribed thiamine during an admission to an acute hospital trust over a 6-month period were identified, and data about their treatment episode were collected retrospectively. Hospital pharmacists then provided all prescribers with a flowchart summarising current prescribing guidelines, and prescribing patterns were re-audited 6 months later.

Over two audit periods, half of the patients prescribed thiamine whose case notes we examined had symptoms suggestive of Wernicke's encephalopathy, and another 30% were at high risk. Prescribing adhered to hospital guidelines only in 14% of cases, with the pharmacy-led intervention associated with a small but significant increase in the number of patients receiving adequate treatment for Wernicke's encephalopathy.

Wernicke's encephalopathy is relatively common in alcohol-dependent individuals admitted to hospital, and it is easily and cheaply managed. However, even when potential cases are identified, prescribing guidelines are followed in a minority of cases, even with prompting by a hospital pharmacist. This may be related to the limited research base concerning the optimum dosing schedule of thiamine, or fears about possible anaphylaxis when using parenteral preparations.

To capture psychiatrists' reasons for ‘significant impaired decision-making ability’ (SIDMA) as there is no definition of SIDMA in the Mental Health (Care and Treatment) (Scotland) Act 2003. One hundred consecutive mental health reports from January to February 2008 were examined using a questionnaire.

More than half the mental health reports noted lack of insight as the main cause of SIDMA. Other reasons for SIDMA included limited cognitive function and presence of psychotic symptoms.

Five reasons for SIDMA were identified: lack of insight, cognitive impairment, presence of psychosis, severe depressive symptoms and learning disability. We recommend psychiatrists working in Scotland give full descriptions of SIDMA, indicating how this has an impact on the patient's ability to make decisions.

We conducted a retrospective audit of 100 discharge summaries to evaluate the accuracy of medication recording and the recording of as required (PRN) prescribing, and to see whether or not general practitioners were advised on how long to continue the latter. After a formal guideline was introduced we conducted a re-audit.

There was an improvement in summaries recording medication correctly (from 64 to 83%). The number of summaries with one or more missing medications halved and PRN sedative prescribing reduced from 18 to 3%, but provision of advice on the latter did not improve.

Accurate recording of medication in the discharge summary is an important element of the transfer of patient care to the general practitioner. Medication errors may pose serious health risks and undermine patient confidence in the service. The clinical audit and interventions implemented helped to reduce errors in medication recording in discharge summaries.

The effective management of patients with anxiety, depression or somatisation, who commonly present across all medical disciplines, requires an understanding of both pharmacological and psychological approaches such as cognitive-behavioural therapy (CBT). However, there is little research addressing effective ways of delivering CBT training that is relevant for doctors. We provided CBT skills training that included supervised casework to medical students at Oxford University and assessed participants' experiences.

The training was feasible, sustainable and highly valued. Students reported marked improvements in knowledge and skills related to CBT and felt more convinced of its effectiveness for patients and its relevance for doctors. They also gained generic medical skills and an increased understanding of mental health problems.

Supervised casework appears to be an effective format for learning. It allowed students enhanced responsibility for patient care and an opportunity to practise using cognitive-behavioural strategies, some of which would be transferable to medical consultations.