This paper reports on a survey of newly appointed consultants in old age psychiatry. The Questionnaire asked for opinions on the adequacy of higher training in a number of areas such as clinical, management, teaching, supervision and research. In addition views were sought on particularly valuable experiences in preparation for consultancy. The results show that overall clinical training was judged to be good, while training in some non-clinical areas, especially management, was found to be insufficient. The importance of management training Is emphasised and some valuable training experiences are highlighted.

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.

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.

Psychiatric distress is commonly found in general hospital patients and is associated with a poorer outcome and increased complexity of care. It is important for non-psychiatric hospital doctors to possess skills of assessment and treatment of common psychiatric problems. This survey of all house officers in their first pre-registration posts in three large teaching hospitals found that Junior doctors rarely ask about or consider the presence of psychiatric problems in their patients. Where psychiatric problems are found, house officers often feel they lack the appropriate skills of assessment and management. This has important implications for medical school course content and emphasis.

The importance of establishing case registers for suicide is discussed along with their potential uses. Suicide data can be derived from the coroner, the District Health Authority or the Office of Population Censuses and Surveys (OPCS). The relative merits of these different data sources are discussed and local methods described. Some data derived from the suicide register are shown.

The importance of establishing registers for non-fatal deliberate self-harm is discussed along with their potential uses. Deliberate self-harm (DSH) data for a single hospital can be derived from the Accident and Emergency (A&E) casualty cards, A&E on-line registers, mental health assessments or general hospital in-patient data. The relative merits of these different data sources are discussed and local methods described. Some data derived from the DSH register are shown.

Prescriptions for psychotropic drugs for in-patients in the Dundee Psychiatric Service were studied for three five-month periods in 1991, 1992 and 1993 using computer data and drug sheets. Information about Journal advertising and advice to doctors was obtained for the same period. A possible effect of Journal advertising was detected in the first year but there was no further Increase in the second year in the total of prescriptions. Information is presented of a similar survey in 1975 and 1976. A high proportion of prescriptions was for formulary drugs and doctors rated the British National Formulary as the strongest influence on their prescribing.

‘Drug induced psychosis' is a commonly used clinical label but lacks a universally accepted definition. Psychiatrists' understanding of the term was examined using a specifically designed questionnaire. Knowledge about the effects of drugs of abuse and their relationship with psychosis was also examined. A substantial proportion of clinicians did not have a logical and coherent scheme for understanding ‘drug-induced psychosis' and there was no consensus as to which reactions to drug taking should be included within the rubric. Diagnostic errors have potentially serious consequences, so lack of knowledge in this area needs attention and a proposed classification is given.

Service usage of 24 patients with a personality disorder was established for one year pre-treatment and one year post-treatment via a prospective survey of the patients, their original referrer and their general practitioner. The average annual cost of psychiatric and prison services (calculated from extra-contractual referrals (ECR) tariffs and Home Office data) was £13 966 pre-treatment compared to £1306 post-treatment, representing a cost-offset of £12 658 per patient per year. The average cost of the specialist admission was £25 641. Thus the cost to the Nation for treating these personality disordered patients in a tertiary treatment resource would be recouped within two years and represent a saving thereafter.

General practitioners (GPs) were surveyed by questionnaire to determine their views on the indications for specialist psychotherapy and their estimates about the number of patients they thought should be referred. GPs had good awareness of the types of treatments available. There was close agreement between referring and non-referring GPs and with specialists on the indications for treatment. Estimates about demand for services showed that those who had not referred in the previous year estimated higher rates than those who had referred. GPs and specialists show good overall agreement on level of service and the indications for its use.

A previous survey carried out in our unit revealed deficiencies in electroconvulsive therapy (ECT) documentation. With the aim of correcting these deficiencies, the standard procedure for completing the audit cycle was followed and the survey was repeated. The results question the assumption that simply completing the audit cycle ‘automatically’ leads to an improvement in practice. Possible reasons why Improvement did not come about in this study are discussed.

A psychosis workshop and its clinical role are presented. The workshop's mode of operation utilising basic psychodynamic concepts is described with related clinical illustrations. The value of the workshop in implementing College guideliness for general professional psychiatric training and the integration of psychotherapeutic skills into psychiatric practice is discussed.

The Strathcona Theatre Company is made up of professional actors with a learning disability and two directors. As part of the teaching course in the Department of Psychiatry of Disability at St George's Hospital Medical School, the medical students participate in a workshop given by the Company, near the beginning of their attachment in psychiatry. During the two-hour workshop the students are taught a variety of ‘ice breaking’ games and mimes by members of the Company. This means that early on in the course, students have face to face contact with adults with a learning disability, and furthermore see them in a socially valued role as teachers and leaders. The students usually find the workshop enjoyable, and give positive feedback although they were unsure how successful the workshop was in changing medical students' attitudes towards people with learning disability. We report an evaluation of students' attitudes before and after the workshop, and show statistically significant changes in attitudes towards people with a learning disability.

Short paper presentations are now a major feature of most medical conferences. While the exact timing varies it is not unusual to have only 10–15 minutes to present the results of research which may have taken years to plan, collect and analyse. Many doctors have not had any training in teaching or presentational skills, a fact which becomes readily apparent to those who have to hear them present at conferences.

In February 1994 the Royal College of Psychiatrists contacted the Benefits Agency Medical Services (BAMS) to take part in their consultation exercise before bringing in the new Incapacity Benefit (IB) in April 1995. This new benefit was to replace the then existing Invalidity Benefit which was being paid to over 250 000 people with a primary diagnosis of mental illness. The main changes were that a patient's own general practitioner (GP) would certify incapacity for work for the first 29 weeks of sickness and after this the continuation of benefit (IB) would require assessment by a BAMS doctor, with some illness categories being exempt from medical examination. The aim was to create standardised criteria across the UK and to do so in an objective fashion, based on function rather than diagnosis. The test is designed to look at ability to work in any capacity rather than the claimant's own work which is the criterion for the first 29 weeks.

Jamaica has one large mental hospital. Recent developments in community care have reduced the number of in-patients. Most patients with serious psychiatric illness live in the community, supported by their families and nurses with some psychiatric training. Substance abuse is a major problem, and the suicide rate is reported to have risen recently.