The difficulty in achieving good quality community mental health care for homeless people has received increasing attention during the last few years. Less consideration has been given to the provision of inpatient care. By comparing data collected before and after its inception, we examined the impact of a specialist community mental health team for homeless people on ‘no fixed abode’ admissions in Birmingham. Although the team was successfully involved in the admission and discharge process in a substantial proportion of cases, many admissions still took place out of hours and involved the police, while discharge was often against medical advice and occurred without follow-up. These findings and their implications for the provision of homeless services are discussed.

The role of carers is explored in the process beginning with the early detection of changes in cognitive function through to the diagnosis of dementia. Carers were not always aware of early cognitive decline before other family and friends. Forty-five per cent of initial diagnoses were made by GPs. In over 50% of cases, the sufferer had not been told their diagnosis by health professionals or carers. A quarter of carers wanted more information about dementia even after referral to specialist services. The importance of early referral and provision of sufficient comprehensive information about dementia are discussed.

This study presents the pattern of assessment and 6-month out-patient attendance of 54 children and adolescents who took an overdose over a 12-month period, and were assessed by a district child and adolescent psychiatry service. Attempts were precipitated by arguments (67%) or school-related stressors (19%). In 70.4% of cases, analgesic tablets were used. A psychiatric disorder was present in 51% of the cases. At 6 months, 13% of the patients were still attending for follow-up, while three children (5.5%) had taken a second overdose. Admission to a paediatric ward can facilitate the initiation of treatment. Child mental health services should aim at providing prompt assessment, good communication with other agencies, and follow-up arrangements, particularly with high-risk young people and their families

Fifty-three female in-patients of a psychiatric hospital were interviewed to obtain their views on their own safety and security, and what improvements they would recommend. Most had experienced sexual harassment and a few had been victims of sexual assault. There was a reluctance to report incidents to staff. The majority felt that female-only wards would improve safety. Other recommendations included higher staffing levels, more staff awareness and vigilance, and single rooms with curtains on the doors.

This study investigated the knowledge and attitude of 100 patients about their depot neuroleptic medication. Patients were well informed about their medication, particularly those seen in depot clinics. Most patients were content with service delivery but 48% did not realise that they had a choice about receiving their treatment. This aspect of patients' rights should be addressed and demands sensitive management in the case of depot refusers, or when assertive outreach is planned. We suggest that such issues should be incorporated into an educational programme and discussed with patients when they are relatively well.

It is unusual for an exhibition of unknown artists to open with critical acclaim and draw crowds to a major gallery. What is more remarkable is that few of the artists received formal tuition, none belonged to a movement or painted commercially and they did not expect their work to be seen by an audience. The artists were mentally ill people residing in asylums throughout Europe whose work was collected between 1918 and 1921 by the German psychiatrist and art historian Hans Prinzhorn (1886–1933).

The Caiman report (Caiman, 1993) aimed to reduce the period of postgraduate specialist training to about seven years, introduce the Certificate of Completion of Specialist Training (CCST), reduce the number of training grades to two, and introduce more structured training. Caiman also recommended four themes which should guide postgraduate training: flexibility, choice, competency and assessment on merit.

As part of the academic programme for senior registrars in forensic psychiatry working in the North Thames Region, a series of visits to outside institutions of special relevance was organised. These visits form part of a larger academic programme which includes consultant tutorials, journal clubs and case conferences. Between May 1995 and October 1996 the author was the senior registrar in charge of organising the programme and this report is intended to share the experiences gained in visiting these other institutions.

This is the final contribution to a five part series on risk in psychiatry. Bowden (1997) has cast a bleak eye on the realities of making risk decisions about difficult and dangerous patients, identifying the essential subjectivity of these decisions and the cognitive distortions that psychiatrists can undergo to make them apparently easier; distortions that can blind the clinician to impending disaster. Morgan (1997) emphasised the limitations of a simplistic ‘risk factor’ approach to the management of potentially suicidal patients, concluding that the priority is the refinement of our basic clinical skills (and by implication deployment of successful treatments for our patients' illnesses). Prins (1997) analysed the particular difficulties faced by mental health review tribunals hearing the cases of Restricted patients. The perhaps unsurprising conclusion is that tribunals make bad decisions when presented with inadequate information (which begs the question why not adjourn and seek the information required before proceeding?). Roy (1997) has addressed a range of risks faced by Trusts and the clinicians who work for them. There is a clear demand that Trusts develop risk management strategies: of necessity these strategies will discourage inherently risky behaviour such as inadequate staffing of in-patient units and the devolution of inappropriate levels of responsibility to staff who are inadequately trained or supported.

Clinical standards were compiled for prescription of psychotropic medication in adults with learning disabilities, and used in a community population for comparisons of current practice in two audit studies 12 months apart. Completing the audit cycle led to improved clinical practice and a rationalisation of prescribing practices. Improvements were achieved on all standards and the methods used to obtain them are discussed.

Pre- and post-change audits of the effect of the changes in community care assessments and funding intro-duced in April 1993 were carried out on a psychiatric in-patient rehabilitation unit in Dundee. There was a substantial reduction in throughput in the rehabilitation unit (from 43 to 22) and in placements to funded staffed accommodation (from 11 to three) despite an increase in void community tenancies. By three months, 17 of 22 referrals for needs assessment were still incomplete, and at one year only three patients had had their needs assessed and appropriately met. Recommendations arising from these findings are discussed.

The experience of a paediatric placement is described. Difficulties encountered mirror those experienced in liasion child psychiatry and the basis for this is dicussed. Early collaboration during specialist training of paediatricians and child psychiatrists can enhance the working relationships between the disciplines and the clinical skills of both.

It seems to be increasingly taken for granted by politicians and commentators that it is more effective to attack one's opponent than to promote a positive vision in order to sway voters in an election campaign. This article examines the relevant evidence in the psychological literature to see if this belief is justified. This includes the evidence on information processing, emotion and the specific effects of negative campaigning.

While waiting for a delayed departure at Goa airport recently, I engaged in conversation with a fellow frustrated passenger who happened to be an American tourist. Upon discovering that I had spent eight months in Goa initiating a field study on common mental disorders in primary care clinics, she expressed amazement exclaiming “but surely there can't be mental problems in this place… it's so beautiful and everyone seems so happy!”. After a brief moment wondering whether my companion was joking, I realised that my work in Goa could in itself seem a bit of a joke to colleagues and friends who associated Goa with being a holiday destination. Not only is the view that living in an apparent paradise is somehow conducive to better mental health a smokescreen, I had come to realise that mental illness was a considerable problem in this coastal state. Perhaps this essay could be an opportunity to explain why.