To engage patients as teachers of psychiatrists in training and non-consultant career grades, for the purpose of enhancing doctors' understanding of the patient point of view and of the complexity of the doctor–patient relationship. Patients have been engaged as teachers in a recurrent cycle of ‘Basic Interview Skills' workshops and the views of the doctors about this initiative have been elicited through a brief anonymous and confidential questionnaire.

Thirty-six psychiatric senior house officers (SHOs), general practitioners, Vocational Training Scheme SHOs in psychiatry, and staff grade and trust doctors in psychiatry have participated in four cycles of workshops. Five patients have engaged in the workshops as teachers, alongside the clinical tutor. Questionnaire feedback indicated some specific criticisms of a number of participants and dissatisfaction by a small minority of doctors, but the overall evaluation of the experience was positive.

Engagement of patients as teachers of psychiatrists in training and other new doctors in mental health services is desirable, feasible and welcomed by most doctors. With due attention to the legitimate sensitivities of participants, the practice of engaging patients as teachers of doctors working in psychiatry could be generalised in training schemes and services across the country.

To explore experiences of psychiatrists considering medication for patients with personality disorder by analysis of transcribed, semi-structured interviews with consultants.

Themes show important relational processes in which not prescribing is expected to be experienced as uncaring rejection, and psychiatrists felt helpless and inadequate as doctors when unable to relieve symptoms by prescribing. Discontinuity in doctor–patient relationships compounds these problems.

Problems arise from: (a) the psychopathology creating powerful relational effects in consultation; (b) the lack of effective treatments, both actual and secondary to under-resourcing and neglect of non-pharmaceutical interventions; and (c) the professionally constructed role of psychiatrists prioritising healing and cure through provision of technological interventions for specific diagnoses. There is a need for more treatments and services for patients with personality disorder; more support and training for psychiatrists in the relational complexities of prescribing; and a rethink of the trend for psychiatrists to be seen primarily as prescribers.

Relapse in schizophrenia carries a heavy burden. This study aimed to describe the characteristics of patients admitted to hospital for relapse and to explore the treatment, length of stay and associated in-patient costs. The sample comprised individuals discharged from a London National Health Service trust following a relapse of schizophrenia. The costs of hospital treatment were obtained by applying referenced unit costs.

The cohort comprised 71 patients. Treatment non-adherence was implicated in 76% of relapses. Mean length of hospital stay was 138.9 days (range 1 week-1.8 years). Mean admission cost was £25 852 (range £1270-120 000). Over 97% of costs were hospital costs and less than 3% drug costs.

Hospital treatment for relapse of schizophrenia carries a considerable economic burden, as shown in this study. Treatment non-adherence is a significant factor contributing to relapse.

To describe a new open access community service for people with personality disorder and to explore interim service utilisation and outcomes. Routine data were analysed together with those from a cross-sectional survey.

During the first 16 months of the service, 171 people attended, of whom 142 (83.0%) returned on at least one other occasion. The median number of attendances was seven (IQR = 3.0–22.0). Over 90% of responders to the survey met criteria for ‘probable personality disorder’ and levels of social dysfunction were high. Presentations to emergency services, contacts with other services and in-patient admissions were reduced. Social functioning improved.

This service attracted a large number of people with significant health and social problems. Use of the service was associated with improved social functioning and reduced use of other services.

This paper assesses the economic impact of a crisis resolution team (CRT) in South London, using data from a prospective controlled trial. Two cohorts of patients were compared. After referral with a psychiatric crisis, the first cohort received existing services and the second cohort had access to input from a CRT. Baseline and follow-up 6-month costs were measured for 181 cases.

At follow-up, mean costs were £1681 less for the post-CRT patients, which was not statistically significant. However, a significant difference of £2189 was observed when patients with any CRT contact were compared with those with none.

The crisis resolution team resulted in lower costs. Such services can thus help to release funds for other forms of care.

To describe the first 6 months of the newly introduced community treatment orders (CTOs) in Birmingham and Solihull mental health services; to establish a clearer picture of patterns of use and some early outcomes. Computerised note systems were used to collect a range of sociodemographic and clinical data using a specially designed data collection tool.

We observed higher than expected numbers of CTOs compared with previous use of Section 25 supervised discharge. Our results were consistent with international studies in showing that CTOs are typically used in males aged around 40 with a primary diagnosis of psychotic illness. Compared with the census population, Black and minority ethnic groups were overrepresented in our sample. There were high recorded rates of comorbid alcohol or substance misuse and violence. The majority of patients on CTOs were being followed up by community mental health teams or assertive outreach teams.

It is difficult to draw firm conclusions at this early stage of implementation. However, there are likely to be resource implications in view of the high numbers of CTOs applied compared with Section 25 discharge. Service providers, clinicians and commissioners need to ensure CTOs are backed up by high-quality care. Further research is required into the impact of CTOs on a range of outcomes and to understand differential rates of CTO across different ethnic groups.

Electronic patient records were used to investigate the level of engagement and treatment that patients with very late-onset schizophrenia-like psychosis (VLOSLP) had with mental health services.

Of 131 patients assessed and diagnosed, 63 (48%) were taking antipsychotic treatment at 3 months, 46 (35%) at 6 months and 36 (27%) at 12 months. At discharge from mental health services, 54% of patients had failed to engage with services or became lost to follow-up, 18% had engaged with services but were not taking antipsychotic medication and only 28% were taking treatment.

Results showed that less than half of the patients with VLOSLP were commenced on antipsychotic treatment and less than a third remained on treatment at 1 year or at point of discharge. This highlights the need for services to consider being more assertive in taking potentially effective treatment to this patient group.

We conducted a survey of the knowledge, attitudes and practices of sexual dysfunction and schizophrenia of general adult psychiatrists in Leicestershire and Lincolnshire mental health trusts.

Two-thirds of psychiatrists that we interviewed do not routinely enquire about sexual dysfunction in their patients and only 17% felt competent in assessing sexual dysfunction, despite 88% agreeing that good sexual function is important to patients. Most practitioners (81.6%) have had no training in this area and wanted some.

Sexual dysfunction is underrecognised and possibly under-treated; suggestions on how to address this are made in this paper.

This study explores the economic cost and carbon footprint associated with current patterns of prescribing long-term flupentixol decanoate long-acting injections. We conducted an analysis of prescription data from a mental health trust followed by economic and carbon cost projections using local and national data.

A reduction of £300 000 could be achieved across England by improving prescribing behaviour, which equates to £250 per patient per year and 170 000 kg CO2e. These savings are unlikely to be released as cash from the service, but will lead to higher-value service provision at the same or lower cost. Most of these carbon emissions are attributable to the carbon footprint of the appointment – 88000 kg CO2e (including energy use and materials used) and the overprescribing of medication – 66000kg CO2e.

Psychiatrists need to review their prescribing practice of long-acting injections to reduce their impact on the National Health Service financial budget and the environment.