To examine the standards of lithium monitoring in eastern Hull following the introduction of a local prescribing framework, we investigated the biochemistry records of patients currently prescribed lithium, identified from primary care computerised records. A survey of patients' knowledge about lithium therapy was also conducted.

Inadequate standards of lithium monitoring were demonstrated, with only 50% of patients having a level recorded during the preceding 3 months. Monitoring of thyroid and renal function was better, with two-thirds of patients tested in the past year. Patients' knowledge of the side-effects and risks of lithium was minimal; only 7 out of 27 patients questioned felt able to identify the signs of lithium toxicity; three-quarters of those surveyed felt they had not been given enough information about their medication.

The introduction of prescribing frameworks or other guidelines does not ensure good practice. Further actions may be needed to ensure lithium is prescribed safely, such as patient registers, monitoring cards and automatic recall systems. Education of patients and primary care staff about the safe use of psychotropic drugs needs to be an ongoing process.

On 1 November 2006, Ireland's Mental Health Act 2001 was implemented, replacing the country's Mental Treatment Act 1945. We aimed to assess the impact of this change in legislation on the number and duration of involuntary admissions. We undertook a retrospective review of all admissions to a psychiatric admissions unit from January to October 2006 (pre-implementation) and January to October 2007 (post-implementation).

There were 46 involuntary admissions in the 10-month period under study in 2006, or 33.8 per 100 000 population. There were 53 in 2007, or 39.3 per 100 000 population. This increase was not significant (z = – 0.7, P = 0.46), however involuntary admissions formed a larger proportion of all admissions under the Mental Health Act 2001 than under the Mental Treatment Act 1945 (χ2 = 4.2, P =0.04). There was no difference in the duration of involuntary admissions but under the 2001 Act, involuntary patients had longer periods of voluntary status as part of their admissions than under the 1945 Act.

The introduction of more rigorous procedures for involuntary admission did not significantly change the rate or duration of involuntary admissions in our centre. The finding that involuntary admissions included longer periods of voluntary status suggests that more care is being taken to revoke involuntary admission orders under the Mental Health Act 2001 than under the Mental Treatment Act 1945.

We carried out a web-based survey to establish the proportion of London psychiatry senior house officers who undertake personal psychotherapy. Demographics, training characteristics and psychotherapy experience were examined using descriptive statistics. Predictors of personal psychotherapy status were examined using logistic regression.

The majority of trainees who undertook personal psychotherapy included training as a reason for doing so. of the participants, 16% had undergone personal psychotherapy and of the remainder, 73% reported that they would consider it in the future. Ethnicity was the only predictor of psychotherapy status, with White British trainees nearly four times more likely to pursue it.

Personal psychotherapy appeared to have relevance to training from both a pastoral and a learning perspective. If training schemes wish to support this practice they will need to address difficulties trainees may face in accessing therapy. Trainees might also be encouraged to think about the effect of cultural factors on their attitudes towards psychological therapies.

Psychiatry in the UK has long-standing issues in recruiting UK-trained doctors. A key potential influence on interest in psychiatry during medical school is the clinical attachment. This narrative review investigates how the clinical experience of psychiatry affects medical students' attitudes towards the specialty.

We identified 107 studies, of which 46 were included. They showed that clinical attachments in psychiatry did result in more positive attitudes towards the specialty and increased career interest. There was inconsistent evidence on whether interest was maintained, with some studies indicating that the increase is transient. Factors which may influence attitudes include attachment setting, duration and student demographics.

The results suggest a need to actively maintain interest in psychiatry throughout medical school. Research with long-term follow-up and evaluation of schemes to maintain students' interest is needed.

Medical reports submitted to mental health review tribunals should be of a clinically acceptable standard. We examined 100 medical reports to assess whether they stated the four criteria for detention under Section 3 of the Mental Health Act 1983. We compared the standard of reports according to the seniority, qualifications and speciality of the doctor, and with the outcome from the tribunal.

The majority of the reports were written by junior doctors and did not fulfil the criteria laid down by the Mental Health Act 1983. Consultant and forensic psychiatry status were associated with completed reports.

This study was performed in one hospital only but highlights the ongoing need to review and improve the workings of the Mental Health Act before reform is considered.

To determine psychological morbidity among staff following actual or threatened violence from patients on acute psychiatric wards. A retrospective survey of all 156 clinical staff on Exeter's acute psychiatric wards was conducted by means of an anonymous questionnaire using standardised measures.

The response rate was 81%, and 72% of respondents had experienced one or more distressing incidents of actual or threatened violence within the previous year. The 12-item General Health Questionnaire and Impact of Events Scale scores were significantly higher in those who reported exposure to ‘frequent’ violent incidents.

Some National Health Service staff may be harmed psychologically when they are at work. This consequently may have implications for patient care, employer liability and recruitment.

Research shows that 16- to 19-year-olds express the greatest level of negative attitudes towards people with mental illness. Our aim was to assess the effectiveness of work experience placements in influencing secondary-school students' attitudes towards mental illness and career choices. The Adolescent Attitude Towards Mental Illness questionnaire measured and assessed the adolescents' attitude changes. Pre- and post-evaluation questionnaires assessed changes in their career choices.

There was a statistically significant change in the adolescents' attitudes, especially regarding categorical thinking and perceptions that people with mental illness are violent and out of control. There was also a positive shift in their career choices towards options in the field of mental health.

Work experience placements can have a positive impact on secondary-school students' attitudes towards mental illness and may improve the level of student recruitment into the field of psychiatry.

We have audited the impact of a dedicated dental clinic on the oral health needs of an inner-city in-patient psychiatric population. A questionnaire assessing patient perception of oral health was undertaken on in-patient wards before opening a dental clinic on the hospital site and 5 months after.

The audit suggested improvements in patients' perception of oral health, behaviour directed at oral hygiene and knowledge of accessing services after initiation of a dedicated in-patient dental clinic.

Psychiatric in-patient settings may provide important opportunities for oral health promotion and intervention. This is a neglected component of in-patient care.

There have been no reports on psychiatric intensive care units (PICUs) in medium secure psychiatric facilities. Using case files, we retrospectively examined the characteristics and outcomes of 73 patients who were admitted to a PICU in a medium secure unit between 1 July 1994 and 30 April 1998.

The PICU population was predominantly male, suffering from illness and detained under Part III of the Mental Health Act, 1983. Although the mean length of stay was 75 days, the majority were ultimately transferred to less intensive nursing environments and only nine required transfer to maximum security. In 10% of cases PICU admission was owing to lack of appropriate facilities elsewhere.

Although the PICU was intended as a crisis facility for the management of challenging behaviours, its function was affected by the lack of clear admission and discharge criteria and appropriate facilities for patients with diverse mental, physical and security needs.