A Trust-wide smoke-free policy was introduced in March 2007. This service evaluation retrospectively reviewed the outcome by focusing on recorded changes in behaviour, incidents and prescribing.

The majority of patients (89%) smoked before the smoke-free policy. There was no significant change in the rate of clinical incidents or the use of tranquillising medication at 3 months and 12 months post-implementation. Clozapine serum levels were raised significantly, necessitating dose reduction in 17% of patients. Fifty-four per cent of patients used nicotine replacement therapy and a small minority continued this treatment for 12 months.

Despite initial concerns there were no significant problems in implementation of the smoke-free policy. This was assisted by extensive preparation, education, patient advocacy and access to treatment beforehand.

There is a lack of current data regarding attitudes of doctors towards psychiatry. General practitioners (GPs) are increasingly involved in teaching psychiatry, and their attitudes towards psychiatry may affect their ability to promote psychiatry. The main aim of the study is to inform on current attitudes of GPs towards psychiatry as a discipline. The Attitudes Towards Psychiatry (ATP-30) questionnaire was administered to all GPs within Shropshire.

The response rate was 61% (n = 145 from N = 239). The mean score for the ATP-30 was 113.9. An association was found between GP trainer status and higher ATP-30 scores. Positive associations were found between demographic data (age, length of career, postgraduate experience of psychiatry, involvement in undergraduate teaching, GP trainer status) and individual response items on the ATP-30 scale.

General practitioners in Shropshire have a positive attitude towards psychiatry. Associations between demographic data and ATP-30 scores indicate that GPs with more experience of psychiatry and those involved in training may have more positive attitudes. The main limitation of the study is the lack of proven validity of the scale for use in this population. The positive attitude towards psychiatry is consistent with GPs providing the role models needed if they are to be involved to a greater degree with teaching and promoting psychiatry as a career. The need for the development of a more specific tool or an update to the existing tool is discussed.

The evidence of the efficacy of cognitive-behavioural interventions is well established. Despite this, clinicians often face a consistent number of not attended appointments or early treatment discontinuation rates. This paper reviews the literature to date regarding the possible causes of early termination of cognitive-behavioural interventions. A literature search was done using Medline, PsycINFO, Embase and the Cochrane Library.

We reviewed 14 articles. Out of these, two were randomised controlled trials, one was a controlled trial and the rest were cohort studies. Drop-out was defined differently across papers. There are many factors that may affect early treatment discontinuation rates and they are described individually.

There does not appear to be a single strong predictor of early treatment discontinuation. Specific literature relating to cognitive-behavioural therapy is scarce. However, some factors such as young age, education level and psychopathology appear to be more strongly associated with early treatment discontinuation than others.

To explore the extent to which 2007 Department of Health guidelines on monitoring of high-dose (⩾100 mg) methadone were followed, the reasons for non-adherence to these and the prevalence of QTc prolongation. We developed a simple tool for collecting data from case notes.

Out of 25 service users, 11 had had an electrocardiogram (ECG) and 7 had evidence of requests sent to general practitioners. After implementation of our recommendations, ten more service users had ECGs within 1 month. All but one ECG was normal. Methadone prescribing in favour of lower doses has been observed. QTc interval prolongation was not common.

Effective communication between primary and secondary care services is important in identifying cases and arranging ECGs.

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.

To identify the provision of psychosocial assessments for all people attending an accident and emergency department in Ireland with a presentation indicative of self-harm over 12 months and to investigate whether the National Institute for Health and Clinical Excellence (NICE) guidelines for self-harm were met.

A total of 834 attendances for self-harm were recorded. A psychosocial assessment was undertaken by a member of the liaison psychiatry team in 59% of attendances. Single male patients under 45 years of age represented 39% of those who did not receive a psychosocial assessment.

Single men under the age of 45 years represent a vulnerable group in which levels of psychosocial assessment need to be optimised in order to meet the NICE guidelines for standards of care.

A 4-month pilot was conducted to assess whether the clinical librarian model, which has been successfully used within acute hospitals, would work in a mental health setting. A librarian attended weekly clinical team meetings in two community mental health teams to help generate clinical questions. A summary of the evidence on each topic was then presented the following week. An evaluation of the pilot was carried out using a questionnaire survey, focus groups and interviews.

Results suggest that the project had produced a positive impact within the teams and begun the process of embedding evidence-based information within clinical practice.

With some adaptations, the clinical librarian model can be an effective method of implementing evidence-based practice and addressing continuing professional development needs within mental health clinical teams.