Psychiatric Bulletin: Volume 25 -

Home or away: which patients are suitable for a psychiatric home treatment service?
Judy Harrison, Nooreen Alam, John Marshall
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02 January 2018, pp. 310-313
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Aims and Method
Home treatment offers an alternative to in-patient care, but little has been written about the practicalities of running such a service. Using routine information sources, details of referral and outcome are presented for patients assessed by a home treatment service over 6 months.
Results
Forty-eight per cent of referrals were not accepted, mainly because of lack of cooperation, risk to self or others or the illness not being acute enough. Referrals from junior doctors and accident & emergency were least likely to be accepted. Seventy-two per cent of patients accepted suffered from schizophrenia, bipolar affective disorder or depression with psychosis, similar to the diagnoses for in-patients. Twenty per cent of patients accepted had to be transferred to in-patient care later.
Clinical Implications
Staffing levels need to take account of time spent assessing patients. Junior doctors need training in how to use home treatment services appropriately and a wider range of options are needed to manage patients in crisis out of hours. It is possible to target patients with severe mental illness in a home treatment setting, but a significant number will need transfer to inpatient care.

That ‘praecox feeling’
Anonymous
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02 January 2018, p. 275
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I've worked in psychiatry now for over a decade but never have I experienced that ‘praecox feeling’ with such certainty and dread as I did with Alyson.

Service innovations: an Australian approach to community care – the Northern Crisis Assessment and Treatment Team
Andrew Carroll, Jane Pickworth, David Protheroe
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02 January 2018, pp. 439-441
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The recent White paper, Modernising Mental Health Services, recommended the provision of home treatment teams for acute mental illness (Department of Health, 1998). Such services are not widespread in the UK and have been the subject of recent debate (Smyth et al, 2000). In Australia, multi-disciplinary teams providing 24–hour community assessment and treatment of psychiatric emergencies have been in place now for over a decade, and form the cornerstone of the public mental health service.

Consultant advisers in every service: Summary report from the working group on the role of consultants in implementing the National Service Framework and NHS Plan
Louis Appleby
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02 January 2018, pp. 441-444
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Shortly after taking up my appointment as National Director for Mental Health, I convened a working group of consultant psychiatrists to consider how to involve psychiatrists more in the current process of changing mental health services. This was in recognition of the fact that, while psychiatrists are central to modernising services, their skills and experience are insufficiently used. It is one of the most frequent complaints that I hear from clinicians.

Mental Health Act reform: treatment of dangerous and severe personality disorder
Prabhat Mahapatra
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02 January 2018, p. 486
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Origins of a Section: liaison psychiatry in the College
Geoffrey G. Lloyd
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02 January 2018, pp. 313-315
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Why has liaison psychiatry been slow to develop in the UK? The asylum mentality and the current flight into the community have focused psychiatric resources on chronic psychotic illnesses, neglecting the psychological problems of general hospital patients. Nevertheless, there is abundant evidence that medical and surgical patients have a high prevalence of psychiatric disorder that can be effectively treated with psychological or pharmacological methods.

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