Taking the temperature: attitudes of patients on an all-female psychiatric ward to staff gender

Aims and MethodTo survey the attitudes of in-patients on an all-female ward to staff gender. All patients were invited to complete an anonymous questionnaire which was then repeated on a four-weekly basis for 4 months. Staff members were surveyed once within this period.ResultsOnly 15% of patients (n = 52) wanted all staff members to be female, whereas 87% reported feeling comfortable with male staff; 51% would prefer a predominantly female, mixed-gender staff. All staff (n = 11) were in favour of mixed-gender staffing.Clinical ImplicationsCurrent best practice for staffing single-gender acute in-patient units is unclear. This survey is in line with findings from other studies in that a large majority of female in-patients prefer to be in a unit with mixed staff.

Service innovation: the first year of lifestyle clinics for psychiatric out-patients

Aims and MethodWe sought to develop and introduce annual physical health checks and offer lifestyle advice for out-patients diagnosed with schizophrenia or bipolar disorder in two semi-rural areas in the north-east of Scotland. the results for the first year of the clinics are presented.ResultsSeventy-eight patients were invited to the clinics in the first year. Attendance rates varied from 76% in one centre to 38% in the other; 75 individual significant physical health problems were identified and highlighted to the patient and their general practitioner.Clinical ImplicationsThe high attendance rate in one half of the catchment area demonstrates the potential for physical health screening for this vulnerable group of patients. the identification of significant levels of previously undiagnosed physical morbidity offers opportunity for intervention. Several innovative lifestyle interventions arose from the project and have been maintained.

Mental capacity assessments in secure care: an unnecessary complication?

SummaryThis is a review of the key criteria and implications of the Mental Capacity Act 2005 for patients in forensic care detained under the Mental Health Act 1983. Both Acts were amended by the Mental Health Act 2007 and its subsequent Code of Practice; the impact of these changes will be explored here. Through review of the Code of Practice and hypothetical clinical scenarios, I argue that capacity judgements in mental disorder are inherently complex, unreliable and inextricably linked to risk assessment, and that an overemphasis on capacity when making decisions about patient management in secure care can paradoxically obscure the more central issue of risk and proportionality. the key clinical implication is a call for secure services to be balanced in how they adopt best practice principles from the new Mental Capacity Act so that the spirit of the Act, such as valuing patient autonomy, is preserved and that the debate about what practices in secure care are truly proportionate and justified remains at the forefront of clinical thinking.

Transfer to hospital under the Mental Capacity Act 2005

SummaryThis paper presents the case of an elderly gentleman who sustained a fractured neck of femur following a fall at home but refused to go to hospital. His general practitioner determined that he lacked capacity but ambulance and police crews refused to escort him due to concerns regarding deprivation of liberty.The legal grounds for treating people who lack capacity in emergencies are discussed and the development of the common law into the Mental Capacity Act 2005 is demonstrated. the Mental Health Act 1983 is inappropriate to treat primarily physical conditions, whereas deprivation of liberty cannot be authorised by the Mental Capacity Act 2005 without a means of challenging the lawfulness of the detention. In response, the government has produced Deprivation of Liberty Safeguards, which came into force in April 2009.

Competence or excellence? Invited commentary on … Workplace-based assessments in Wessex and Wales

SummaryThis commentary discusses the problems with workplace-based assessments and questions whether these methods are fit for purpose. It suggests that there is a risk that assessment methods that focus on competence may undermine the need for trainees to aspire to acquire excellent skills rather than merely be competent, which is no more than a rigid adherence to standardised and routinised procedures.

Workplace-based assessments in Wessex: the first 6 months

Aims and MethodWe surveyed educational supervisors and trainees in Wessex about their experience of the first 6 months of using workplace-based assessments (WPBAs), to see whether they needed further support in using them and, if so, in which areas. An anonymous questionnaire was sent to all trainees and educational supervisors in Wessex.ResultsOverall, 63% of trainees and 61% of educational supervisors responded; 22% of supervisors had not received training in WPBA and 61% of trainees identified barriers to completing it. Non-medical staff were rarely approached for assessments.Clinical ImplicationsThere is a need for further training of supervisors, a more user-friendly IT system and expansion of the role of non-medical staff as assessors.