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The death of a patient by suicide can severely affect mental health professionals, particularly if it occurs despite major efforts to intervene. Notwithstanding the difficulties faced by clinicians, suicide prevention remains of paramount importance in order to help save lives. This article seeks to promote a pragmatic and compassionate biopsychosocial response using evidence-based interventions to reduce suicide. It introduces practical strategies that psychiatrists can use in everyday clinical practice, in particular the paradigm shift of suicide mitigation to help prevent suicide. We believe that every encounter with a suicidal person is an opportunity to intervene to reduce their distress and, potentially, to save a life. We believe that it is no longer acceptable for clinicians to state that if patients wish to kill themselves they can do so, in the absence of any attempt at a compassionate intervention.

This paper seeks to offer a methodology for practitioners to encourage the development of meaningful reflection. Such reflection on practical values and theories, which inform everyday actions are a source of continuous learning and define professional practice. This reflection draws on two case studies of the development of separate information systems. The first a case study focused on the design and implementation of an information system that offered a solution to restraints on the growth of the business, and a second case study of Small and Medium-sized Enterprise (SME) unable to articulate information system requirements was able to commission a sustainable system. Multi-view was used as a reflective framework, so practitioners were able to extract meaningful outcomes on both practice and praxis. Although the paper bases its speculations on a small number of examples the framework for reflection is offered as a model for future development and adoption elsewhere.

Self-harm is an important health issue. It is more prevalent in the UK than the rest of Europe. An estimated 170 000 people present to hospital each year but most acts of self-harm do not result in presentation for medical attention; so self-harm is largely a community problem with real-term figures an unknown. This article explains the terminology associated with self-harm, provides explanations for the different motives and suggest ways in which primary care can contribute to assessing and responding to patients engaging in self-harm. It will also explain a process to mitigate risk.

It is 3 a.m. and your patient is at home, wide awake and being tormented by suicidal thoughts. What is likely to stop him ending his life and make him seek help? A complex lengthy risk assessment he underwent earlier that day or the skill and understanding of an empathic and trusted GP with whom he agreed a simple crisis plan? Every contact a suicidal individual has with a health care professional represents an opportunity to intervene and prevent that individual from going on to die by suicide. As long as suicide is seen as the preserve of specialist mental health services, opportunities for early intervention will be missed. This paper will introduce a comprehensive way of assessing and responding to patients experiencing suicidal thoughts in primary care.

It is 3 a.m. and your patient is at home, wide awake and being tormented by suicidal thoughts. What is likely to stop him ending his life and make him seek help? A complex lengthy risk assessment he underwent earlier that day or the skill and understanding of an empathic and trusted GP with whom he agreed a simple crisis plan? Every contact a suicidal individual has with a health care professional represents an opportunity to intervene and prevent that individual from going on to die by suicide. As long as suicide is seen as the preserve of specialist mental health services, opportunities for early intervention will be missed. This paper will introduce a comprehensive way of assessing and responding to patients experiencing suicidal thoughts in primary care.

Self-harm is an important health issue. It is more prevalent in the UK than the rest of Europe. An estimated 170 000 people present to hospital each year but most acts of self-harm do not result in presentation for medical attention; so self-harm is largely a community problem with real-term figures an unknown. This article explains the terminology associated with self-harm, provides explanations for the different motives and suggest ways in which primary care can contribute to assessing and responding to patients engaging in self-harm. It will also explain a process to mitigate risk.

Non-medical prescribing has undergone radical changes in recent years, and there is clearly a need to evaluate its impact on practice. The study reported in this article focused on one county in the south-east of England. A two-part strategy was adopted: a questionnaire was distributed to all nurses who held the non-medical prescribing qualification; and interviews conducted with a variety of nurses, pharmacists, doctors and managers. An earlier paper (Avery et al, 2007) focused on the extent to which effectiveness of non-medical prescribing was associated with the doctor–nurse relationship, but this article examines its impact for all the stakeholders involved. The findings suggested that, in a number of areas, patient throughput was increasing, nurses and doctors were re-assessing their roles, and that the qualification enhanced personal feelings of job satisfaction and autonomy. Moreover, although patients were not directly involved in the study, the overall perception was that they too were experiencing satisfaction with a system that enabled speedier access to treatment.

This paper reports a study that was commissioned to evaluate non-medical prescribing in one health authority in the south-east of England. A questionnaire was distributed to all nurses and pharmacists who held a non-medical prescribing qualification, and this was followed up by semi-structured interviews with nurses, pharmacists, doctors and managers. The findings confirmed that the majority of respondents were very experienced, and that they were making good use of the qualification. In addition, there were clear signs that patient care was being enhanced, but this was more evident when there was a close working relationship with the doctor. In the absence of this relationship, there is a need for the organization to develop a clear strategy for the implementation of non-medical prescribing, which should incorporate the views of all key stakeholders.

Care professionals were interviewed regarding the extent, nature and victims of inappropriate sexual behaviour of 46 males with learning disabilities, and an adapted and expanded form of a version of the Structured Anchored Clinical Judgement risk assessment protocol (SACJ-Min: Hanson and Thornton, 2000) was completed for each client. Comparisons of the 16 criminally convicted and 30 non-convicted men revealed few differences on factors associated with sexual recidivism. However, convicted men were more likely to have targeted children and males as victims and had perpetrated more serious sexual offences. Variables that differed significantly, or nearly so, between the two groups were entered as predictors in a logistic regression analysis. The analysis generated a powerful model, accounting for almost 50% of the variance. However, the only significant predictors of convicted status to emerge from this analysis were child victim and, less reliably, emotional loneliness. The results suggest that the decision to prosecute a man with learning disabilities who displays sexually inappropriate behaviour is based more on the identity of the victim than on the nature of the offence.

The satisfaction of health service users is an increasingly important concern to service providers, yet there is little guidance about how it should be assessed. This study compares three different methods of collecting service users’ views (postal questionnaire; face-to-face interview; focus groups) to identify the strengths, weaknesses, usefulness, and what the service user thinks of each method.

The article presents a discussion on the origin and innovation of the textiles used at the Khmer Court in Cambodia from a paper delivered at the Southeast Asian Textiles Through the Threat of Time conference held in Bangkok, Thailand in 1999.

The number of women inseminating by donor informally, outside a fertility treatment clinic, is increasing. This article reports on a study examining the experiences of 20 women who considered informal insemination and the procedures they used to select and screen donors.

Quantitative and qualitative data were gathered from a sample of 66 seropositive and 67 seronegative men and women about the impact of an HIV diagnosis upon psychosocial well-being. No significant differences between seropositives and seronegatives were found on any of the psychosocial measures except hopelessness. Nor was there significant variation by disease progression (but this may be due to the restricted size of the sample). The qualitative data are used to illustrate these findings and explore their meaning. It is concluded that, with the exception of a hopeless future orientation, psychosocial disturbance of seropositives tends to be episodic and short-lived and thereby difficult to measure.

The article focuses on the weaving tradition and artefacts in Cambodia. "Etude sur le Tissage au Cambodge" was published by Jean Stoeckel, assistant director of the Cambodian School of Arts, in 1923, where he specified artefacts used in the preparation of silk and cotton for weaving and the composition and use of a Cambodian frame loom. According to Stoeckel, many of the artefacts were still decorated with sculptures/carvings and even lacquered and gilded. The history of weaving is considered by author Mattiebelle Gittinger as a mystery.

The article describes a flower arrangement which used bricks, burnt logs, the leaves and flowers of Cotinus, berry branches, and the dead leaves of Cordyline.

A letter to the editor in response to the article on pre- and Angkorian period gold jewelry by Theresa McCullough in the January-February 2000 issue is presented.