Search

In late 2008, the Regional Office for Europe of the World Health Organization (WHO, 2008) issued a report based on a survey of the policies and practices for mental health within its area of operation. Forty-two European states were examined and a great diversity in practice was recorded. Almost everywhere, the report suggested, policy making and legislative initiatives were seen; since 2005, some 57% of the countries studied had adopted new mental health policies and 48% had introduced new legislation. Many countries were reported to be closing mental hospital beds and replacing them with community-based services. In some countries, however, the report suggested, desks in ministries were collapsing under the weight of policies that had never been implemented, and compliance with legislation by planners and psychiatrists was distinctly variable. The WHO felt that even the role that general practitioners played in treating people with mental illness was limited in many European states and that the availability of home treatment options, assertive outreach for people with complex mental health needs and community-based early intervention was not only variable but often severely limited. Given the wide discrepancies of procedure and practice, it was difficult for the WHO to gain any clear perspective on such legislative matters as arrangements for compulsory care in the community.

In psychiatric medicine, as in other fields, Europe offers a diversity of history and academic tradition that belies its limited geographical area. There are numerous centres of excellence - in psychiatric research, service innovation and practice - and many countries have internationally recognised and excellent training schemes in psychiatry. But uniformity of practice is seldom in evidence.

The records of 79 children whose firesetting led to referral to a Children's Hearing (the Scottish equivalent of a juvenile court) were examined. All but one of the children were boys. They had very disturbed backgrounds, with much family disruption and absent or unemployed fathers. Firesetting was predominantly a group activity and the damage caused was extensive. Although the children frequently engaged in other offences, in over 90 per cent there was no recurrence of reported firesetting within the limited period of possible follow-up.

This paper describes the development of a new day-care provision for psychiatric patients. A purpose-built psychiatric day hospital was established in 1986 at the Royal Victoria Hospital, Edinburgh. A description is given of the first two years of operation. The unit's aim, to integrate treatment of both long-term and acute patients, has been successfully maintained after two years. Patient progress was assessed using the Morningside Rehabilitation Status Scale (MRSS). A problem area identified was that of patients who would not engage with the day hospital.

Two groups of patients representing the common objectives of Day Hospitals, namely steady progress and maintenance in the community, were studied. The Morningside Rehabilitation Scale was used to measure dependency, inactivity, isolation and the effects of current symptoms on the patient's life-style. Small but significant changes including in some cases crucial changes which involve working capacity were observed. There is discussion on the value of standardised measurement and the expression of results in terms of levels of functioning. The effect on multi-professional communication and on the possibilities of comparison and planning of services is discussed.

Centres for the treatment of drug abusers are often integrated with regional psychiatric hospitals and are the focus of the British response to opiate addiction. Little is known, however, about the use made of these services by drug users in the community or about the success of these services. This study examined the use made of one centre offering a detoxification service by a cohort of 183 heroin users from a large Scottish general practice. Over half of this cohort were referred to the psychiatric drug treatment service, but less than one third started treatment. The evidence did not indicate that patients who had extended contact with the psychiatric service showed prolonged abstinence, though methodological difficulties necessitate further prospective studies. This study raises important questions about the value and appropriateness of this type of service in the light of the pattern of voluntary remission and relapse displayed by heroin users and in the absence of adequate provision for drug abusers in the community.