Suicide of a patient is a very distressing event for a consultant psychiatrist and can adversely affect both their personal and professional life. Consultant psychiatrists have been shown to have higher levels of work-related exhaustion than their medical and surgical colleagues and patient suicide potentially contributes to this.1 A review of studies from the USA, Canada and the UK suggests that 50-70% of consultant psychiatrists will experience the suicide of a patient at some point in their career.2 Despite it potentially being one of the most distressing events in a psychiatrist's career, the number of studies in the literature is relatively small and there has been only one Irish study to date.3 The studies conducted thus far have all identified patient suicide as a cause of considerable distress, yet it is an event for which training leaves psychiatrists underprepared. We conducted a nationwide study of all consultant adult psychiatrists in Ireland to establish the impact on their personal and professional life. MethodWe sent a confidential postal questionnaire to 292 consultant psychiatrists in Ireland (not including child and adolescent psychiatrists), identified through records held by the Irish Medical Council and the Irish Medical Directory (www.imd.ie) that were cross-checked with each individual hospital. To maintain confidentiality and thus optimise our response rate, the questionnaires were not coded or numbered in any way and were sent with a noncoded, stamped, addressed return envelope. However, each participant was assigned a number and was sent a corresponding numbered envelope and asked to post this simultaneously with their questionnaire, to aid identification of non-responders. Non-responders were contacted again by post after 10 weeks and after a further 8 weeks they were contacted by email if available.We examined each consultant's most recent experience of patient suicide as well as the suicide they perceived to be most distressing. We did not specify that the deaths had to have been recorded as suicides in the coroner's court, instead leaving the choice of case to each individual's judgement.The questionnaire (available from the author on request) was divided into three sections: the first gathered basic demographic data; this was followed by a section relating to the consultant's most recent experience of patient suicide, the individual patient's characteristics, the effect the suicide had on the consultant, both personally and professionally, and what coping strategies they used in its aftermath. The final section of the questionnaire asked the psychiatrists to provide that same information regarding the suicide they had found to be most distressing during their consultant career. Consultants had the opportunity to provide additional information in free-text boxes. Results Study sampleA total of 292 questionnaires were sent. We received 182 responses, of which 4 were excluded owing to incomplete information; this gave us a response rate of 61%. The Aims and method To study the effects...

Objective: Irish psychiatrists may begin to spend, as their British have counterparts have, at least some of their time delivering a psychiatric service from primary care settings. It was therefore decided to review the origins and development of attitudes towards and outcome this practice in Britain.Method: A literature search and review of relevant papers was undertaken.Results: Collaboration between psychiatrists and general practitioners began to expand significantly in the 1970s and 1980s. Three main models are used, the shifted outpatient model, the selected consultation model and the liaison-attachment team model. The shifted out-patient model is liked by patients whose attendance rate is better at such clinics and in some areas this model has resulted in a fall in hospital admission rates. There is a paucity of papers examining outcome of the other models. Results of the one extensively studied team liaison approach reports higher treated prevalence rates and lower admission rates for those patients referred. There was no effect on detection of illness by GPs and the service was much more costly.Conclusions: While some benefits may result from use of the shifted out-patient approach, they are not compelling enough to enable a firm recommendation for its widespread implementation to be made. The results to date suggest the team-liaison approach does not produce benefits sufficient to outweigh the increased cost. The selected consultation model may hold greater potential but needs to be more extensively researched. Finally the structure of general practice in Ireland, with so few GPs working in multiple partner practices makes it highly unlikely that the widespread introduction of collaboration will be feasible.

Objectives: To determine to what extent official suicide rates in counties Kildare and Mayo underestimate the rates as clinically determined, and to examine and compare the association between the sociodemographic characteristics of the two Irish counties and trends in the suicide rates.Method: Populations for the two counties for the years 1988-1994 were calculated. Official suicide mortality data was obtained from the Central Statistics Office. Following examination of the coroners' files for both counties the number of suicides was estimated using clinical criteria.Results: Neither county showed a significant change in suicide mortality over time from 1988-1994. Suicide was underestimated in official mortality data for each county. There were significant differences in the choice of method of suicide with an excess of drowning in Mayo and of shooting in Kildare. Mayo suicides were more likely to be single and unemployed.Conclusions: Much local research is needed before implementing suicide prevention programmes due to the many demographic differences and differences in traditions and choice of method of suicide that exist between counties.

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