The extent of illicit substance use within inpatient mental health settings is becoming a major cause of concern. This poses growing challenges not only for the management of inpatient units, but also for providing continuity of care. Service users with co-occurring substance use are more likely to disengage from services. The process of engagement can be hindered by negative attitudes of staff. This study aimed to identify and explore multidisciplinary staff attitudes and experiences in caring for inpatients with co-occurring ill-mental health problems and illicit substance use. A questionnaire incorporating the Drug and Drugs Problems Perceptions Questionnaire (DDPPQ) was used with a non-probability sample of 84 multidisciplinary staff working on nine mental health units. Semi-structured interviews were then carried out with 10 members of staff. Overall, respondents reported: lack of training; difficulty in accessing support structures; and problematic issues with multidisciplinary decision making and processes. The DDPPQ results showed that staff who had received training held less negative attitudes towards illicit substance users regardless of their length of clinical work experience or type of work setting. Recommendations are made about the importance of training and staff support for the development of less negative attitudes towards this client group.

The development of anti-psychotic medications and deinstitutionalization has shifted the primary focus of mental health treatment from hospital to the community. As a consequence, carers have become an integral part of the care system (Thornicroft and Tansella, 2005). Historically, interventions for families with people with psychosis have tended to focus on service user outcomes that attempt to reduce or prevent relapse (Askey et al., 2007). As a consequence, carers often feel ignored or marginalized by services (Shepherd et al., 1995; Beck and Minghella, 1998; Henwood, 1998). This problem has recently been recognized, and it has been highlighted that there is a need for more involvement with carers of clients with mental illness (DoH, 1999). However, there continues to be a lack of knowledge about carers' needs and how professionals specifically meet carers' needs (Chambers et al., 2001). This article presents the results of a study aimed at exploring the views and experiences of carers, service users and professionals with regard to what carers of people with psychosis need from mental health services. It will initially review the literature on carer burden and needs, as well as interventions such as family intervention and carers' assessments/care plans which have been developed to address carer needs

Childhood disruptive behaviour has powerful long-term effects on adult antisocial outcomes, which continue into middle adulthood. The importance of number of symptoms, the presence of disruptive disorder, and intermediate experiences highlight three areas where interventions might be targeted.

Aims: To establish how much knowledge and experience secondary school-teachers have about psychosis, sources of help available and how to access help. Methods:A questionnaire survey of 130 secondary school teachers from three secondary schools and one pupil referral unit within the catchment area of the Camden and Islington Early Intervention Service in London. Teachers completed a questionnaire about diagnosis, age of onset, aetiology, prognosis and treatment. They were also asked about their experiences of pupils with possible psychosis and for their views on the teacher's role regarding referral of pupils.Results: The majority of teachers were able to recognize psychotic symptoms from a case vignette and many were able to correctly identify possible causal factors, prognosis and factors that might help or hinder recovery. Almost a third of teachers had experienced a pupil with possible symptoms of psychosis. However, teachers were much less certain about their own role towards pupils presenting with psychosis and there was much confusion about who had responsibility to help, and how and where to refer such pupils. Conclusions:The results reinforce the view that teachers are in a strong position in relation to early detection and referral for young people with psychosis. The findings suggest a considerable staff development agenda, especially regarding how to access help and services. Teachers in this study seemed keen for further training in this area.

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