Aims and MethodTo evaluate the effects of a crisis resolution and home-based treatment team upon in-patient admission rates. We collected data for 2 years prior and 1 year post-implementation of such a service in Leeds. The chosen time frame allowed the new service to settle in and controlled for seasonal variations.ResultsThere were 4353 admissions during the period of the study, with 3325 in the 2 years prior to the service and 1028 in the year after. Generalised linear analysis found a 37.5% reduction in monthly admissions after the introduction of the team (P < 0.0001).Clinical ImplicationsThis study shows that in everyday clinical practice crisis resolution and home treatment teams lead to a sustained reduction in in-patient admission rates.

Insufficient evidence exists to support the new legislation for England and Wales

This paper describes an audit of the basic standard of record keeping for inpatient clinical records. Following an initial audit, the Royal College of Physicians' inpatient record keeping standards 6 and 7 were adopted. The standard was then reassessed in a second audit. During the first audit, 189 medical entries were assessed and 274 were assessed on repeat audit. A significant improvement was achieved in many areas including recording of time (19-82%), name of author (60-89%), location of patient (58-94%) and identity of the most senior doctor present (68-89%), (p<0.001). The Royal College of Physicians' record keeping standards through the use of audit can lead to considerable improvement in the standard of record keeping within psychiatric practice.

SummaryIn England and Wales diminished responsibility is a partial defence to the charge of murder. If successfully argued by the defence, it reduces the charge from murder to manslaughter and thus avoids the mandatory life sentence. Alcohol has been reported to be a feature in up to 80% of all homicides but for many years the judiciary have set an almost unattainable threshold for the disease of alcoholism to amount to a finding of diminished responsibility, in accordance with other aspects of criminal law. Reform of the law on murder is likely to take many years but it is timely to recap the current law on diminished responsibility and review advances in case law in England and Wales on alcohol.

No abstract