AimThe early intervention (EI) model appears to improve outcomes of psychosis for younger people, and there is now interest in implementing it in older groups. In the UK, the National Institute of Clinical Excellence advised that EI should be accessible to all individuals with first episode psychosis (FEP). We aimed to explore the likely impact on EI workloads and clinical populations of extending age range.MethodsData were collected on all patients aged 36–65 years who were referred to an inner London EI service from 2011–2014 using the MiData 2 tool at entry and at 1‐year follow up.ResultsPeople aged between 36 and 65 represented 30% of all referrals to the service. There were high levels of recorded past trauma in the sample (62.5%), half had dependent children (58.3%) and just under half physical comorbidity (48.6%). Duration of untreated psychosis was less than a year for the majority. At 1‐year follow up, inpatient admission rates were lower than in previously studied younger EI populations, but only 15% experienced a single episode with full remission.ConclusionsThese findings indicate that admitting over 35‐year‐olds to EI results in a substantial increase in workload. A large proportion had become unwell relatively recently, indicating that the concept of EI may not be redundant in this age range. Evidence is needed on EI effectiveness in this group.

SUMMARY Mental health services are recognised to have an important role in responding to domestic abuse, but approach across the UK's National Health Service (NHS) is inconsistent. We describe an example of taking a whole- organisation approach to responding to domestic abuse in one NHS mental health foundation trust.

Training in psychiatry involves a fascinating and rewarding journey, and is a wonderful career for women. This chapter explores what it means to be a female psychiatric trainee. The authors discuss the recruitment crisis within psychiatry and the way that stigma and financial pressures upon the NHS compound this. They discuss their own experiences as medical students interested in psychiatry, particularly with regard to overcoming prejudices within the wider medical profession. There are certain challenges that are particular to training in psychiatry that women trainees face, including everyday sexism and how it impacts on self-esteem, as well as exposure to violence and stalking, and the effect of social media on medical practice. The authors discuss their own experiences in facing these challenges, what more could be done to support trainees, and they consider the importance of self-care and the way in which training as a psychiatrist can give trainees particular skills of self-reflection and insights into group dynamics that can be invaluable in developing as medical leaders.

The concurrent assessment and treatment of mental health disorders and palliative illnesses is complex. Affective disorders are more prevalent in people who need palliative care. Identifying the most suitable place of care and multi-professional multidisciplinary teams to provide support can be challenging and bewildering for professionals and patients. Mental health clinicians may be left with a sense of therapeutic nihilism, while palliative care teams can feel limited by the mental health resources available for treating those living with significant physical and mental health needs. We discuss the fictional case of a gentleman with metastatic bowel cancer who has developed symptoms of depressive disorder and identify how taking a pragmatic patient-centred approach can offer a route through potential dilemmas when seeking to provide individualised care based on needs. We used lay person experience alongside our own experiences of novel mechanisms for cross-specialty working in order to direct psychiatric trainees’ approaches to such cases.