The value and benefit of narrative medicine for psychiatric practice.

This article describes how applying techniques from literary studies and considering patient histories as texts helps me understand and formulate systemic issues in psychiatric assessments. Psychiatrists are not generally taught to pay close attention to aspects of language, including metaphor and syntax, but I argue that paying attention to the form, as well as to the content, of the stories patients bring us, can make us better attuned to the contexts of their needs and distress, and therefore better placed to help.

Online groups and patient forums.

Online mental health support forums are becoming increasingly popular and there is evidence that they are useful: particularly for providing anonymous support and filling information gaps. However, there are also very real concerns about negative outcomes for users. One online mental health service, Big White Wall, manages these risks and supports its members through the provision of 24 hour professional moderation. Comparison of Big White Wall's member population with the population of one London borough shows a diverse user group, but members are more likely to be female, and aged 25 to 34, or unemployed.

The children's services interview: validity and reliability.

BACKGROUND: The Children Service Interview was designed as a brief measure of service use related to mental health problems in Great Britain. METHOD: We validated the Children's Services Interview against medical records from a sample of 87 children, and assessed test-retest reliability from 25 parents completing two interviews. We examined criterion validity by looking at the service use patterns of children attending clinics for different types of disorders. RESULTS: The Children's Services Interview showed high levels of face validity and moderate or better concordance with medical records as far as contacts were recorded in the case notes. Test-retest reliability was moderate or better apart from contacts with the voluntary sector, teachers, and the number and duration of appointments with some professionals. CONCLUSION: The study suggests the Children's Services Interview can extract moderately valid and reliable data on service use. DECLARATION OF INTEREST: Tamsin Ford was supported by a Wellcome Clinical Training Fellowship in Health Services Research while completing this work.

Recruitment of doctors to non-standard grades in the NHS: analysis of job advertisements and survey of advertisers.

OBJECTIVES: To estimate the proportion of advertised non-consultant hospital posts that do not conform to nationally recognised terms and conditions of service and to investigate why these posts exist, who fills them, and what the doctors in such jobs do. DESIGN: Analysis of job advertisements and a cross sectional survey of advertisers. SETTING: Job advertisements in one of the leading UK publications listing hospital doctor vacancies (BMJ Careers). RESULTS: Nearly a quarter of non-consultant posts advertised in the two study periods (23% and 21%) were for non-standard grade posts. A questionnaire was sent to the medical staffing officer for each post. Of 430 questionnaires sent out 192 (45%) were returned. 98 trusts said they advertised non-standard grades because there was no more funding from the deanery for approved posts and 75 because service needs could not be met by doctors in training grades. In 132 posts (69%) the post holder would be required to do on-call work, and 50 advertisers (26%) required on-call duty for 1 in 5 or more frequently, which would conflict with the European Working Time Directive. 131 advertisers (68%) expected the posts to be filled by doctors from outside the European Economic Area. CONCLUSIONS: Non-standard grade posts are mostly being created to meet service requirements when there is no more funding for standard training posts and are expected to be filled by doctors from overseas. Doctors in such posts can be more easily exploited and their careers hindered. The Department of Health's annual census should include non-standard grade doctors.