'Benign invigilation': using appreciative inquiry to reposition clinical risk in multi-disciplinary CAMH teams.

In response to a spate of serious untoward incident enquiries, CAMHS team leaders in East London, UK, embarked on a series of clinical risk workshops with staff teams. Complementary to what might be called retrospective organisational responses to high risk events, these prospective workshops were predicated on the idea that risk reduction is increased when individuals in teams are responsive to one another, when teams are positively risk-aware and when risk awareness is seen as having the capacity to predict what may go wrong in the future.

Developing a tier I CAMHS foundation course: report on a 4-year initiative.

Despite a growing recognition of the strategic importance of the UK's Tier 1 in supporting children and young people with mental health needs, detailed descriptions of the developmental hurdles and content of such courses remain obscure. There are a number of initiatives being undertaken nationally to remedy this and the aim of this article is to contribute the authors' experience to what is becoming a burgeoning national endeavour. Particular attention is drawn to the problems of developing volume multiagency trainings in areas of significant social deprivation and mental health morbidity but innovation is needed to balance the competing needs for quality, penetration into Tier 1, pressures on staff time and managers' release constraints. A core syllabus is tentatively suggested, with additional skills components, and a teaching session is explored in detail to illustrate the authors' methodology and approach.

Pervasive alienation: on seeing the invisible, meeting the inaccessible and engaging 'lost to contact' clients with major mental illness.

Increasing integration of services for adults with severe mental health problems has highlighted the challenges to services posed by clients who are difficult to engage. There is a dearth of studies on direct work with individuals who are reclusive and difficult to contact, in contrast with the bulk of literature where the patient and network are present and available. This paper describes the work of a busy CMHT with such clients; barriers to collaborative work are explored and some of the team's strategies to overcome these barriers are delineated. Long, slow and persistent contact is observed to be a core feature of the work. The paper goes on to examine the fit between the realities of ongoing work with such clients and the available therapeutic and service discourses.