For individuals diagnosed with chronic psychosis, the DVLA mandates a minimum of 3 months of stability before they can resume driving standard cars and motorcycles. However, for those driving LGVs of PCVs, this period is extended to 3 years. Similar guidelines apply to those with acute psychotic disorders and hypomania/mania. In the case of severe anxiety of depression, LGV/PCV drivers may be allowed to resume driving after 6 months of stability.

Studies investigating the effectiveness of DBS in treating depression have most commonly focused on the subgenual cingulate gyrus. A review conducted in 2012 found that out of the six studies (with a total of 65 patients) that were analyzed, all of them targeted this area. Other areas that were targeted in smaller studies included the ventral capsule/ventral striatum (two studies with 32 patients) and the nucleus accumbens (three studies with 24 patients). There were also individual case reports that looked at the inferior thalamic peduncle and lateral habenula.

Challenges and Benefits of Service User Involvement

Paragraph 1: Implementing service user involvement can be costly and time-consuming for both organisations and service users. However, if done properly, it can bring significant benefits.

Paragraph 2: In the past, there has been resistance to the idea of using service users as experts. However, involving service users in decision-making processes can lead to more effective and relevant services.

Paragraph 3: Contrary to popular belief, service user involvement can actually help overcome social isolation and improve mental health outcomes.

Paragraph 4: Despite the benefits, there has historically been a lack of resources for service users and carers on how to get involved in their local services. This needs to be addressed to ensure that service user involvement is accessible and inclusive.

Preventative Treatment Options for Psychosis

According to NICE guidelines, individual cognitive-behavioral therapy (CBT) is a recommended preventative treatment option for individuals at high risk of developing psychosis, with of without family intervention. However, antipsychotic medication is not recommended for preventing of reducing the risk of psychosis. Dialectic behavior therapy (DBT) is typically used for patients with borderline personality disorder, while omega 3 fatty acids have shown some potential in treating refractory schizophrenia. Psychodynamic psychotherapy is generally not recommended for possible early onset psychosis.

A randomized control trial conducted by Prakash demonstrated that the memory enhancing drug, donepezil hydrochloride, can decrease the time required for recovery after undergoing ECT. This finding suggests that donepezil may have therapeutic and prophylactic benefits for patients undergoing ECT. The study was published in the Journal of ECT in 2006.

ECT and Seizure Duration: Effect of Psychotropics

On the whole, most drugs do not interfere with ECT. However, it is important to note the effect of psychotropics on seizure duration. The table below summarizes the effect of important psychotropics and their advice:

Psychotropic class: Benzodiazepine
Effect on seizure duration: Reduced
Advice: Avoid where possible

Psychotropic class: SSRIs
Effect on seizure duration: Minimal effect

Psychotropic class: Venlafaxine
Effect on seizure duration: Minimal effect

Psychotropic class: TCAs
Effect on seizure duration: Possibly increased
Advice: TCAs are associated with arrhythmia following ECT in the elderly and those with cardiac disease, so they should be avoided in ECT in these groups.

Psychotropic class: MAOIs
Effect on seizure duration: Minimal effect

Psychotropic class: Lithium
Effect on seizure duration: Possibly increased
Advice: Generally used in ECT without significant problems.

Psychotropic class: Antipsychotics
Effect on seizure duration: Some potential increase in clozapine and phenothiazines, other antipsychotics considered ok
Advice: Limited data.

Psychotropic class: Anticonvulsants
Effect on seizure duration: Reduced
Advice: If used as a mood stabilizer, continue but be prepared to use higher energy stimulus.

(Source: Maudsley Guidelines 10th Edition, p.187)

ECT (Treatment) – Summary of Effectiveness and Recommendations

ECT (Electroconvulsive Therapy) is a treatment that induces a therapeutic seizure through the application of electrical current under general anesthesia and muscle relaxation. It is prescribed as a course and is usually administered twice weekly for 6 to 12 treatments. ECT is the most effective short-term treatment for major depression, with remission rates of around 60-80% when used as first-line treatment in a severe depressive episode. However, without maintenance treatment, the relapse rate is extremely high (over 80%) in the 6 months after successful ECT.

Cognitive effects are the main limitation to the wider use of ECT, particularly acute confusion shortly after the treatment, retrograde amnesia, and some losses in autobiographical memory longer term. The current state of evidence does not allow the general use of ECT in the management of schizophrenia. Bilateral ECT is more effective than unilateral ECT but may cause more cognitive impairment. With unilateral ECT, a higher stimulus dose is associated with greater efficacy but also increased cognitive impairment compared with a lower stimulus dose.

NICE (National Institute for Health and Care Excellence) recommends that ECT is used only to achieve rapid and short-term improvement of severe symptoms after an adequate trial of other treatment options has proven ineffective and/of when the condition is considered to be potentially life-threatening. ECT is recommended for individuals with severe depression (that is life-threatening and when a rapid response is required, of when other treatments have failed), moderate depression (consider it if their depression has not responded to multiple drug treatments and psychological treatment), catatonia, and a prolonged of severe manic episode.

The RCPsych (Royal College of Psychiatrists) position on ECT recommends it as a first-line treatment for individuals with high suicidal risk, severe psychomotor retardation and associated problems of compromised eating and drinking and/of physical deterioration, treatment-resistant depression that has responded to ECT in a previous episode of illness, pregnant individuals with severe depression, of severe mixed affective states, mania of catatonia and whose physical health of that of the fetus is at serious risk, and those who prefer this form of treatment. ECT is recommended as a second-line treatment for individuals with treatment-resistant depression, severe side-effects from medication, and persistent of life-threatening symptoms in severe of prolonged mania. ECT is indicated in some circumstances for individuals with bipolar depression, postnatal psychosis, treatment-resistant schizophrenia, treatment-resistant catatonia, and frequent relapses and recurrences of depression (maintenance).

ECT and Seizure Duration: Effect of Psychotropics

On the whole, most drugs do not interfere with ECT. However, it is important to note the effect of psychotropics on seizure duration. The table below summarizes the effect of important psychotropics and their advice:

Psychotropic class: Benzodiazepine
Effect on seizure duration: Reduced
Advice: Avoid where possible

Psychotropic class: SSRIs
Effect on seizure duration: Minimal effect

Psychotropic class: Venlafaxine
Effect on seizure duration: Minimal effect

Psychotropic class: TCAs
Effect on seizure duration: Possibly increased
Advice: TCAs are associated with arrhythmia following ECT in the elderly and those with cardiac disease, so they should be avoided in ECT in these groups.

Psychotropic class: MAOIs
Effect on seizure duration: Minimal effect

Psychotropic class: Lithium
Effect on seizure duration: Possibly increased
Advice: Generally used in ECT without significant problems.

Psychotropic class: Antipsychotics
Effect on seizure duration: Some potential increase in clozapine and phenothiazines, other antipsychotics considered ok
Advice: Limited data.

Psychotropic class: Anticonvulsants
Effect on seizure duration: Reduced
Advice: If used as a mood stabilizer, continue but be prepared to use higher energy stimulus.

(Source: Maudsley Guidelines 10th Edition, p.187)

The History of Psychosurgery

Psychosurgery, the surgical treatment of mental illness, has a long and controversial history. The modern era of psychosurgery began in the late 19th century with the pioneering work of Swiss neurosurgeon Burckhardt, who removed areas of cortex from the frontal and parietal regions of six patients.

In 1910, Russian neurosurgeon Puseep ablated the frontoparietal tracts of three bipolar patients. However, it was Egas Moniz who refined psychosurgical techniques and was awarded the Nobel Prize for Medicine in 1949 for his work in the treatment of psychiatric disorders.

American neurosurgeon Freeman also developed similar procedures and advocated for psychosurgery as a first-line treatment for mental illness. Luver and Bucy described the effect of temporal lobectomy on aggression, further advancing the field of psychosurgery. Despite its controversial history, psychosurgery continues to be used today in select cases as a treatment option for severe mental illness.

The Care Program Approach (CPA) was implemented in 1991 to enhance community care for individuals with severe mental illness. The CPA comprises four primary components, including assessment, a care plan, a Care Coordinator (formerly known as a Key Worker), and regular review. There are two levels of CPA, namely standard and enhanced. Standard care plans are suitable for individuals who require minimal input from a single agency and pose minimal risk to themselves of others. Enhanced care plans are designed for individuals with complex needs who require collaboration among multiple agencies.

The study by Brown and Harris explores the societal factors that contribute to the development of depression.

Model for Identifying Pathways to Psychiatric Care

Goldberg and Huxley (1992) proposed a model that can be used to examine the identification, assessment, and pathway to psychiatric care for individuals with common mental health disorders. The model consists of five levels of care, with filters between them that are influenced by the behavior of those with the disorders and the healthcare practitioners they encounter. The authors highlight that only a small percentage of individuals with mental disorders receive specialized psychiatric care.

DBS, a type of neurosurgery, is typically conducted in an operating theatre and has been shown to be effective in treating OCD based on randomized controlled trial (RCT) data. However, there are currently no NICE Guidelines available for DBS.

Neurostimulation is a treatment that uses electromagnetic energy targeted at the brain. There are several forms of neurostimulation, including TMS, deep brain stimulation, and ECT. TMS is a non-invasive, non-convulsive technique used to stimulate neural tissue. It involves the placement of an electromagnetic coil on the patient’s scalp to deliver a short, powerful magnetic field pulse through the scalp and induce electric current in the brain. TMS is used to treat depression when standard treatments have failed. Deep brain stimulation is a neurosurgical technique that involves placing an electrode within the brain to deliver a high-frequency current in a specific subcortical of deep cortical structure. It has been used to treat Parkinson’s, dysthymia, OCD, and Tourette syndrome. There is RCT evidence to demonstrate its effectiveness in OCD, but conflicting results in depression and Tourette’s. DBS is also being trailed in other conditions such as anorexia, bipolar, and additions.

Electroconvulsive therapy (ECT) is known to cause retrograde amnesia, which is the most persistent cognitive side effect (Lisanby, 2000). Patients often experience memory gaps for events that occurred around the time of ECT, and sometimes even for events that happened months of years prior. While retrograde amnesia typically improves within a few months after treatment, some patients may not fully recover and may have permanent memory loss for events close to the time of treatment. Additionally, anterograde amnesia may also be a possible side effect.

ECT (Treatment) – Summary of Effectiveness and Recommendations

ECT (Electroconvulsive Therapy) is a treatment that induces a therapeutic seizure through the application of electrical current under general anesthesia and muscle relaxation. It is prescribed as a course and is usually administered twice weekly for 6 to 12 treatments. ECT is the most effective short-term treatment for major depression, with remission rates of around 60-80% when used as first-line treatment in a severe depressive episode. However, without maintenance treatment, the relapse rate is extremely high (over 80%) in the 6 months after successful ECT.

Cognitive effects are the main limitation to the wider use of ECT, particularly acute confusion shortly after the treatment, retrograde amnesia, and some losses in autobiographical memory longer term. The current state of evidence does not allow the general use of ECT in the management of schizophrenia. Bilateral ECT is more effective than unilateral ECT but may cause more cognitive impairment. With unilateral ECT, a higher stimulus dose is associated with greater efficacy but also increased cognitive impairment compared with a lower stimulus dose.

NICE (National Institute for Health and Care Excellence) recommends that ECT is used only to achieve rapid and short-term improvement of severe symptoms after an adequate trial of other treatment options has proven ineffective and/of when the condition is considered to be potentially life-threatening. ECT is recommended for individuals with severe depression (that is life-threatening and when a rapid response is required, of when other treatments have failed), moderate depression (consider it if their depression has not responded to multiple drug treatments and psychological treatment), catatonia, and a prolonged of severe manic episode.

The RCPsych (Royal College of Psychiatrists) position on ECT recommends it as a first-line treatment for individuals with high suicidal risk, severe psychomotor retardation and associated problems of compromised eating and drinking and/of physical deterioration, treatment-resistant depression that has responded to ECT in a previous episode of illness, pregnant individuals with severe depression, of severe mixed affective states, mania of catatonia and whose physical health of that of the fetus is at serious risk, and those who prefer this form of treatment. ECT is recommended as a second-line treatment for individuals with treatment-resistant depression, severe side-effects from medication, and persistent of life-threatening symptoms in severe of prolonged mania. ECT is indicated in some circumstances for individuals with bipolar depression, postnatal psychosis, treatment-resistant schizophrenia, treatment-resistant catatonia, and frequent relapses and recurrences of depression (maintenance).

Principles of Prevention for Depression

Depression can be prevented through various principles of prevention. According to an article on depression prevention, there are different levels of prevention that aim to reduce the incidence, prevalence, and associated disability of depression.

Primary prevention focuses on reducing the occurrence of depression in the general population. This can be achieved through public health campaigns, education, and awareness programs.

Secondary prevention targets subgroups of the population who are identified as at risk for depression. This can include individuals with a family history of depression, those who have experienced traumatic events, of those with chronic illnesses.

Tertiary prevention aims to reduce the disability associated with depression. This can involve providing support and treatment to individuals who have already developed depression, in order to prevent further complications and improve their quality of life.

Universal prevention targets the entire population, while selective prevention targets specific subgroups. Indicated prevention targets individuals who are at a prodromal stage of depression, meaning they are showing early signs of the illness.

By implementing these principles of prevention, it is possible to reduce the incidence, prevalence, and disability associated with depression.

– ABV indicates the number of units of alcohol per litre of a liquid.
– The total number of alcoholic units in any given amount of liquid may be calculated by multiplying the volume of liquid (ml) by the ABV and dividing by 1000.
– A 1L bottle of 20% ABV port contains 20 units of alcohol.
– 6 large (250 ml) glasses of 12% ABV wine contain 18 units of alcohol.
– 12 330ml bottles of 5% ABV lager contain 20 units of alcohol.
– 12 500 ml bottles of 4% ABV ‘alcopop’ contain 24 units of alcohol.
– 20 standard (25 ml) measures of 40% ABV whiskey contain 20 units of alcohol.

Research has consistently shown that out-patient services, whether they are general of specialized eating disorder clinics, are more likely to be cost-effective than in-patient care. The majority of patients with eating disorders can be effectively managed in out-patient clinics, with only a small percentage requiring in-patient care. When comparing outpatient treatment models, including general child and adolescent mental health services, with in-patient treatment, there were significant improvements in all groups at different points during follow-up, with no significant differences between the two types of treatment. The availability of out-patient care is associated with a lower rate of admission to inpatient units. Clinically and economically, lengthy in-patient stays are not recommended, as they are associated with worse outcomes, particularly when they disrupt the patient’s life, such as their work, studies, of time away from family.

Individuals who have experienced four of more mood swings within a 12 month period must demonstrate a period of stability lasting at least 6 months before resuming driving. For those who have experienced hypomania of mania, a period of stability lasting 3 months is required before returning to driving, which is extended to 6 months if there have been repeated mood changes over a 12 month period. Similarly, individuals with psychosis must also demonstrate a period of stability lasting 3 months before resuming driving. However, HGV drivers who have experienced mania/hypomania of psychosis must demonstrate a longer period of stability lasting 3 years (36 months) before returning to driving.

Given the patient’s improved psychotic symptoms, an extended stay in an acute ward would not be beneficial. However, due to ongoing substance misuse and challenging behaviors, discharge from the hospital is not yet possible. While an addictions admission of transfer to a forensic ward is not necessary, a rehabilitation psychiatry ward would be the most appropriate next step. This would provide the patient with the necessary support to address their substance misuse and challenging behaviors, while also promoting their skills and independence for a successful return to community living.

Neurostimulation is a treatment that uses electromagnetic energy targeted at the brain. There are several forms of neurostimulation, including TMS, deep brain stimulation, and ECT. TMS is a non-invasive, non-convulsive technique used to stimulate neural tissue. It involves the placement of an electromagnetic coil on the patient’s scalp to deliver a short, powerful magnetic field pulse through the scalp and induce electric current in the brain. TMS is used to treat depression when standard treatments have failed. Deep brain stimulation is a neurosurgical technique that involves placing an electrode within the brain to deliver a high-frequency current in a specific subcortical of deep cortical structure. It has been used to treat Parkinson’s, dysthymia, OCD, and Tourette syndrome. There is RCT evidence to demonstrate its effectiveness in OCD, but conflicting results in depression and Tourette’s. DBS is also being trailed in other conditions such as anorexia, bipolar, and additions.

The Care Program Approach (CPA) was implemented in 1991 to enhance community care for individuals with severe mental illness. The CPA comprises four primary components, including assessment, a care plan, a Care Coordinator (formerly known as a Key Worker), and regular review. There are two levels of CPA, namely standard and enhanced. Standard care plans are suitable for individuals who require minimal input from a single agency and pose minimal risk to themselves of others. Enhanced care plans are designed for individuals with complex needs who require collaboration among multiple agencies.

The ECTAS Guidelines 2019 recommend a frequency of two times per week.

ECT (Treatment) – Summary of Effectiveness and Recommendations

ECT (Electroconvulsive Therapy) is a treatment that induces a therapeutic seizure through the application of electrical current under general anesthesia and muscle relaxation. It is prescribed as a course and is usually administered twice weekly for 6 to 12 treatments. ECT is the most effective short-term treatment for major depression, with remission rates of around 60-80% when used as first-line treatment in a severe depressive episode. However, without maintenance treatment, the relapse rate is extremely high (over 80%) in the 6 months after successful ECT.

Cognitive effects are the main limitation to the wider use of ECT, particularly acute confusion shortly after the treatment, retrograde amnesia, and some losses in autobiographical memory longer term. The current state of evidence does not allow the general use of ECT in the management of schizophrenia. Bilateral ECT is more effective than unilateral ECT but may cause more cognitive impairment. With unilateral ECT, a higher stimulus dose is associated with greater efficacy but also increased cognitive impairment compared with a lower stimulus dose.

NICE (National Institute for Health and Care Excellence) recommends that ECT is used only to achieve rapid and short-term improvement of severe symptoms after an adequate trial of other treatment options has proven ineffective and/of when the condition is considered to be potentially life-threatening. ECT is recommended for individuals with severe depression (that is life-threatening and when a rapid response is required, of when other treatments have failed), moderate depression (consider it if their depression has not responded to multiple drug treatments and psychological treatment), catatonia, and a prolonged of severe manic episode.

The RCPsych (Royal College of Psychiatrists) position on ECT recommends it as a first-line treatment for individuals with high suicidal risk, severe psychomotor retardation and associated problems of compromised eating and drinking and/of physical deterioration, treatment-resistant depression that has responded to ECT in a previous episode of illness, pregnant individuals with severe depression, of severe mixed affective states, mania of catatonia and whose physical health of that of the fetus is at serious risk, and those who prefer this form of treatment. ECT is recommended as a second-line treatment for individuals with treatment-resistant depression, severe side-effects from medication, and persistent of life-threatening symptoms in severe of prolonged mania. ECT is indicated in some circumstances for individuals with bipolar depression, postnatal psychosis, treatment-resistant schizophrenia, treatment-resistant catatonia, and frequent relapses and recurrences of depression (maintenance).

If a patient’s plasma clozapine to norclozapine ratio decreases while on a consistent clozapine dose, it may indicate enzyme induction. Conversely, an increase in the ratio may suggest enzyme inhibition of saturation, recent non-trough sample, of poor compliance. The clozapine to norclozapine ratio is typically stable among patients with stable clozapine doses.

According to a study conducted by the University of Sheffield, implementing a minimum unit price of 45 pence for alcohol could potentially save 624 lives and prevent 237,000 hospital admissions in England every year. Additionally, the research suggests that the ban on selling alcohol below cost, which was implemented in May 2014, could prevent 14 deaths and 500 hospital admissions annually.

In essence, the most appropriate term to describe this intervention is tertiary prevention since universal, indicated, and selective prevention strategies target individuals before the onset of a full-blown illness.

Prevention measures can be classified into different levels, depending on the stage at which they are implemented. The first model, developed in the 1960s, includes primary, secondary, and tertiary prevention. Primary prevention aims to intervene before a disease of problem begins, and can be universal (targeted to the general public), selective (targeted to a high-risk population), of indicated (targeted to individuals with minimal but detectable signs of a disorder). Secondary prevention aims to detect and treat disease that has not yet become symptomatic, while tertiary prevention involves the care of established disease.

A newer model, developed in 1992, focuses on prevention interventions used before the initial onset of a disorder. This model also includes three levels: universal prevention (targeted to the general population), selective prevention (targeted to a high-risk population), and indicated prevention (targeted to individuals with minimal but detectable signs of a disorder). Examples of prevention measures include cognitive interventions for adolescents with cognitive deficits to prevent the later phases of schizophrenia, screening procedures for early detection and treatment of disease, and the use of low-dose atypical antipsychotics and CBT for patients with prodromal symptoms of schizophrenia to delay of prevent disease onset.

Gillick Competency and Fraser Guidelines

Gillick competency and Fraser guidelines refer to a legal case which looked specifically at whether doctors should be able to give contraceptive advice of treatment to under 16-year-olds without parental consent. But since then, they have been more widely used to help assess whether a child has the maturity to make their own decisions and to understand the implications of those decisions.

In 1982, Mrs Victoria Gillick took her local health authority (West Norfolk and Wisbech Area Health Authority) and the Department of Health and Social Security to court in an attempt to stop doctors from giving contraceptive advice of treatment to under 16-year-olds without parental consent.

The case went to the High Court where Mr Justice Woolf dismissed Mrs Gillick’s claims. The Court of Appeal reversed this decision, but in 1985 it went to the House of Lords and the Law Lords (Lord Scarman, Lord Fraser and Lord Bridge) ruled in favour of the original judgement delivered by Mr Justice Woolf.

The Fraser Guidelines were laid down by Lord Fraser in the House of Lords’ case and state that it is lawful for doctors to provide contraceptive advice and treatment without parental consent providing that they are satisfied that:

– The young person will understand the professional’s advice
– The young person cannot be persuaded to inform their parents
– The young person is likely to begin, of to continue having, sexual intercourse with of without contraceptive treatment
– Unless the young person receives contraceptive treatment, their physical of mental health, of both, are likely to suffer
– The young person’s best interests require them to receive contraceptive advice of treatment with of without parental consent.

The process of ECT includes creating a widespread seizure that results in stiffness and rigidity of muscles, followed by repetitive jerking movements. Absence seizures cause a brief period of unconsciousness, while atonic seizures lead to a loss of muscle tone.

Institutional Racism in Psychiatry

There has been growing concern that institutional racism may be contributing to the overrepresentation of Black patients in mental health settings. Despite ethnic minorities making up only 9% of the UK population, the 2010 ‘Count me in Census’ found that 23% of inpatients and those on CTOs were from Black and minority ethnic groups. Black minority groups also had higher rates of admission, detention, and seclusion.

While patient factors, such as higher rates of mental illness in Black minority groups, may contribute to these findings, there is also a suggestion of inherent racism within psychiatry. This may manifest in perceptions of Black and minority ethnic patients being at greater risk, as well as systemic factors that disadvantage these groups.

It is important to address these issues and work towards a more equitable and just mental health system for all patients, regardless of their ethnicity.

Non-Pharmacological Interventions for Treatment-Resistant Depression

One non-pharmacological intervention for treatment-resistant depression is repetitive transcranial magnetic stimulation (rTMS). This outpatient procedure involves using an electromagnetic coil to induce electric currents in the cerebral cortex without the need for anesthesia. It is typically used for patients who have not responded to antidepressant medication of for whom antidepressants are not suitable. Treatment can be delivered unilaterally or bilaterally and lasts for 2 to 6 weeks.

Electroconvulsive therapy (ECT) is another option for treatment-resistant depression, but it is associated with adverse effects such as autobiographical retrograde memory loss. It is not recommended for patients who have recently had a heart attack and are keen to avoid side effects.

Psychosurgery is rarely used and only as a last resort for severely debilitating mental illness. It is associated with seizures and permanent cognitive impairment.

Deep brain stimulation (DBS) is a controversial option for treatment-resistant depression. It involves targeting specific areas of the brain, such as the subcallosal cingulate and medial forebrain bundle. However, it is not currently recommended by NICE and is more commonly used for Parkinson’s disorder.

Lithium may also be an option, but the question specifically asks for non-pharmacological interventions.

The typical location for the implanted pulse generator (IPG) in DBS treatment is subcutaneously below the clavicle, which is similar to where cardiac pacemakers are placed. While IPGs are sometimes placed abdominally, it is less common. Peripherally inserted central catheter (PICC) lines are usually located in the antecubital fossa, and external microphones for cochlear implants are implanted in the temporal bone. Cardiac pacemakers may be placed in the axilla.

Phototherapy, also known as light therapy, has been extensively studied for its use in treating seasonal affective disorder (SAD) of winter depression. The treatment involves sitting next to a bright light for 1-2 hours. A 2005 meta-analysis of randomized, controlled trials found that bright light treatment is effective, with results equivalent to most antidepressant pharmacotherapy trials. However, the National Institute for Health and Care Excellence (NICE) advises that the evidence for the efficacy of light therapy is uncertain for those with winter depression. Light therapy has also been found to be effective in treating non-seasonal depression and ADHD. The type and strength of light that works best and the timing of the therapy remain unclear. It is important for the light to enter the eye, so it cannot be delivered while a person is asleep. (Golden, 2005).

The Rapid Assessment Interface and Discharge (RAID) psychiatric liaison service at Birmingham’s City Hospital was evaluated by the London School of Economics, which found that the benefit:cost ratio was over 4:1. The evaluation showed that the service resulted in savings of £3.55 million per year in general hospital bed use, at a cost of £0.8 million.