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There remain problems with satisfaction scales. Qualitative approaches to examine patients' experiences in hospital and the causes of dissatisfaction are recommended.

It is premature to define an optimal configuration for home based care services. The need for introducing differing components of such care will depend on what is currently available locally. Where regular home visiting to psychotic patients plus a broad service model incorporating health and social care objectives are provided, major reductions in in-patient care are not currently to be anticipated by service re-configurations.

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R. L. Lindeman's empirically based generalizations that both progressive efficiencies and percent of energy lost due to respiration increase with trophic level appeared contradictory, because he linked trophic levels in series to form a simple trophic chain. This model equates the energy not respired by the populations aggregated to form a trophic level to the productivity of the populations assigned to the next trophic level. This is clearly not the case for Cedar Bog Lake and ecosystems generally, because of nonpredatory losses and energy gains from other than the previous step in the trophic chain, e.g., bacterivory, detritivory, and feeding on organisms at more than one trophic level. Network analyses of energy—flow models make possible an objective and unambiguous definition of trophic level that does not suffer this contradiction. Trophic guild is proposed as an alternative to trophic level when is meant is an aggregation of species with similar trophic resources.

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Aims and Method We conducted a questionnaire study to establish the incidence, specialist staff availability, treatment provision and socio-demographic profile of patients with first-episode psychosis referred to all adult and child and adolescent community mental health teams in south and west London. Results All 39 teams completed the questionnaire, identifying 295 cases of first-episode psychosis (annual incidence 21/100 000/year) referred in the year 2000. Teams manage to engage most patients with first-episode psychosis. A total of 73% of cases of first-episode psychosis were on some form of Care Programme Approach. However, many teams did not have adequately trained staff to provide psychosocial interventions. Even where such staff were available, care was focused mainly on monitoring medication and risk assessment, with only half the teams providing psycho-educational programmes and only a quarter offering individual cognitive–behavioural therapy to those with first-episode psychosis. Clinical Implications Establishing early intervention services nationwide will require significant new resources, including specialist trained staff, which could prove difficult to provide in inner-city areas. Rather than a single, uniform service model, several models of early intervention services based on locally determined need might be more realistic and appropriate, and also allow research into their relative efficacy.