Increasing workload and the pressure of constant change have left London's mental health managers struggling to implement government policy, according to a forthcoming survey.

Managers fully support the government drive for 'partnership' working, but are too busy to fulfil a key requirement of talking to local stakeholders, according to a draft of the third annual London Managers in Mental Health survey, seen by HSJ .

New government priorities are taken on without replacing old priorities.

'The list just gets longer, ' said Edward Peck, director of the centre for mental health services development at King's College, London, which conducted the survey.

Dr Peck said the findings showed that managers needed extra help with service development, as promised by the national service framework for mental health. 'The framework's emphasis on development is a new departure for the health department, which is extremely welcome if it helps managers locally to handle change, ' he said.

The increased stress was counterbalanced by high levels of endorsement for government initiatives such as modernising grants and the duty of partnership.

Last year, managers surveyed mentioned improving bed management and joint working as priorities. This year, priority had shifted to further integration, improving join commissioning and providing. 'There has been a real change in 12 months.

People are exploring in much more practical ways what partnership means and issues of integrated services, ' said Dr Peck.

In 1998, managers were most concerned about external factors such as the impact of GP priorities and confused or conflicting national strategies. This year, the greatest problems were internal: managing change and managerial problems.

ECT survey finds gender divide A snapshot survey of the use of electro-convulsive therapy has highlighted huge gender differences in its use.

More than two-thirds of 2,800 patients given ECT between January and March this year were women and 44 per cent of them were 65 or over, according to the Department of Health.

Three-quarters of ECT patients were not formally detained under the Mental Health Act 1983. Of the 700 who were, 59 per cent did not consent to treatment.

Mental health charity Mind said the statistics highlighted the need for a thorough review of the treatment.

Department of Health Statistical Bulletin. Electro-Convulsive Therapy (ECT): survey covering the period from January - March 1999 . 0171-972 5614. Free.