Assessment of patients referred for psychotherapy has more commonly consisted of a psychodynamic assessment with less emphasis on a formal psychiatric diagnosis, whereas the reverse tends to be the case in the general psychiatric services. Within the National Health Service there are close links between the two services. A common frame of reference regarding the definition of the patient groups using the services could Improve communication, the planning and evaluation of specific treatment programmes, and outcome studies. A retrospective case-note study was carried out at a regional psychotherapy unit in order to define the population referred between 1991 and 1992 according to ICD–10 (WHO, 1992).

Mental health services in the UK National Health Service have evolved to include primary-care generalist, secondary-care generalist and secondary-care specialist services. We argue that there continues to be an important role for the secondary-care generalists as they minimise interfaces, can live with diagnostic uncertainty and support continuity of care. The lack of commissioning and clinical boundaries in secondary-care generalist services can undermine their feasibility, leading to difficulties recruiting and retaining staff. There is a risk of a polo-mint service, where the specialist services on the edge are well resourced, but the secondary-care generalist services taking the greatest burden struggle to recruit and retain clinicians. We need to establish equity in resources and expectations between generalist and specialist mental health services.

The UK Mental Health Act 1983 does not apply in prison. The legal framework for the care and treatment of people with mental illness in prison is provided by the Mental Capacity Act 2005. We raise dilemmas about its use. We highlight how assessing best interests and defining harm involves making challenging judgements. How best interests and harm are interpreted has a potentially significant impact on clinical practice within a prison context.

Within paediatrics, young children experiencing physical and emotional distress are admitted to hospital with their parents as a matter of course, recognising the trauma associated with parting children from their carers. Much of this practice is underpinned by our understanding of attachment theory, which also sits as a fundamental tenet of child psychiatry. Yet the culture in psychiatric in-patient hospitals remains to admit young children without their parents, often to units that are geographically distant from the family home. We argue that the practice of admitting lone children to psychiatric in-patient units is likely to be traumatising as well as less effective. We believe this culture requires challenge and change.

The topic of patients recording healthcare consultations has been previously debated in the literature, but little consideration has been given to the risks and benefits of such recordings in the context of mental health assessments and treatment. This issue is of growing importance given the increasing use of technology in healthcare and the recent increase in online healthcare services, largely accelerated by the COVID-19 pandemic. We discuss the clinical, ethical and legal considerations relevant to audio or visual recordings of mental health consultations by patients, with reference to existing UK guidance and the inclusion of a patient's perspective.

Fonagy & Clark confirm in their rebuttal that they have an ideological commitment to the failed technical model of understanding and intervening in mental health problems that dominates current service provision. They fail to acknowledge the limitations and problems associated with Improving Access to Psychological Therapies (IAPT) and Children's and Young People's IAPT (CYP-IAPT) and offer an unconvincing explanation for why they did not allow some of the vast tax payers' money that they had at their dispoal to be used to implement evidence supported relational models.

The opportunity to travel and practise one's skills in a variety of settings is an attractive aspect of the medical profession. However, in the current atmosphere of competition for jobs and structured career paths, deviation from which may mean losing one's place on the ladder, the prospects of working abroad are limited and the decision to do so often risky. One way round this is to arrange jobs on an exchange basis for a limited period. This is most convenient where the countries involved have similar teaching programmes and reciprocal arrangements for college recognition: in the case of psychiatry this includes Australia, New Zealand, USA, Canada and Hong Kong.

Risk, and how to manage risk, have become dominant themes of this decade. Risk is essentially any feature of an organisation which is likely to prevent that organisation from achieving its primary aims (Rosen, 1995). In general, the lower the risk in an organisation, the higher the performance of that organisation is likely to be. In turn this can lead to more efficient use of resources. In the area of mental health, the consequences of risk can be serious, this being amply demonstrated by the public inquiries into homicides by mentally disordered people. Such inquiries consistently reveal inadequacies in local services providing mental health care (Appleby, 1997). The identification and management of risk within local mental health services has therefore become a priority. Clinicians as managers have a key role in such a development, particularly with the introduction of clinical governance (Oyebode et al, 1999). This paper outlines a simple approach to risk management in a local mental health service.

Section 63 of the Mental Health Act 1983 states that an approved clinician can provide medical treatment irrespective of whether or not a detained patient has capacity to refuse such treatment. Case law has established that a range of acts ancillary to the core mental disorder treatment are allowed under Section 63. This article analyses a unique court judgment involving a detained Jehovah's Witness patient who had made an advance decision refusing blood transfusions but who self-inflicted lacerations resulting in blood loss. Core issues within the case involved capacity to consent to treatment and the ethics of treating or not treating patients in such cases.

Until recently, the UK led the addiction field worldwide as the only country to prescribe diamorphine for the treatment of opiate drug dependence. However, the approach was inconsistent, with development conducted in a haphazard and arbitrary manner (Audit Commission, 2002), with variation in criteria, individualistic approaches and many doctors ‘inheriting’ patients on these long-term prescriptions from other doctors. There were relatively few restrictions once the doctor had been granted a licence by the Home Office.

The American psychologist and philosopher William James drew inspiration from British evolutionary theory, neurology, psychiatry, psychology and philosophy. Trained in anatomy, physiology and medicine, he developed a physiological psychology that offered acute analyses of consciousness and of the relations between mind and brain, habit and thought, cognition and emotion and other aspects of psychology. One of his insights, regarding the relation between attention and will, was based upon his own experience of panic anxiety, which was resolved through his reading of several British authors. The story of his psychiatric experience, practical response and later theoretical conclusion offers a potential contribution to contemporary therapeutic practice.

A postal survey was carried out on a random sample of Fellows and Members of the Royal College of Psychiatrists in the United Kingdom or Eire in order to investigate current Continuing Professional Development (CPD) practice and the impact of resources and funding for CPD. One hundred and thirteen of 264 anonymised questionnaires were returned (43%). Most respondents considered CPD should be mandatory for consultants, for educational supervisors, for eligibility for the Certificate of Completion of Specialist Training and for election to the Fellowship of the College.

There is increasing recognition of the importance of the humanities and arts in medical and psychiatric training. We explore the poetry of Charles Baudelaire (1821–1867) and its evocations of depression through themes of mood, time and self-consciousness and discuss their relation to images of ‘spleen’, the ‘snuffling clock’ and the ‘sinister mirror’. Following the literary critical commentaries of Walter Benjamin (1892–1940) and Jean Starobinski (1920–2019) we identify some of their roots in the poet's experience of the rapid and alienating urbanisation of 19th-century Paris. Appreciation of the rich vocabulary of poetry and the images it generates adds depth to clinical practice by painting vivid pictures of subjective experience, including subjective experience of the ‘social’ as part of the biopsychosocial constellation.