In April 1987 the Bulletin of the Royal College of Psychiatrists published the results of a survey of the training of junior psychiatrists in behavioural psychotherapy in the South West Thames Region (Drummond & Bhat, 1987). This survey reported the experience of trainees based at 10 postgraduate teaching rotations in the Region. The survey was conducted shortly after the appointment of a new peripatetic senior lecturer. Prior to this appointment there had been no regular senior lecturer teaching in behavioural psychotherapy in the Region for at least one year. The paper demonstrated that the majority of trainees had received little or no previous teaching or supervision in behavioural psychotherapy. It also demonstrated that trainees welcomed the introduction of such teaching and that their knowledge of the subject improved significantly after three teaching sessions held at monthly intervals. However, after this short time only 17.1% of the trainees reported that they had started to use any of the techniques they had learned in clinical practice.

When planning new service initiatives it is important to review the role and functioning of existing services. As more patients are discharged from long-stay beds, there is increasing concern regarding the quality of community care and the accessibility of urgent psychiatric help. The Department of Health has recently expressed concern over the level of such services provided (DoH, 1989). In Edinburgh, alternative methods of delivering psychiatric emergency care are currently being considered. Community-orientated crisis intervention teams may be useful, but only a small proportion of people presenting to general psychiatric services fit into the stereotyped model of crisis. Centres with short-term admission facilities have been developed in other countries and within the United Kingdom many general hospital casualty departments have a psychiatrist available on call. Walk-in or self-referral psychiatric clinics provide an easily accessible service but few have been systematically reported (Lim, 1983; Haw, 1987). Such clinics have been described as seeing mainly chronic patients of the hospital who are already in current contact and who present with less severe psychiatric disorders than GP-referred cases. In a climate of NHS financial restraint it is pertinent to ask whether such clinics are needed.

Although personality disorders are prevalent conditions and the cause of considerable morbidity, their management remains controversial. The rationale for using psychotropic medication in these conditions is poorly articulated and its evidence base is weak. Nonetheless, psychiatrists continue to prescribe medication for this group as the accompanying paper makes clear. What is less clear is their reason for doing so, as there are frequent co-occurring conditions that might justify the use of medication in their own right. If the field is to progress, there is no substitute for well-designed randomised controlled trials and these ought to be a priority in the setting of any research agenda.

Psychiatry has a long past but a short history in Iran. References to causes and treatment of mental disorders can be found in parts of the Avesta, the holy book of pre-Islamic Iranians. Early muslim physicians like Tabari, Majusi, Razi and Ibn Sina, who were mostly born and brought up in Iran, have devoted long sections of their books to a discussion of mental disorders under the general title of ‘the diseases of the head and the brain’. In fact, the oldest medical textbook in modern Persian—which was completed around 970 A.D.—was written by a practising physician who claims to have been known as a ‘doctor of the insane’ by his contemporaries.

Psychiatrists are becoming increasingly involved in the assessment of candidates for genetic testing for Huntington's disease (HD) in which their role ranges from diagnosing conventional psychiatric disorder to identifying ‘new odd behaviours'. They are also expected to predict dysfunctional response to test results (e.g. self-harm). This paper describes the psychiatric component of the Cambridge HD Clinic and its assessment protocols. Practical concepts, useful to the understanding of the clinical problems that may be encountered, are also discussed.

This paper outlines a three-year controlled study, funded by the Department of Health and Social Security, which started at the Maudsley Hospital in October 1987. The research will compare seriously mentally ill patients maintained outside hospital on the daily living programme (DLP) with standard hospital-based care, and devise a multi-disciplinary training course in DLP for mental health care providers. It will be the first UK attempt at controlled replication of successful controlled studies from North America and Australia, and the first anywhere to devise systematic training in the approach.

A small, city-wide clinical outreach service for the homeless mentally ill in Sheffield, UK, attained its present configuration 6 years ago. This paper discusses the lessons learnt in the course of the service's existence.

The homeless mentally ill identified by the service have disengaged from the ‘mainstream’ services and society. Most are from disturbed homes, nearly all have had prior contact with psychiatric services and as many as half have served prison terms. As service users, they must be actively sought out and engaged, which places specific demands upon a mental health team: flexibility of approach, patience and a willingness not to judge others' values.

Though largely anecdotal, the inferences drawn in Sheffield may have parallels elsewhere, not least since individual lives can turn upon pivotal (‘anecdotal’) encounters and those evinced by the homeless tell us much about society, psychiatry and the values of contemporary healthcare providers. Also, most of the time, the proposed model has been successful.

The Equality Act 2010 made it unlawful to discriminate in the provision of services on the grounds of age. This legislation is open to interpretation, but it is affecting the way older people's services are defined and provided. Historical evidence indicates that, since the 1940s, apart from psychiatrists working in dedicated old age services, most were unenthusiastic about working with mentally unwell older people and unsupportive of those who chose to do so. A historical analysis might shed light on current dilemmas about ‘all age’ or ‘old age’ services and inform decision-making on future mental health services.

That art is an expression of man's attempts to understand himself and his environment is as important as the purely aesthetic qualities of the piece, whatever it may be. Opera, together with the other performing arts, literature and painting, cannot simply be seen as pure entertainment. It is also a reflection of the society in which the composer and librettist lived, and the issues and values contemporary to those people. Opera with its fusion of words, music and theatre is able to delineate those issues involved and present them with an emotional intensity possibly unequalled elsewhere in art. Musical imagery is used to portray and develop the characters in opera by inflecting the librettist's words and embedding them in a sound world. This is how we can gain access to those characters' thoughts and emotions. As psycho-dramas the works of the late 19th and the 20th centuries reach the greatest level of complexity.

Recent concerns about the future of psychiatry have led to various calls for action. We argue that an overhaul of postgraduate training in psychiatry is the necessary first step to ensuring a strong future for the profession. Central to these improvements are reaffirming the ideals of psychiatric training, ensuring appropriate prominence of crucial knowledge and skills in the curriculum and providing tailored training placements with an emphasis on excellence. It is imperative that short-term service-provision need does not adversely have an impact on the training that is needed to ensure excellent patient care for the future. We urge the College to continue to work closely with psychiatric trainees to secure their future.

Since the first journal clubs were started this educational tool has been used by the medical profession with varying degrees of success (Linzer, 1987). Journal clubs allow trainees to review a piece of published research and discuss it with senior colleagues. They are frequently plagued by poor attendance and perceived as less than exciting, and at worst frankly boring. The enormous choice of journals compared with 100 years ago and the diversity of the media available mean that journal clubs should look towards developing in their format. Various methods have been tried to improve attendance, perceived relevance and enjoyment, such as evidence-based medicine reviews (Gilbody, 1996), teaching critical appraisal skills, and using structured review methods (Burstein et al, 1996). Sidorov (1995) surveyed 131 postgraduate programmes in the eastern USA and found the following features were associated with high attendance and continuous existence of journal clubs: smaller residency programmes, making attendance mandatory, providing food and promoting original research articles.

This paper describes a link between a mental health trust (the East London Foundation Trust (ELFT)) in the UK and mental health services in Uganda which has developed since 2004. the aim of the link was to help support the development of mental health services in Uganda by establishing an educational partnership. During the first 3 years, nine staff from ELFT and nine staff from Butabika, from a variety of disciplines, have made short-term exchange visits. Evaluation of the link has demonstrated that benefits have been experienced in both London and Uganda. Such links can provide one way of strategically supporting and strengthening existing health services in low- and middle-income countries.

This article addresses some of the common uncertainties and dilemmas encountered by both adult and child mental health workers in the course of their clinical practice when dealing with cases of suspected emotional abuse or neglect (EAN) of children. We suggest ways of dealing with these according to current best practice guidelines and our own clinical experience working in the field of child maltreatment.