Narrative medicine is a well established academic field and has been shown to increase clinical skill and improve the therapeutic relationship of those who study its principles (Banks et al, 1995; Jones, 1999). Literary analysis is a convenient means of fostering advanced communication skills. Moreover, the skills gained from such an education are highly applicable to everyday psychiatric practice. The evidence for the efficacy of narrative medicine is well established, and on this basis a strong argument can be made for its inclusion as a compulsory part of the current MRCPsych course.

The NHS International Fellowship Scheme for consultants offers overseas consultants, in specialties including psychiatry, an opportunity to work in the UK (Goldberg, 2003). This was launched by the Department of Health in 2002 and so far over 100 consultant psychiatrists have been recruited. However, there are several aspects of the project that are unclear. How long will this recruitment continue? Are there any arrangements in place to encourage overseas consultants to return to their home country at the end of their fellowship? Are they eligible to train senior house officers (SHOs) and specialist registrars (SpRs)? Will the recruitment under the scheme have an impact on job opportunities for SpRs currently training in the UK? Why is membership of the Royal College of Psychiatrists being granted to the newly recruited consultants without an examination? These and many more concerns have arisen in the wake of this scheme. In this article, we evaluate the scheme, discuss its implications and suggest possible ways forward.

Traditional British undergraduate medical education has evolved with the development of medicine as a profession. However, despite dramatic progress in the provision of healthcare, the medical curriculum has remained mostly unchanged until recently. Conventional medical courses rely on the teacher-centred didactic setting of a lecture theatre to transmit vast quantities of information. This one-way traffic of facts is divided initially into the preclinical basic sciences and later into the medical specialties, with relatively little horizontal or vertical integration. Much of the assessment of students relies on their reproducing information as accurately as possible. This traditional format has been widely criticised (Lowry, 1992).

The need to confine and restrain psychotic patients at the turn of the last century saw the building of a few large asylums which soon became overcrowded with the growth of the population. These asylums were the only service available to the mentally ill until 1959 when the trend to decentralise began with the building of general hospital psychiatric units.

This paper reports the results of a nationwide survey of social services responses to psychiatric emergencies. The survey is a companion to that by Johnson & Thornicroft (1991) (J&T) who reviewed the emergency service options available in psychiatry, including the emergency clinic, general hospital services, the emergency ward, acute day hospital and crisis intervention and residential services, as well as considering the role of sectorised services, and community mental health centres (CMHCs). For the purposes of our respective surveys of health and social services in England and Wales, we have defined a psychiatric emergency as “occurring when someone (patient, friend, relative or professional) requests urgent intervention on behalf of someone in the community who is suffering from a mental disorder”.

A consumer satisfaction survey of patients with learning disabilities and mental health needs attending outpatient psychiatry clinics was performed using a questionnaire administered by their carer. Sixty completed questionnaires were returned and the results were analysed to determine whether demographic or service variables were correlated with the degree of satisfaction. Younger patients living independently or with their family and those who were not prescribed psychotropic medication were more satisfied. The service variables associated with increased satisfaction were comfortable waiting areas, punctuality and good communication with the doctors.

The 1994 Trainees' Forum was held on the first day of the Winter Meeting of the Royal College of Psychiatrists and was well attended by psychiatrists of all grades. The speakers were Dr David Wilson, Senior Lecturer in Learning Disabilities in Nottingham, Dr Chris Freeman, Consultant Psychotherapist in Edinburgh, Professor Anthony Clare from Dublin, Vice President of the College, and Dr Dinesh Bhugra from London who is secretary of the General Psychiatry section of the College.

Over recent years Central Manchester GPs have supplied over 50% of the referrals to the Gaskell House Department of Psychotherapy. Yet there is no formal channel for feedback from these GPs concerning the services provided and for opportunites for realistic enhancement of the relationship between them and the predominantly hospital-based psychotherapists. It would appear that this communication gap applies to many psychotherapy centres in the UK though Tyson and Reder1 have specified the opinions of GPs as one variable to be considered when planning psychotherapy service.

I became a Divisional Public Education Officer (DPEO) for the College's External Affairs Department in 1990. My first media training day was most informative. I learned how to disseminate information; how to inform journalists about issues pertinent on the day; and ways to challenge stigma. I learned that it was safest to assume that most journalists do not usually understand the complexity of mental health issues. The health correspondent for the BBC at the time showed how adequate preparation – making written information available in a helpful question and answer format – and development of personal relationships with journalists through understanding how they work, their deadlines, pressures, etc., are important factors in trying to do the job properly. I also learned the golden rule: never say anything off the record.

A substantial proportion of our patients use or consider using complementary and alternative medicines (CAM) and other coping strategies. It is important that we acknowledge this, know something about the subject and are aware of current or potential developments in the field. These remedies might be harmless, beneficial or harmful and their side-effects might alter and confuse clinical presentations. We need to be vigilant of the potential for significant drug interactions between complementary and orthodox treatments. There is a substantial growth in complementary and alternative medical research in the USA, now beginning to follow in the UK. This will hopefully bring useful future progress.