The 1984 Scottish Mental Health Act (and its counterpart in England and Wales) invoked unique restrictions in medical practice in this country. For the first time certain standard treatments could not be given to particular patients unless an independent second opinion doctor authorised that treatment. Fortunately, in respect of drug treatment and ECT the second opinion doctors are themselves practising clinicians. Second opinion doctors are asked to give their opinion about the suitability of a proposed treatment using the following guidelines: “the appointed doctor will have in mind his/her understanding of practice accepted as proper by a responsible body of medical men skilled in this particular art in Scotland at this time and should avoid any idiosyncratic view of treatment however firmly held”.

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.

The contribution of the chaplain to patient care is rarely discussed and is sometimes forgotten. This paper discusses the role of the chaplain in a regional secure unit.

It is well known that there is a high prevalence of psychiatric disorder among residents in hostels for the homeless (Timms & Fry, 1989), and staff in these hostels are looking after the mental health needs of these people sometimes with little help from the institutional services. Recent studies have emphasised the plight of schizophrenia sufferers (Marshall, 1993) while other subgroups of mentally disordered homeless people have received less attention.

Although the work of general practitioners (GPs) with mental illness generally, particularly in relation to minor mental illness, has been extensively examined, there has been practically no work devoted to the role of GPs in assessment for compulsory admission, either under the 1959 or 1983 Acts. The notable exception is the work of Bean (1980), who is, in some respects, highly critical, accusing them of showing little interest in patients, referring at times inappropriately, committed to the rhetoric rather than reality of care and of knowing little or nothing of the law they were supposed to be using. Bean's work is, however, a study of the 1959 Act, and no research exists on the 1983 Act which now governs section assessments. This neglect of GPs is surprising, in view of the severe consequences of compulsory admissions (sections) and research on the use of the 1983 Act already available on other participating professionals (Sheppard, 1990; Rogers, 1989). GPs are likely to be professional instigators of section assessments as well as involved in the assessment itself.

The College Research Unit was established initially with donations from College members. After a year of pilot work and fund-raising a programme of work began in October 1990 supported by a three-year grant from the Department of Health. The main theme of the programme is clinical audit. This report outlines the nature and role of audit in psychiatry, describes the structure of the Unit, and presents a brief summary of the Unit's work.

A new approach to research and development (R&D) for mental health services is developing in the North-East, Yorkshire and Humber. It derives from experience with service redesign using the ‘collaborative’ approach developed by the US Institute for Health Improvement. Kennedy & Griffiths (2003) described such an approach involving 37 mental health trusts, each with a multidisciplinary team, with the aim of improving acute in-patient wards. After studying the patient's journey through care they agreed a set of improvement targets that all teams would work to achieve. Progress towards targets was measured and reported by all teams, who met periodically to compare performance and learn from each other. Remarkable energy to achieve objectives was released among front-line staff involved. Focus was sustained on what most concerned and benefited patients. Good ideas and results quickly spread to all these services affecting thousands of patients.

This paper focuses on issues relating to the place of psychotherapy within general psychiatry rather than describing details of psychotherapeutic methods and their range of application in psychiatric practice.

Bob Spitzer died in December 2015 but is not likely to be forgotten quickly. His Herculean task in reforming psychiatric diagnosis, mainly by the development of the third edition of the Diagnostic and Statistical Manual of Mental Disorders in 1980, has been acknowledged by many, but it remains unfinished. To complete the process, we need more than good diagnostic reliability, we need better veracity.

The new syllabus for both general and psychiatric nurses, Project 2000, is a manifestation of the gradual revolution taking place in nursing. It attempts to address some long-standing issues which have concerned the profession in several countries. The resolution of these issues will determine the role of nurses as members of the multidisciplinary team and effect cooperation and interactions therein.