In the second of this occasional series, Mark Jones looks at Mozart and his 1788 masterpiece, Don Giovanni, and interviews Tom Sutcliffe, opera critic of The Guardian, about his views on this problematical work and its portrayal on the stage.

The 40th anniversary celebrations at Keele are proving to be a lively acknowledgement that the University is now firmly back on its feet and has a renewed confidence in its baptismal vows. There has indeed been a recovery of Keele's raison d'être to provide multi-faculty education (all students study an arts and science subject), to pioneer a Foundation Year to allow more informed choice of Honours courses, and to accommodate undergraduates as well as many staff on its leafy 18th century estate. The Vice Chancellor has succeeded in putting Keele back in the black, and on the map, and now plans to increase the number of students to 6,000 in the next decade.

Observers of the American Psychological Association's enthusiastic support for the gathering momentum to accredit psychologists with prescribing privileges will detect professional and economic motives among others: the same can also be said of the AMA's campaign to stop it. Health care in the USA is underpinned by a business culture in which psychologists and psychiatrists operate widely as independent practitioners in the open market place. The prestige value and pecuniary advantages to American psychologists would not be insignificant. Also, since health care insurance companies purchase separate psychological and medical treatment for their customers, it would be to their economic advantage for these treatments to be embodied in one individual. Thankfully, pressures on this scale have yet to reach these shores. Nevertheless, serious consideration should be given to establishing a grade of prescribing psychologist in the NHS if it can be shown to raise the overall quality of care; if prescribing could be done appropriately and safely; and if this did not detract from the quality of psychological intervention.

It is generally stated that the Mental Health Act 1983 does not apply to prisoners, and this is a useful shorthand to remind those unfamiliar with British prisons that treatment cannot be administered under the Mental Health Act, even to the most severely mentally ill prisoners. However, the legal situation is actually more nuanced given that the Mental Health Act does make provision for prisoners – intending that they be promptly transferred to hospital for treatment. This does not happen in practice for service reasons. It is not clear whether the Mental Capacity Act 2005 applies to those falling through the cracks.

One in four of the UK population is expected to have a mental health problem at some time in their lives. There is no reason to believe that this statistic should not apply to doctors just as it does to everyone else. This paper discusses the obstacles to accessing treatment that doctors with mental ill health face, and goes on to consider potential solutions to these problems. There is a great pool of talent within the field of medicine and those doctors with mental health problems often have increased empathy as well as professional expertise. This article sets out to demonstrate that there are ways of supporting these doctors and enabling them to overcome their illnesses and regain satisfaction in their work.

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.

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.

Occupational stress is frequent among individuals whose work brings them into close contact with other people. One putative means of preventing or alleviating such stress is meditation (West, 1987). A six week course in meditation was recently held for staff in the Drug Dependence Service based at University College Hospital, London. The idea for the course came from the head of the unit who had personal experience of meditation. The course and its acceptability to staff are described below.

Rollo May Ward, a long-term medium secure facility integrated within the West London Mental Health National Health Service (NHS) Trust, is the first dedicated long-term NHS medium secure unit to have opened in England. It caters for a group of men with complex clinical needs and risk assessment issues who had previously been inappropriately detained within high secure services owing to a lack of suitable, less secure placement facilities. We describe the background to the development of the long-term medium secure service, the referral and assessment processes, the structure of the ward and the therapeutic programmes available to patients. We also outline the characteristics of the first 21 patients to be admitted to the ward and offer advice for similar future developments.

Conventional antipsychotics, historically the mainstay of schizophrenia treatment, were ineffective in many patients, at least 30% fitting treatment-resistance criteria (Kane & Lieberman, 1987). All had the same mechanism of action: none was any more effective in the individual than any other. Therapeutic nihilism accepted poorly controlled positive symptoms and disabling negative symptoms: nearly all patients suffered side-effects (Barnes & Edwards, 1993), particularly extrapyramidal side-effects (EPS) and hyperprolactinaemia. Conventional antipsychotics raise prolactin to a range associated with sexual dysfunction or even macroprolactinoma: effects in men include erectile dysfunction and hypospermatogenesis; in women, galactorrhoea, oligo- or amenorrhoea, hirsutism and increased risk of osteoporosis. In both men and women there is loss of libido, and a link between hyperprolactinaemia and weight gain.