The strong recent public interest in attention deficit disorder and its drug treatment has led to the need for, and development of, guidelines for clinical practice. As a first step in this process our aim was to ascertain the current level of professional consensus on certain points regarding the use of medication in attention deficit disorder. Although a high level of consensus was found in relation to indications and prescribing issues, opinion was divided on details of how the treatment should be delivered – including the role of paediatricians, and the use of psychological treatments.

As more people with mental handicaps∗ (MH) live in the community, in line with government community care policies (Department of Health, 1989), referrals to CMHTs∗ and other community based services will increase. Such referrals may be routine, urgent or emergency, come from various sources, and concern health and social care needs.

Luty (2005, this issue) performs a valuable service by directing attention to the new guidelines from the National Treatment Agency. He explains clearly why he thinks these guidelines are wrong. I was a member of the expert advisory group that produced the guidelines, and will therefore attempt to defend them (my arguments do not necessarily reflect the views of all members of the group).

A survey was undertaken to ascertain if doctors working in psychiatry knew when to perform electrocardiograms (ECGs) prior to and during psychiatric treatments where indicated, and to investigate the training, confidence and ability of doctors in ECG interpretation. Half had received no training in the indications for performing an ECG. Opinion differed widely as to when to perform an ECG, with 54% stating an ECG was required before treatment with pimozide and only 19% and 11% stating ECGs were required during the course of treatment with pimozide and high dose antipsychotic medication respectively.

Ability in ECG interpretation correlated negatively with time spent in psychiatry but no correlation existed between grade and ability to identify an ECG as normal or abnormal.

The closure of large mental hospitals, the move of services into the community and the formation of multi-district rotations have led to a dispersal of trainees onto many sites. This paper seeks to raise awareness of the problems faced by trainees working and training on disposed sites and suggests some solutions. It is the product of discussions within the Collegiate Trainees Committee, the Education Committee and the Psychiatric Tutors Sub-committee.

The sudden collapse of the communist order in Czechoslovakia and the formal installation of the new government in June 1990 has led, inter alia, to a fundamental reappraisal of mental health care. On a visit to Prague in September 1990 the system under the 40-year-old communist regime was still largely intact but clearly about to undergo major changes. Among the reform proposals made by a working group of the Ministry of Health and Social Affairs of the Czech republic are practices familiar to western psychiatrists: mental health care and specialist liaison in primary care settings; formal specialisation within psychiatry into general adult psychiatry, psychogeriatrics, child and adolescent psychiatry, psychotherapy; psychiatric units in general hospitals; community care with restructuring of funding away from the mental hospital budget and devolution to districts. More “humanisation” of psychiatry is envisaged, with choice of consultant, increased competition between doctors and legal definitions of involuntary treatment (Potucek et al, 1990). Voluntary organisations, existing until recently only underground, will be encouraged as also will be counselling services. Dementia, and drugs and alcohol misuse, are seen more as social service than medical issues. Of particular interest is a proposal to separate mental health funding from the rest of the health care budget.

During their period of training, trainee psychiatrists are usually involved in multiple educational activities. Clinical activities include case demonstrations at the bedside, ward rounds, and other multidisciplinary team meetings. Another group of activities, not directly clinical, include didactic teaching in the form of lectures, case presentations at conferences, seminars, audit and journal clubs.

The Psychiatric Bulletin offers the post of a trainee editor on its Editorial Board, open to all trainees in psychiatry. In this paper we (the immediate past and current Trainee Editor) describe the roles and responsibilities, learning opportunities and our own experiences from our time as Trainee Editor of the Bulletin. We hope we will give readers some understanding of the immense learning potential and academic exposure that this post offers, and encourage trainees to consider whether it is of interest to them.

It is possible to tackle exclusion by altering the nature of transactions between individuals and groups, including mental health services. One way to do this is to cultivate ‘social capital’ or interdependence between individuals and groups – as well as giving, each is entitled, but not compelled, to claim something in return. It is difficult, if not impossible, to sustain stigma and social exclusion when people are meeting mutual needs, building trust and helping each other. Mental health providers can foster social capital by creating community cohesion, namely interdependent relationships between individuals and organisations. This approach has been put into practice in the USA, where providers assert that small investments in building social capital return many times the cost. In the UK there is evidence that community development can make a contribution to mental health but it does not fit well with conventional approaches to mental health services – it calls for different skills and a vision that is collective rather than individualised.

A worldwide demographic shift towards old age is being accompanied by a corresponding increase in the number of old people presenting with psychiatric disorders, and traditional systems are unable to cope with the problem.

The Richmond Fellowship has for almost 30 years been a leading mental health organisation delivering half way house care and rehabilitation to people needing to overcome the secondary social effects of mental breakdown. It has developed the half way house therapeutic community principally as a short term institution with a programme which stresses social relations and self management, and as such has been beneficial to many thousands of people who have quickly re-established themselves into their families and communities.