For many patients and healthcare providers, the move to virtual psychiatric care has been fast-tracked by the COVID-19 pandemic. In this article, we consider a patient perspective and a provider perspective on the transition to virtual psychiatric care and its strengths and limitations, as well as a call for much-needed future research.

This paper aims to consider postgraduate psychiatric training in the context of New Ways of Working for psychiatrists in England. It summarises the impact of recent changes in postgraduate training and the major training implications of New Ways of Working. Finally, it outlines some broad principles that need to be considered for training when implementing New Ways of Working locally.

The new Mental Health Act 2007 for England and Wales has introduced substantial amendments to the 1983 Mental Health Act and has also amended the Mental Capacity Act 2005. Most provisions came into effect in November 2008. the introduction of supervised community treatment, changes to professional roles such as the role of ‘responsible clinician’, and the introduction of deprivation of liberty safeguards in the Mental Capacity Act are discussed. Many of the new safeguards in the Act are welcomed by clinicians and service user groups. However, other changes are more controversial and could potentially lead to an increase in the work load of clinicians.

The characteristics of clients admitted to a community support bed unit (SBU) serving an isolated, rural community were compared with those of clients from the same sector, admitted to a district general hospital (DGH) unit over the same period. There were few differences In the nature of the problems presenting to the two units, although there were more readmissions to the SBU, and more women tended to be admitted there. These results suggest that although the need for inpatient care remains for some patients, many who are currently admitted to such units can be managed in less institutional settings in the community. A support bed unit may play an important part in offering service users more choice about where and when they received help.

This paper reports a retrospective case note study of all patients with learning disability and challenging behaviour admitted to Kneesworth House Hospital between 1986 and 1991 (n=70), describing their demographic and clinical characteristics. The subjects had high levels of psychiatric morbidity, in addition to learning disability. Patients whose stay was relatively short, or who were discharged to community placements, were not able to be differentiated on clinical grounds, suggesting that the provision of local facilities determined the length of the admission. There is a need for more regional and sub-regional services for this group with multiple long-term problems.

This paper presents and responds to On the Heels of Ignorance, a sociological study which identifies five fundamental epistemological paradigm changes in American psychiatry in the service of its survival and details several tactics that have been employed to facilitate these professional reinventions. Issues raised in this presentation include the relationship between psychiatry, society and the state, and the nature and significance of psychiatric expertise. The dynamic of these relationships and the complexities of the required expertise create their own challenges for the advancement and professional accountability of the specialty. The conclusion suggests some future imperatives.

I examine here the activity of ‘unsolicited diagnosis' of psychiatric disorder – the act of informing a person that they show signs and symptoms of mental disorder, outside of a patient-professional relationship. Whether unsolicited psychiatric diagnosis is a legitimate ethical activity for psychiatrists (and other healthcare professionals) in which to engage is an issue founded upon the trade-off between potential benefits and harm to the recipient of the diagnosis. However, potential harm specific to a psychiatric diagnosis (such as issues related to stigma, confidentiality and paternalism) suggests that making unsolicited diagnoses of psychiatric disorder is even more ethically fraught than making unsolicited diagnoses of physical disorder.

When any organisation is exposed to pressure to change, this not only mobilises considerable anxieties within the organisation but calls a variety of defensive operations into play. The work of Jaques (1955) and Menzies Lyth (1959, 1988) has demonstrated that this can result in the central problem ceasing to be the focus of attention, with primitive defensive mechanisms (often of an obssesional or paranoid kind) being mobilised. This process may either lead to energy being devoted to isolated elements of the situation, or staff withdrawing into a state of passivity and hopelessness. Indeed, Jaques has observed that when changes are imposed on an institution in a way which fails to take account of the functions that existing structures serve in relation to the deeper needs and anxieties of those working within the institution, such changes are likely to be resisted, and may even fail.

Stigmatising opinions about mental illness are more common among young people than older people (Yarney, 1999). Whether the media should carry responsibility for this was the subject of the College's 13th Christmas Lecture for Young People. Over 300 school children gathered in central London to take part in a debate on the role of the media in the portrayal of mental illness. Alison Lowe introduced the debate by illustrating how common mental illness is. She invited everyone to look at the eight people sitting around them before adding, “In your lifetimes at least one of you will see a psychiatrist”.

A postal survey of old age psychiatrists was carried out to examine the pattern of services currently available for elderly people with chronic functional mental disorder, and to identify innovative models of care for this group. The opinion of respondents was sought regarding problems with service provision and additional resources that would be desirable. The majority of respondents felt that the needs of individual patients should determine whether they should be cared for by old age, general or rehabilitation services. Seventy-three per cent of respondents felt that more specialist residential care outside hospital was needed to improve the care of this group.

ECT has been valued for over 50 years as an effective treatment for mental illness and especially for depressive illness, and its value has been confirmed by many double-blind comparisons of real and simulated ECT.

Over the past three decades there has been a shift in emphasis from hospital based to community care of psychiatric patients. Central to this change has been the development of the community psychiatric nursing services and an increase in its numbers. Until recently community psychiatric nurses (CPNs) were almost entirely hospital based, working as members of a multidisciplinary team and providing follow-up for psychiatric patients.