Payment by results is likely to be applicable to mental health services, with the exception of specialist services, next year. Its introduction will completely change the way mental health services are funded. It has three main components: national tariffs for treatments, codings or currencies for treatments according to resource use, and diagnosis and activity-based funding. This article describes payment by results, how ‘currencies’ are being developed for mental health, and outlines some of the problems and advantages of introducing this new system.

Hyponatraemia is usually defined as a serum sodium concentration below 135 mmol/1. The condition is rarely symptomatic until serum sodium falls below 120 mmol/1 and symptoms are more usually associated with values around 110 mmol/1. These symptoms include confusion and restlessness, progressing to drowsiness, myoclonic jerks, generalised convulsions and eventually coma. In a general hospital population about 1% of patients develop hyponatraemia (Rutsky, 1992), whereas in psychiatric patients the prevalence has been reported to range from 3.3% to 12.2% (Ohsawa et al, 1992).

This paper puts the case for accessible multidisciplinary mental health services for children and young people to managers, purchasers and GPs, in a framework of national and international statutes and guidance. The essential differences between the disciplines are explained, based on detailed advice from mental health colleagues in nursing, teaching, social work, psychology, child psychotherapy and child and adolescent psychiatry.

The Critical Review Paper (CRP) has been part of the MRCPsych Part II examination for only two sittings and is still fairly uncharted territory. As two people who have separately sat the two papers, we examine whether evidence-based journal clubs (EBJCs) are useful preparation for the exams. We make an argument for changing the format of journal clubs to make them more relevant to the exam, as well as to promote the development of evidence-based practice.

It is 16 years since the Royal College of Psychiatrists published its recommendations for the training of psychiatrists. The guidelines for the training of general psychiatrists in psychotherapy have recently been reviewed and, once again, experience in behavioural psychotherapy was an integral part of such training.

Many admissions to general adult psychiatric beds occur as emergencies, either due to social crisis or relapse of psychiatric illness. Other admissions are planned to arrest or reverse deterioration in mental state. Length of stay varies from days to months depending on reason for admission and adequacy of support in the community. Rapid readmission or failed discharge, defined as readmission within three months, has been linked with multiple previous admissions and personality factors (Jones, 1991).

The high prevalence of post-traumatic and other psychiatric disorders in children and adults who have experienced violence and war-related traumas are well documented by research (Thabet & Vostanis, 1998, 1999). So far, there has been less systematic evaluation of treatment interventions or training programmes for staff working with traumatised individuals in war zones. Training initiatives have recently been described in countries such as Rwanda (Brandon, 1998). This paper describes the work of a community mental health programme in the Gaza strip, particularly through a visit by P. V. to work with the child mental health care staff.

Recruitment into psychiatry varies across medical schools. There is evidence that positive attitudes towards psychiatry at the end of undergraduate education influence career choice and that a major determinant of positive attitudes is exposure to well organised and well taught psychiatry programmes. The General Medical Council's (GMC) guidance on undergraduate medical education provides many opportunities for psychiatrists to increase the exposure of medical students to psychiatry. These opportunities should be seized if we wish to increase recruitment into psychiatry.

Recent years have seen considerable progress in understanding the genetic basis of many diseases. There has also been a welcome and informed public debate regarding the ethical and social implications of genetic research, including predictive testing of adult onset illnesses. The UK Huntington's Prediction Consortium, a forum open to scientists, clinicians and representives from patient organisations, has established protocols for testing and has facilitated development of clinical genetic services. It has been suggested that the Huntington's disease experience might prove informative for other conditions, and a meeting was held on 5 January 1994 at the Institute of Psychiatry, London, to discuss recent research findings and possible genetic testing in Alzheimer's disease (AD). Professionals from a number of disciplines took part along with representatives of the Alzheimer's Disease Society. It was decided to form a consortium that would meet regularly and produce guidelines for future clinical applications of possible genetic tests.

For many involved in the management of people with personality disorders the title of this article may appear to be a contradiction; drugs may alter mental state but intrinsically seem unlikely to alter personality. Nevertheless, drugs are available for treating personality disorders (even though none of them are licensed for these conditions). So it is hardly surprising that there is now a considerable body of literature on the subject which has recently been extensively reviewed (Stein, 1992) but which has attracted more attention since personality disorders have achieved greater prominence in all parts of psychiatric practice.

Those who attempt suicide by jumping often have a history of major psychiatric disorder, are left with a high level of physical and psychological morbidity and have a poor outcome. Services are failing this group in that national statistics may underestimate its size, and even when patients are in contact and are symptomatic and expressing suicidal intent before the incident many go on to jump. Care in hospital and preparation for follow up is uncoordinated.

In 2012, the coalition government introduced the legal right for National Health Service (NHS) patients in England to choose their mental healthcare provider for out-patient treatment. This was a significant step towards parity of care between mental and physical ill health, and NHS Improvement and NHS England have provided sensible guidance on its implementation. However, several factors prevent the system from working as it was intended: lack of awareness of the principle of patient choice for out-patient treatment; complacency from some trusts and commissioners; mental health trusts operating outside the e-referrals system; misuse of care pathways; lack of direct access by many general practitioners for out-of-area referrals; and delays in authorisation for funding. I describe how I have come to this conclusion and suggest some solutions.