A 45-year-old woman with a long history of schizoaffective symptoms associated with disruptive and antisocial behaviour refused to cooperate with out-patient treatment and particularly medication, having developed a strong distrust of psychiatrists. After discussions with the multidisciplinary team, the psychiatrist agreed to share treatment decisions with the patient and accepted her refusal of medication. This course of action is not always comfortable for professionals, especially when a patient challenges clinical judgement. However, this case illustrates how, by adopting a less paternalistic approach, the therapeutic alliance developed and, most importantly, the patient's health improved. The scenario described raises similar issues to those explored in the play Whose Life Is It Anyway?

The aim of the defence medical services (DMS) is to maintain the health of those individuals who volunteer for service in HM Armed Forces, in order that they may efficiently discharge their duties.

Health professionals are increasingly expected to take a share in the management of risk in a systematic manner. At its most blunt, clinical risk management is defined as the identification and planned response to negative events that occur during the provision of clinical care and can lead to litigation, the cost of this to the NHS is rapidly rising (Vincent & Clements, 1995). There are, of course, much broader risks to any healthcare organisation, and the approach to risk management in any organisation needs to be systematic. At the start of the process the development of a list of clinical and non-clinical areas in which failures might occur can be overwhelming to clinicians and support staff alike. Rigorous prioritisation of the process is essential, and for practitioners the first rule of sound clinical risk management is common sense.

There is a deluge of written information for users and carers being produced about schizophrenia, which shows no sign of abating, so this article makes no attempt to be comprehensive. It would be out-of-date by the time of publication and would inevitably miss leaflets cherished by individual psychiatrists, mental health workers, users and carers. However, remarkably few up-to-date books exist and this issue will be discussed later in the article.

At a time of increasing European harmonisation this paper gives a brief history of the main European organisation for trainees in psychiatry (the European Federation of Psychiatric Trainees) and details the proceedings of the most recent European Forum held in Berlin.

A postal survey was conducted within four regional Health Authorities to ascertain how widely the supervision register had been applied in its first year of operation in adult mental health. A 72% response rate was achieved. The results showed that the register has been absorbed organisationally but is less accepted professionally. One hundred and nineteen of the 367 consultants in the sample (32%) had no entries on the register at 31st March 1995. The provision of training on its use had a significant effect on compliance, although London-based services had marginally less registrations per consultant than their colleagues elsewhere. Very few outside agencies had required access to the register.

An experiment in community care, training Omanis with bachelor degrees in social work, psychology and education to act as psychiatric care givers in the community, is currently being developed in the Sultanate of Oman. This experiment is based on the Alma-Ata declaration to achieve Health For All by the Year 2000 (WHO, 1978) and WHO aspirations to move psychiatric care back into the community (WHO, 1990), and the fact that in many developing countries psychiatric care has remained on the fringe due to lack of resources and manpower.

It is a stressful experience for parents and/or carers when their child is admitted to an in-patient unit because of severe mental illness.

Since the Liverpool Care Pathway has been withdrawn in the UK, clinicians supporting the palliative needs of patients have faced further challenges, particularly for patients with dementia who are unable to go to a hospice owing to challenging behaviours. It is becoming more important for different services to provide long-term palliative care for patients with dementia. Mental health trusts should construct end-of-life care policies and train staff members accordingly. Through collaborative working, dying patients may be kept where they are best suited. We present the case study of a patient who received end-of-life care at a psychiatric hospital in the UK. We aim to demonstrate how effective end-of-life care might be provided in a psychiatric hospital, in accordance with recent new palliative care guidelines, and highlight potential barriers.