Engaging people with mental illness in horticultural activities is nothing new. Asylums encouraged patients to work on farms, in orchards and in kitchen gardens. This activity gradually became distilled, formalised and applied clinically as ‘moral treatment’, out of which occupational therapy evolved (Paterson, 1997). ‘Fertile Imaginations' is an attempt to offer horticultural activities to people with mental illness, within the framework of an inner city community mental health team (CMHT) and to ensure that the activities that engaged and benefited patients in the past, are not now denied.

In June last year, the committee on safety of medicines (CSM) advised against the use of paroxetine in depressed children and adolescents. This was subsequently followed by a similar warning regarding the use of other selective serotonin reuptake inhibitors (SSRIs), with the exception of fluoxetine (http://www.mhra.gov.uk/). The basis of this decision was a detailed review of both the published and the unpublished data. The latter were obtained from pharmaceutical companies who had not reported negative results from clinical trials to the medical community. The addition of the pharmaceutical industry data to published results exerted dramatic effects on the efficacy of available compounds. Thus with the exception of fluoxetine, the risks outweigh the benefits of the SSRIs in the treatment of childhood depression. In particular, there is evidence of a non-significant trend towards increased suicidality with most SSRIs compared with placebo. These findings have been supported by a further recent meta-analysis of the available published and unpublished data (Whittington et al, 2004). A review of the safety and efficacy of antidepressants in children and adolescents by Jureidini et al (2004) has also criticised the quality of reporting of the published trials. The review concluded that the benefits of SSRIs have been exaggerated, including those of fluoxetine, and the adverse effects have been downplayed. The authors suggest that psychological treatments are probably safer and more effective.

Mystery shopping is being increasingly used in psychiatric service evaluation but because it involves an element of deception, akin to research involving pseudo-patients, questions have been raised about its ethical acceptability. Here we discuss these ethical issues and argue that mystery shopping should only take place subject to certain conditions. First, it ought to be clear that the evaluation cannot be done by using non-deceptive methods. Second, independent scrutiny should conclude that the importance of the aims of the evaluation is sufficient to justify the deception used.

Todd Phillips's film Joker, a 2019 psychological thriller, has stirred up strong reactions to the portrayal of the lead character's mental disorder, which is never specified. I used DSM-5 criteria to study whether Joker/Arthur Fleck showed signs of a real mental disorder. The psychopathology Arthur exhibits is unclear, preventing diagnosis of psychotic disorder or schizophrenia; the unusual combination of symptoms suggests a complex mix of features of certain personality traits, namely psychopathy and narcissism (he meets DSM-5 criteria for narcissistic personality disorder). He also shows the symptoms of pseudobulbar affect due to traumatic brain injury. This apparent co-occurrence of both mental disorder and a neurological condition may be confusing for audiences trying to understand mental illness.

Data were collected on a six month sample of patients attending a psychiatric emergency walk-in clinic (n=378), based on the clinical impressions of the interviewing doctor. This information was then compared with a hypothetical model emergency service on the following five items: nature of patient problem, severity of problem, diagnosis, referring agent and current contact with psychiatric services. The severity of the perceived threat to the interviewer was recorded. Only 4.7% of referrals conformed to the hypothetical model on all five criteria. The majority of patients referred themselves, and the problems of self-referrals were significantly less severe than those of general practitioner referrals; 17.2% of consultations were perceived by the interviewing doctor as presenting a moderate or severe threat to his or her safety. The findings suggest that such an emergency facility operates as a form of primary care and is therefore inappropriately used. The level of perceived threat to interviewing doctors is unacceptably high.

In October 1998, the Royal College of Psychiatrists launched a new five-year campaign entitled ‘Changing Minds: Every Family in the Land’, which aims to tackle the problems of stigmatisation of and discrimination against people with mental disorders. As part of the campaign, the College recently sent to the membership a ‘Declaration of Intent’, asking members to sign up to the Campaign's aims and to indicate their support for it. To date we have received more than 2000 signatures and would like to encourage all readers of the Bulletin to return their forms immediately. If you have lost your declaration form please contact the External Affairs Department.

This paper examines the ethical principles of justice and autonomy in psychotherapy. A case history is presented which illustrates how ethical dilemmas concerning the type of psychotherapy to be offered are powerfully influenced by often unconscious counter-transference feelings in the resource allocators. The question of how autonomous a psychotherapy patient can be, when unconscious motivations could be affecting rational choice, is also explored and possible answers provided.

In mid-1991, the Conference of Medical Royal Colleges and their Faculties initiated an Advisory Group on Information Services with broad representation from the profession, the NHS Management Executive, and the Department of Health. The aim of the group is to facilitate and co-ordinate input from the profession to the NHS Information and Technology Strategy. It is chaired by Sir Duncan Nichol, NHS Chief Executive.

Psychiatric in-patient care is perhaps the component of mental health services that service users are most critical about. This, coupled with a growing awareness of the close association between quality and safety in this setting, has led to a recent flurry of national initiatives. These can be broadly grouped into those that have described the problems facing in-patient services and suggested some of the underlying causes, and those that are attempting to address these.

A descriptive study of a psychiatric probation clinic based in South Wales is presented. Over a three year period, 100 probation clients were assessed by forensic psychiatrists at the request of the Probation Services in South Wales. The majority of these clients were mentally disordered, with common diagnoses being personality disorder (35%), substance misuse (11%), schizophrenia (10%) and post-traumatic stress disorder (9%). The non-attendance rates for these clients was 0% for the first and 13.3% for subsequent appointments. Psychiatric probation clinics seem to be analogous to general psychiatric clinics based in Primary Care.

It is the intention of the Mental Handicap Services of the Chichester Health Authority to implement a discrete electronic alert system for some of the patients who are incapable of consent. An activator, similar to the bar code in a library book, or tag in a clothing store will be kept in a pocket of the patient's clothing. When a patient who carries the activator walks through a magnetic field at the door of the unit, it will trigger a bleep held by the nurse in charge to inform him/her that this particular patient is leaving.