The effective psychiatric leader in clinical administration must possess organisational knowledge, financial acumen, negotiation and conflict resolution skills, and a broad knowledge of our field. Team building, motivating others, mentorship, and the ability to hire excellent colleagues are all important attributes of leadership. It is opportune for our profession to promote training and skill acquisition in leadership development.

Of all the medical specialities, psychiatry seems the most resistant to change in the face of rapidly evolving technology. Yet psychiatry could become the speciality most revolutionised by advanced technology in the new millennium. If the following predictions for psychiatry in the next 1000 years appear difficult to believe, imagine what might have been the reaction of those living in 999 to being told what would happen by 1999. Back then the profession of medicine as we understand it did not even exist, neither did there appear to be any institutions devoted to the care of the mentally ill. Indeed, in 1000 years' time from now, we might yet return to a similar situation in both these respects!

In spring 2003, the format of the Patient Management Problems (PMP) part of the MRCPsych Part 2 will change. At present, examiners bring their ‘vignettes' to the examination. The Examinations committee believes that the examination should be more structured, and that there should be a ‘bank’ of vignettes. The working group, which I chair, was set up to make recommendations about the best way forward.

Although the Representation of the People Act 2000 permits most psychiatric in-patients to register on the electoral register, transferred prisoners and those admitted to hospital under hospital orders remain disenfranchised by law. This article clarifies the voting rights of individuals receiving in-patient psychiatric care and contends that the selective disenfranchisement of some mentally disordered offenders is problematic, discriminatory and may breach international human rights law. There are therefore strong arguments for the UK government to address this long-standing inequality before the next general election.

Patients with severe anorexia nervosa have a high mortality and relapse rate, yet specialist services and practitioners are few. A significant minority need detention with involuntary treatment. Furthermore, the mean age at presentation is 16 years, where detention under the Mental Health Act 1983 or parental consent is unclear and variable. This article addresses the implications of the proposed new Mental Health Act for people with eating disorders. The main issues are those of incapacity, assessment procedures, community detention, detention in 16–18-year-olds, implications for carers and resource implications. We hope to show that eating disorders, just like other illness categories, have special needs that cannot be blanketed under one process and that the Act has positive features, but also presents significant concerns.

A reason sometimes given for not applying a section off the Mental Health Act 1983 to patients for the first time is that this may stigmatise them in some way. A practical example off stigmatisation is that patients who have previously been ‘sectioned’ may be refused tourist or immigration visas to other countries. Since no information on this subject is available in the psychiatric literature this paper attempts to clarify the policy of diplomatic missions in the UK in relation to visa applicants who report a history of mental illness and compulsory hospital treatment.

Sleep is vital for our physical and mental health. Studies have shown that there is a high prevalence of sleep disorders and sleep difficulties amongst adults with intellectual disabilities. Despite this, sleep is often overlooked or its disorders are considered to be difficult to treat in adults with intellectual disabilities. There is a significant amount of research and guidance on management of sleep disorders in the general population. However, the evidence base for sleep disorders in adults with intellectual disabilities is limited. In this review paper, we look at the current evidence base for sleep disorders in adults with an intellectual disability, discuss collaborative working between intellectual disabilities psychiatrists and sleep medicine specialists to manage sleep disorders, and provide recommendations for future directions.

‘Welcome To Reality’ announces the bright orange graffito, in English, on the perimeter wall of The City Psychiatric Hospital Number 3. A superfluous arrow points to the gate house. This is a large general psychiatric hospital of 2150 beds serving a population of 1.7 million people and also providing my first experience of Russian psychiatry. The buildings, some wooden, date from 1870 onwards and are set in a large area of mature woodland enclosed by a high wall in the northern suburbs of the city.

Recent years have seen increased pressures on psychiatrists to work closely with user/survivor and carer groups. We argue that although many groups are happy for this to remain at the level of consultation, there are growing demands from more radical elements of the user/survivor movement for moves towards a more collaborative framework. A number of these groups challenge some of the central assumptions of psychiatry. for productive engagement and collaboration to take place, psychiatry will have to be able to react positively, not defensively, to these challenges. We suggest that this raises questions about how we should think about the nature of science, truth and expertise.

In July 2012, the American Psychiatric Association (APA) closed its final commenting period on draft criteria for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), slated for publication in May 2013. DSM-5 raises familiar questions about the cultural assumptions of proposed diagnoses, the scientific evidence base of these criteria and their validity in international settings. I review these issues since the publication of DSM-IV. I assess the cultural validity of DSM-5 and suggest areas of improvement.

Clinicians in all specialties may encounter patients who are in the process of seeking asylum in the UK. This article outlines the practical realities of this process, particularly the legal, social, and economic challenges faced by applicants, and the long wait for resolution. These are highlighted as factors that may have an impact on the psychological health and social functioning of patients. This social and economic context is of particular interest to mental health professionals involved in the care of asylum-seekers; assisting in the process of case formulation, risk assessment, care planning, and the preparation of medico-legal reports.

NHS Direct is a nurse-led telephone helpline covering England and Wales. The intention to develop this helpline was announced in December 1997 in a White Paper, The New NHS, Modern and Dependable (Department of Health, 1997), following recommendations in the Chief Medical Officers' report, Developing Emergency Services in the Community (Caiman, 1997). Three initial pilot sites were set up in Lancashire, Milton Keynes and Northumbria and began taking calls in March 1998. The project was extended in April 1999 to cover 40% of the population of England and by November 2000 was available throughout the whole of England and Wales. NHS Direct provides 24-hour advice and information via 22 call centres and is the largest telephone health care service in the world. A similar system is planned in Scotland, NHS 24.

The nature of perception has fascinated philosophers for centuries, and has more recently been the focus of research in psychology and neuroscience. Many psychiatric disorders are characterised by perceptual abnormalities, ranging from sensory distortions to illusions and hallucinations. The distinction between normal and abnormal perception is, however, hard to articulate. In this article we argue that the distinction between normal perception and abnormal perception is best seen as a quantitative one, resting on the degree to which the observer's prior expectations influence perceptual inference. We illustrate this point with an example taken from researchers at Google working on computer vision.