Recovery from mental illness is a fairly straightforward concept to members of the general public: “am I going to recover”, “what are the chances of recovery”, or “is our son/daughter ever likely to recover”? These are the sorts of questions that doctors and psychiatrists get asked every day.

Sir: Bristow (Psychiatric Bulletin, August 1999, 23, 478–480) found 9.5% of psychiatrists said their trust restricted clozapine funding. By contrast, the Maudsley National Schizophrenia Fellowship (1998) survey of health authority pharmaceutical advisors reported in the Pharmaceutical Journal found clozapine funding restricted by 45% of health authorities. We have recently carried out a postal questionnaire of members of the UK Psychiatric Pharmacists Group on the use and evaluation of atypical antipsychotics. We received 82 replies giving a response rate of 45%. Eleven per cent of pharmacists reported their trust capped the number of patients prescribed clozapine. However, there was widespread use of measures by trusts to try and limit expenditure on atypicals, restricting the prescribing of atypicals to consultants only and the use of guidelines in which atypicals are not first line treatment for schizophrenia. Only 12% of trusts, our hospital among them, used no cost-containment measures.

As a registrar, I took part in a six-month exchange between the Maudsley Hospital in London and the Psychiatric Hospital in Barbados. My main motivation for taking up this opportunity was a long-standing desire to spend at least part of my psychiatric training in a less well-developed setting. My expectations were that Barbados would provide this kind of experience, with the emphasis being on service delivery in a very different cultural setting to which I was accustomed.

Every once in a while there is a mini renaissance in an area of medicine. The flowering of research that has taken place world-wide in the field of psycho-oncology in the last decade is one such example. This deepening interest in all the different psychological aspects of cancer, with the prevention of psychiatric morbidity and the development of a healthy adaptation being the main outcome aims, has led to hundreds of publications in recent years, along with the launching of two high-quality journals, the Journal of Psychosocial Oncology and the Journal of Psycho-Oncology. There have been numerous robust research findings proving the efficacy of psychosocial interventions in cancer patients on a range of outcome measures (Stein et al, 1993; Fawzy et al, 1995). The search for conclusive evidence of the positive effects of psychological therapy on disease progression and hence survival rates has also developed, becoming a holy grail for researchers in mind/body medicine, and has been brought tantalisingly within reach by a number of well-controlled trials (Spiegel et al, 1989; Richardson et al, 1990; Fawzy et al, 1993; Ratcliffe et al, 1995).

Sri Lanka is a developing country situated in the Indian ocean with a population of about 18.5 million. Its education and health care services are free in the state sector. Psychiatric services are mainly confined to the units in the general hospitals and two large mental hospitals situated in Angoda and Mulleriyawa (suburbs of Colombo) at the moment. However the institutional care is gradually changing and many professionals are aware of the importance of community care. There are a few reasonably organised community centres available at present.

When the Australian Governor General, Sir William Deane, referred in a speech in 1996 to the “appalling problems relating to Aboriginal health” he was not exaggerating. The Australia Bureau of Statistics report on The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples (McLennan & Madden, 1997) outlines the following statistics. The life expectancy for Aboriginal Australians is 15 to 20 years lower than for non-Aboriginal Australians, and is lower than for most countries of the world with the exception of central Africa and India. Aboriginal babies are two to three times more likely to be of lower birth weight and two to four times more likely to die at birth than non-Aboriginal babies. Hospitalisation rates are two to three times higher for Aboriginal than non-Aboriginal Australians. Death rates from infectious diseases are 15 times higher among Aboriginal Australians than non-Aboriginal Australians. Rates for heart disease, diabetes, injury and respiratory diseases are also all higher among Aboriginals – and so the list goes on. It is fair to say that Aboriginal people have higher rates for almost every type of illness for which statistics are currently recorded.

Since the first journal clubs were started this educational tool has been used by the medical profession with varying degrees of success (Linzer, 1987). Journal clubs allow trainees to review a piece of published research and discuss it with senior colleagues. They are frequently plagued by poor attendance and perceived as less than exciting, and at worst frankly boring. The enormous choice of journals compared with 100 years ago and the diversity of the media available mean that journal clubs should look towards developing in their format. Various methods have been tried to improve attendance, perceived relevance and enjoyment, such as evidence-based medicine reviews (Gilbody, 1996), teaching critical appraisal skills, and using structured review methods (Burstein et al, 1996). Sidorov (1995) surveyed 131 postgraduate programmes in the eastern USA and found the following features were associated with high attendance and continuous existence of journal clubs: smaller residency programmes, making attendance mandatory, providing food and promoting original research articles.

The recent British Medical Journal series of articles entitled Getting Research into Practice included a paper which described the practice of evidence-based medicine as “a process of lifelong self-directed learning in which caring for patients creates a need for clinically important information about diagnoses, prognoses, treatment, and other healthcare issues” (Straus & Sackett, 1998). The Centre for Evidence-Based Mental Health located in Oxford, aims to promote and support the teaching and practice of evidence-based mental health (EBMH). Since April 1998 the Centre has been developing a website aimed at two broad groups of users; those who have an active role in teaching evidence-based practice in mental health, and those who wish to find high quality mental health evidence on the Internet. The site contains a wide range of tools to help professionals develop their skills in practising EBMH, as well as tools to enable groups to run training courses in evidence-based practice. In addition to this the site provides a regularly updated list of ‘quicklinks' to sources of evidence for the busy mental health care professional.

Sir: Thompson (Psychiatric Bulletin, August 1999, 23, 449–451), states ‘the Suicide Act of 1961 prohibits others from encouraging suicide’, and concludes that there may, therefore, exist ‘legal grounds' sanctioning suicide Websites. These suggested measures include possibly tracing Vulnerable individuals' who have disclosed suicidal thoughts, or who have communicated, for example, by way of the site bulletin board, that they have just acted on their suicidal ideation. Yet, it is difficult to see how there could be legal grounds propelling health care professionals (presumably), or any other individual, into such interventions. The Suicide Act 1961, prohibits the ‘aiding and abetting’ of suicide, but this is not necessarily synonymous with merely ‘encouraging’ suicide per se. Criminal liability arises in circumstances where a person takes active steps in assisting the suicide of another, such as by telling someone the amount of a drug required to secure death and leaving this within their reach. The Suicide Act 1961 does not extend to Scotland, although any individual taking similarly unambiguous steps to assist another in suicide might face ‘art and part’ liability in the aiding and abetting of a suicide, possibly resulting in a charge of culpable homicide. Neither does it apply to other countries, and it must be borne in mind that assistance in suicide is not a crime everywhere. Therefore, there can exist no competent application of the English law or governmental quantitative targets over the conduct of others in a wholly different jurisdiction.

On Wednesday 11 August 1999 there will be a total eclipse of the sun. The path of totality will start at sunrise south of Nova Scotia and pass over the Atlantic toward the UK. It will then pass through northern France, central and southern Germany, Austria, the Middle East, Pakistan and India (Bell, 1997).

A 45-year-old woman with no previous psychiatric history had three psychiatric in-patient admissions with symptoms of suicidal ideation and depression which she attributed solely to the effect on her of Princess Diana's death.

Traditional British undergraduate medical education has evolved with the development of medicine as a profession. However, despite dramatic progress in the provision of healthcare, the medical curriculum has remained mostly unchanged until recently. Conventional medical courses rely on the teacher-centred didactic setting of a lecture theatre to transmit vast quantities of information. This one-way traffic of facts is divided initially into the preclinical basic sciences and later into the medical specialties, with relatively little horizontal or vertical integration. Much of the assessment of students relies on their reproducing information as accurately as possible. This traditional format has been widely criticised (Lowry, 1992).

British Medical Journalwww.bmj.com – this is an excellent site. It has the full text of all articles published in the British Medical Journal since the beginning of 1997.