The new Mental Health Act for England and Wales is likely to extend the powers of mental health review tribunals (MHRTs) by giving tribunals the power to approve all compulsory treatment (Department of Health, 1999a, b). The medical member may be dropped entirely from the tribunal's proceedings (Richardson & Machin, 2000). In Ireland, a proposed new Mental Health Act will introduce MHRTs for the first time (Calvert, 2000). The 1983 Mental Health Act contains no explicit statement of underlying principles, although some were introduced in the revised Code of Practice. The Expert Committee (Department of Health, 1999b) suggested that the new Act should specify broad principles where these would help in statutory interpretation, particularly because a range of practitioners working in different settings will be required to understand and implement its provisions. The Green Paper initially suggested that the proper place for setting out principles should be a Code of Practice, but ended by inviting comments on the principles proposed by the Expert Committee, and on whether inclusion of principles would aid interpretation of the new Act.

Suicide has consistently been the most common cause of premature death in schizophrenia. A large 5-year World Health Organization study consisting of the follow-up of 1056 patients exhibiting psychotic symptoms found the most common cause of death in those with schizophrenia was suicide (Sartorius et al, 1986). In their review of the subject Caldwell and Gottesman (1990) found that 9–13% of patients with schizophrenia eventually commit suicide. At least 20–40% make suicide attempts (Meltzer & Fatemi, 1995) and 1–2% go on to complete in their attempt within the next 12 months (Meltzer & Okayli 1995). Therefore, suicide in schizophrenia has long been a major area of concern and research efforts.

Any review of service user involvement must acknowledge the progress that has been made in recent years. In the early 1980s service users were usually passive recipients of their own care and treatment and had little or no collective involvement, even in voluntary organisations that claimed to be speaking on their behalf. The few independent service user groups that existed were marginalised and lacked significant resources. In 1985 the House of Commons Social Services Select Committee Report on Community Care (1985) complained about the difficulty “of hearing the authentic voice of the ultimate consumers of community care”.

The profession awaits the Government's White Paper on a new Mental Health Act (MHA) with trepidation. At the time of writing, the closing date for consultation on the Green Paper (Department of Health, 1999a) has passed. None the less, discussion and lobbying must continue.

Until recently the provision of health care within prisons was the sole responsibility of the prison service. The Prison Health Service (formerly known as the Prison Medical Service) is the oldest civilian medical service in Britain. In addition to being much older than the NHS the Prison Health Service is much smaller, less well developed and less well resourced. Prison health care was coordinated by the Directorate of Health Care at the Home Office; the Department of Health and the NHS had no direct input. As a result, prisoners were afforded a standard of health care well below that provided by the NHS, and without radical reform there was little prospect of improvement. However, in recent years things have begun to change and last year collaboration between the prison service and the NHS resulted in the creation of a partnership between these two organisations (Joint Prison Service and NHS Executive Working Group, 1999). Although the intention is to improve health care standards for prisoners, the formal nature of this partnership also has the effect of making the NHS more directly responsible for health care in prisons.

In the UK the notion of diverting people suffering from mental disorders from the criminal justice system to treatment within the health service is not new (Home Office, 1990), nor is the concept of a court-based psychiatric assessment and liaison service (Joseph & Potter, 1990; James & Hamilton, 1991; Joseph, 1992). Similarly, the concept of 'specialist'courts is not a novelty in the USA (Bean, 1998; Schwartz & Schwartz, 1998). We report on the first specialist mental health court in the USA and propose a modification of the current provision of psychiatric services to courts in England and Wales by combining elements of the mental health court with current court diversion practice.

Clinical psychiatrists are today in a position to prescribe an expanded range of antipsychotic drugs for the treatment of schizophrenia and related psychoses. The introduction of chlorpromazine in 1952 was followed by many others. They varied in potency and in side-effect profile, but they shared the capacity to cause extrapyramidal side-effects (EPS). These side-effects were produced by a mechanism intrinsically similar to that responsible for the antipsychotic effectiveness of the drug. They seemed to be the price that had to be paid for the resolution of psychotic symptoms.

There is public concern about medical errors. In Britain, the Bristol Inquiry is the paradigmatic example that focuses professional and public attention on the safety of medical interventions. In the US the Institute of Medicine's recent report To Err is Human: Building a Safer Health System (1999) was widely seen on both sides of the Atlantic as confirming what most already feared, that medical interventions were accompanied by unacceptably high levels of preventable harms (Barach & Small, 2000). The response to these public concerns has been multifold. In the UK clinical governance was introduced in April 1999, principally to focus attention on continuously improving the quality of clinical care. At the same time, the arrangements for the registration of doctors by the General Medical Council (GMC) was under review and there was an expectation that NHS trusts would bring consultants, who hitherto had been regarded as independent practitioners outside any supervisory system or arrangement, within an appraisal system. It has become clear that this appraisal system will be a component part of the GMC's revalidation of doctors (GMC, 2000). What is clear is that these varying systems are designed to restore public trust by providing an open process, which has the confidence of the profession, management and public alike. In this paper we aim to discuss the historical development of appraisal as a system for reviewing the performance of individual practitioners, suggest a method for appraising senior medical staff and finally to discuss the limitations and problems inherent in the introduction of such a system.

How racist is British psychiatry? Why does psychiatric practice in this country continue to discriminate against Irish, Black and Asian people? How do we, as a profession, respond to the charge of institutional racism, increasingly accepted as a major problem within British psychiatry?

The behaviour of X in childhood had been described as ‘difficult‘, ‘aggressive’ and ‘bizarre‘, including bizarre gestures, mannerisms, ‘making scenes in public‘, ripping her clothes and trying to set fires.

In our special article (pp. 439–441, this issue) we have described the structure and function of a 24–hour crisis assessment and treatment team (CATT). Comprehensive, accessible, specialist, out of hours crisis services designed to facilitate community treatment are not new in the UK but they are not currently widespread. Services employing the CATT model have become widespread in Australasia and are considered to be a success there. In this paper we discuss some of the advantages of CATTs and some possible reasons why they are not more commonly employed in the UK.