This paper presents the case of an elderly gentleman who sustained a fractured neck of femur following a fall at home but refused to go to hospital. His general practitioner determined that he lacked capacity but ambulance and police crews refused to escort him due to concerns regarding deprivation of liberty.

The legal grounds for treating people who lack capacity in emergencies are discussed and the development of the common law into the Mental Capacity Act 2005 is demonstrated. the Mental Health Act 1983 is inappropriate to treat primarily physical conditions, whereas deprivation of liberty cannot be authorised by the Mental Capacity Act 2005 without a means of challenging the lawfulness of the detention. In response, the government has produced Deprivation of Liberty Safeguards, which came into force in April 2009.

Sexual harassment and assault on psychiatric wards is an ongoing concern. A number of incidents have been reported in the media. This paper focuses on a policy drafted to deal with allegations of sexual assault or rape on an in-patient psychiatric ward. We aimed to produce a practical, easy-to-follow guide for junior doctors and ward staff who may face complex and possibly contentious issues surrounding consent, capacity to consent and police involvement.

New psychological services are about to roll out across England. the National Institute for Health and Clinical Excellence clinical guidelines have led to government investment in the Improving Access to Psychological Therapies (IAPT) programme. New IAPT services should cut waiting times for psychological treatment of depression and anxiety disorders from months to days. They are intended to be available for all adults on the basis of need rather than age. It is not currently illegal for patients to be discriminated against by the National Health Service (NHS) because of their age. the government intends to introduce new legislation against age discrimination in the provision of goods, facilities and services by the NHS. Further investment and service development will be needed to counter existing age-related inequalities in mental health services

This paper describes a link between a mental health trust (the East London Foundation Trust (ELFT)) in the UK and mental health services in Uganda which has developed since 2004. the aim of the link was to help support the development of mental health services in Uganda by establishing an educational partnership. During the first 3 years, nine staff from ELFT and nine staff from Butabika, from a variety of disciplines, have made short-term exchange visits. Evaluation of the link has demonstrated that benefits have been experienced in both London and Uganda. Such links can provide one way of strategically supporting and strengthening existing health services in low- and middle-income countries.

The Clinical Assessment of Skills and Competencies (CASC) is the latest change to the MRCPsych examination. the CASC is a complex version of an Observed Structured Clinical Examination (OSCE) format, with paired stations, and is now the only clinical component in the MRCPsych examination. We describe how to organise a relatively inexpensive and workforce-light 1-day course and mock CASC examination by adapting a previously described method for running an OSCE workshop. We also evaluate the acceptability to trainees of a mock CASC examination and course, and describe their views on this new clinical examination format.

In 2009, the Royal College of Psychiatrists piloted a system for national recruitment to the first year of training (CT1) in England. This paper reviews the changes in recruitment of UK medical graduates to psychiatry over the past 20 years, both within the West Midlands and nationally. Fewer UK graduates are entering psychiatric training in the West Midlands despite the introduction of pre-registration training in psychiatry and the expansion of medical schools in the region; this picture is reflected nationally. Reasons for the continuing problems in recruitment are discussed and suggestions made for improving the attractiveness of psychiatry as a medical specialty. the latter include: engaging more closely with medical students, continuing to lobby politically with regard to overseas recruitment and presenting a unified vision of the profession.

This article assesses the quality of higher psychiatric training opportunities under Modernising Medical Careers (MMC) and compares them with the existing specialist registrar (SpR) grade; the UK psychiatric educational literature is reviewed, and trainee concerns reported. Anecdotal reports of higher training losses under MMC suggest disparity between specialty training year 4 (ST4) and the first SpR year. the roles, controversies and losses of protected clinical special interest sessions and the research day are reviewed. UK psychiatric literature notes underutilisation and poor supervision of these highly valued protected training sessions, with suggestions for improvement. the sacrifice of protected training to service provision may have implications for training quality, leading to under-trained consultants in the long term, to the detriment of patients.

Since the introduction of the Human Rights Act 1998, all courts and tribunals are obliged to interpret all laws and statute consistently and compatibly with the Human Rights Act. This includes the Mental Health Act 1983 (and the 2007 amendments) and mental health review tribunals. Mental health case law has evolved with regard to medical treatment under Part IV (Consent to Treatment) of the Mental Health Act being compliant with the Human Rights Act. Review and analysis of such case law can aide everyday clinical decision-making as well as improving knowledge of the Human Rights Act.

This article reviews the literature on research as part of the career of a psychiatrist. Many of the reviewed articles emphasised an interest among psychiatry trainees for conducting psychiatric research. A number of reviewed articles discussed the aspects of research training experiences that lead to a career with a major research emphasis. A few articles described the percentage of time dedicated to research by academic psychiatrists. for those trainees completing their training and who plan to pursue a career as a clinician, there are still ways to incorporate research into clinical practice and continue to maintain some of the research skills that were learned as a psychiatry trainee.

The participation of service users with intellectual disability and carers is essential in medical and psychiatric training at all levels. It validates the training experience provided by incorporating service users' and carers' perspectives and their experience of mental illness/challenging behaviour, anxieties, interactions and feelings generated when dealing with professionals involved in their care, and also provides an understanding of expectations, views on met and unmet needs and how management options are best explained and communicated for meaningful participation in providing consent and in making treatment decisions. This article brings together the benefits of involving service users with intellectual disability and carers in teaching, discussing their roles as trainers, and providing practical tips to plan sessions as well as recognise and overcome barriers.

We performed a review of the international literature, Royal College of Psychiatrists guidelines and Irish legislation concerning psychiatric trainees and their experience of violence. Physical violence in the workplace was reported by 16% of trainees in Ireland and 67% of specialist registrars in the UK; 72% of trainees in Belgium reported verbal violence. Personal characteristics of trainees which increase the risk of experiencing violence are under-researched, although it is observed that the duration of clinical experience seems to be somewhat protective. the advent of community psychiatry brings new risks to trainees. the Royal College of Psychiatrists issued guidelines and reports that are useful in developing facilities and promoting trainee safety. Although legislation provides some protection to trainees, it also places responsibility on them as employees.