As the Medical Director and Deputy Medical Director of the Avon and Wiltshire Mental Health Partnership Trust, we are responsible for the recruitment and development of a large number of medical staff. We are also extensively involved in trying to develop new services in line with the two National Service Frameworks (NSFs), and other central and local directives. Discussion with colleagues elsewhere suggests that we are not alone in experiencing a number of problems, including being hampered by the financial position of our commissioners and the lack of structural protection for mental health funding. However, the task is also made more difficult by the conflicting local and central imperatives from the Royal College of Psychiatrists and the Department of Health. The current problems facing our Trust are outlined as an illustration of the more generally experienced difficulties. Some possible solutions are proposed.

With the development of crisis resolution/home treatment (CR/HT) teams according to the National Health Service (NHS) Plan and Policy Implementation Guidance (Department of Health, 2000), it is important to anticipate the issues involved in their collaboration with acute in-patient units. What are the implications for in-patient care (IC) of CR/HT availability? How can we realise the opportunities that full integration can offer towards an improved acute service?

In war, truth is said to be the first casualty. Something similar may be said for psychiatry. The ability of the media to distort public understanding of mental illness is well described (Wahl, 1995; Philo et al, 1994). Psychiatric disorders, their treatments and those who provide them are all subject to overwhelmingly negative portrayals in the print and broadcast media (Hyler et al, 1991). Dehumanisation, inaccuracy and sensationalism seem to be the media's stock-in-trade. Media professionals make no apology for this, citing the provision of impartial, emotionally-neutral accounts as one of their least pressing concerns (Salter & Byrne, 2000). They also reject the notion that they are responsible for the perpetuation of harmful stereotypes, claiming instead that they merely mirror the values and beliefs of our society (Bolton, 2000). This distorting mirror is of great relevance to psychiatry. It is probably no exaggeration to state that the celebrated cases of Christopher Clunis and Ben Silcock have done more to change the practice of community psychiatry than any College President or Secretary of State over the past 5 decades.

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.

In this article, I shall give an overview of the emerging field of collaborative research between clinical academics and service users in the field of mental health, along with some examples of different kinds of collaborative research and the value they can bring to more mainstream studies. I shall also discuss some of the obstacles to collaborative research in mental health and suggest directions for the future.

Although there seems to be a shared impression that the proportion of women in academic psychiatry is substantially lower than in National Health Service (NHS) posts, we are not aware of any empirical data on this. In the USA, women physicians have been shown to be more likely to pursue an academic career than men (Nonnemaker, 2000), but the number who advance to Professor appears significantly lower than expected (Reiser et al, 1993; Nonnemaker, 2000). Women in academic psychiatry in Canada also appear less likely to advance to senior positions than their male colleagues (Penfold, 1987). A recent survey of 44 academic institutions in the UK, carried out by the National Centre for Social Research (Blake & La Valle, 2000), found that women occupied lower grade academic posts than their male counterparts and therefore were less eligible to apply for project research grants. Those that were eligible were as successful in gaining funding as their male colleagues.