The practice of psychiatry in the UK has for most of its existence been focused on the needs of adults, and it has been with this age group in mind that educational programmes and training needs have been formulated. It is not surprising, then, that the content and shape of psychiatric training programmes have followed this clinically-driven pattern. Trainees entering psychiatry begin their clinical careers working with adults or older people and are expected to obtain a grasp of the fundamental clinical tools of the trade working with these populations. Experience with younger people's mental health is explicitly excluded in the first year of training, emphasising the primacy of adulthood in the approach to learning clinical mental health skills.

Self-harm is a major risk factor for suicide (Gunnell & Frankel, 1994) with around a quarter of suicides preceded by non-fatal self-harm in the previous year (Owens & House, 1994). Strategies for suicide prevention should include accurate monitoring of health service contacts due to self-harm. Unfortunately, the published literature points to few practical steps for ensuring this accuracy. We offer an account of running a database, to assist others who might be setting out on this monitoring process.

The German mental health care system differs significantly from the system in the UK. There is no central organisation with overall responsibility as in the National Health Service (NHS), and the government is not entitled to prescribe details of policy or set specific targets. It can only determine the legal framework, define general goals and, with difficulties, influence the spending level. Responsibilities for mental health care, as for other fields of health care, are shared between federal authorities, the 16 states (Lander), local authorities, and semi-statutory organisations, which govern out-patient health care provided by psychiatrists in office-based practices. Virtually every citizen is health-insured and there is free access to health care for those who have no insurance coverage, in which case social services usually cover the costs. Social services also directly fund various services in the community. The fragmented system can be difficult to comprehend. However, many of the challenges are similar to those in other countries, and policy makers and practitioners elsewhere might be interested to know some of the lessons learnt in the German system.

The Electroconvulsive Therapy Accreditation Service (ECTAS) was launched in May 2003. Its purpose is to assure and improve the quality of the administration of electroconvulsive therapy. Participating clinics undergo a process of self- and peer-review. The Royal College of Psychiatrists' Court of Electors will award an accreditation rating to clinics that meet essential standards; this accreditation will last for 3 years, subject to annual self-review. Participating clinics will also receive feedback and advice about local strengths and areas for improvement. The accreditation service is endorsed by the Royal College of Nursing and the Royal College of Anaesthetists and has the support of the Healthcare Commission in relation to English services. Clinics that participate in ECTAS will be listed on the College website, with the accreditation rating awarded.

In line with the Royal College of Psychiatrists' commitment to improve its professional examinations based on the best current evidence, Spring 2003 has seen the introduction of the objective structured clinical examination (OSCE). This has replaced the individual patient assessment (IPA) in the MRCPsych Part I clinical examination. An OSCE consists of a series of time-limited clinical tasks that candidates have to perform in a consecutive series of ‘stations' or booths. They have the advantage of being able to test clinical competence using a number of different scenarios via a standardised format (Katona et al, 2000). Their use has become widespread over recent years, particularly in undergraduate psychiatry exams (Brewin & Cantwell, 1997), as they have good reliability and validity (Hodges et al, 1998). This was confirmed by the College's initial pilot OSCE, which had a κ score of around 0.8 for the examination as a whole (Oyebode, 2002).

Robert Gardiner Hill, house surgeon, and Edward Charlesworth, physician and governor, at the Lincoln County Asylum are generally regarded as being the pioneers of the non-restraint movement in the UK, having totally abolished the use of mechanical restraints at that institution by 1838 (Lincolnshire Archives, 1838; Smith, 1999). John Connolly introduced non-restraint to the Hanwell Asylum in the summer of 1839, closely following Lincoln (Hunter & Macalpine, 1968). However, Gardiner Hill suggested the credit for introducing non-restraint in its full extent should go to Dr Thomas Prichard of the Northampton Asylum (Hill, 1857).