Attention-deficit hyperactivity disorder (ADHD) and its pharmacological treatment remain the objects of intense controversy. The conflict reaches far beyond the area of scientific debate. An article on ‘behavioural syndromes', published in The Times on 28 July 2003, was headlined: ‘Hyperactive? Just go to a park and climb a tree’. An internet search will produce equal numbers of sites warning either that the prescription of stimulant medication is a denial of children's human rights, or that not prescribing stimulant to an ADHD child denies their right to treatment.

The next 2 years will see radical changes to the way medical training is delivered. First, the old apprenticeship and time served model will no longer be applicable. Second, from August 2004 the European Work Time Directive (EWTD) applies to trainees in the same way that it applies to all other grades (European Union, 1993, 2000). August 2005 will bring the first full intake into foundation programmes and will see the implementation of Modernising Medical Careers (MMC) (Department of Health, 2003). Further in 2005, the General Medical Council's (GMC's) new requirements for revalidation will come into force (GMC, 2003).

The stated aim of the new Foundation Programme is to equip all doctors with a range of generic competencies before they embark on a specialist training programme, following the advice in Modernising Medical Careers (Department of Health, 2003, 2004), which built upon Unfinished Business, Proposals for the Reform of the Senior House Officer Grade (Department of Health, 2002). The educational aims of this 2-year programme are to develop generic skills, competencies and attitudes to ensure professional conduct that will reflect ‘good medical practice’ as defined by the General Medical Council (1998). Any education for the Foundation Programme must concentrate on these areas. A Curriculum for the Foundation Years in Postgraduate Education and Training is being produced by the Academy of Medical Royal Colleges in co-operation with the Modernising Medical Careers Implementation Team at the Department of Health (Department of Health, 2005).

Following the publication by the National Institute for Mental Health in England (NIMHE) of Personality Disorder: No Longer A Diagnosis of Exclusion (National Institute for Mental Health in England, 2003), it is perhaps surprising that so soon after there have been threats to the survival of some of the small number of existing specialist personality disorder services to which it refers. Indeed, one of the few in-patient units specialising in such disorders (Webb House in Crewe) closed in July 2004. Such closures or threats argue for closer collaboration in planning between the relevant secondary and tertiary services and also between the Department of Health, the NIMHE and local National Health Service commissioners. Not safeguarding existing tertiary specialist services, at a time of increasing awareness of the needs of patients with personality disorders, may be short-sighted.

There are a number of issues that arise when an older person with dementia is a victim of crime. The safety of the individual and how to prevent further such incidents occurring is a clear priority. There may be considerations such as whether the person can continue to live safely at home. In addition, there is the prospect of future legal proceedings, and concerns such as the person's capacity to give evidence, and whether they will be able to cope with the pressures of attending court. Similar issues are also pertinent to younger people with serious mental illnesses living in the community.

Few treatments are more controversial than the prescribing of injectable heroin (diamorphine) to heroin addicts. This practice is still banned in the USA and Australia, despite the serious drug problems in those countries. At present any UK doctor can prescribe injectable methadone for the treatment of heroin addiction; however, the prescribing of heroin requires a special licence from the Home Office. The National Treatment Agency for Substance Misuse is the statutory body currently responsible for advising purchasers (local drug action teams) in regard to specialist services for addictions. They have recently commissioned and published guidelines for the prescription of injectables in opiate addiction (National Treatment Agency for Substance Misuse, 2003). This follows the report of a Government committee, which stated:

‘If diamorphine treatment could be offered to all problematic users who do not successfully access other treatments, we believe it could play a useful part in managing the social problems generated by this group of people’ (House of Commons Home Affairs Committee, 2003).

This is the second in a series of three articles about clinical guidelines in mental health. In the first article (Kendall et al, 2004), we introduced the National Collaborating Centre for Mental Health (NCCMH) and its guidelines work programme commissioned by the National Institute for Clinical Excellence (NICE); the possible uses of clinical guidelines; and the different guideline products generated alongside each NICE guideline.