I describe the needs for and impediments in provision of psychological support services for doctors. Morbidity and the resistance in the profession to addressing their own health needs are discussed. I also explore the principles of bespoke services for doctors, with particular emphasis on overcoming stigma and facilitating therapeutic engagement. I argue that triage is an inappropriate service model of care for doctors.

This article considers why whole-person care is often aspired to but remains problematic for psychiatry. One reason is that psychiatry wants to use ideas about the self in restricted senses rather than examine the idea as a whole. In particular, this includes wider issues that interconnect values to identity, which then ambiguously get raised in clinical practice, such as questions about who it is good to be. This issue is the context behind unresolved boundary disputes in mental health around well-being, spirituality, self-esteem and recovery, and reflects broader cultural tensions about the making of modern identity best understood in a historical context. It has impacts on service design, therapeutics and training. Suggestions are made about how the self can be approached in psychiatric practice.

Charles Taylor provides important philosophical accounts of what it means to be a ‘self’ in a secular age. Psychiatry has not traditionally concerned itself with other than limited accounts of the concept of the self but Taylor's work sheds a revealing light on the challenges to be met by aspirations to an holistic practice of psychiatry in our secular age.

One in four of the UK population is expected to have a mental health problem at some time in their lives. There is no reason to believe that this statistic should not apply to doctors just as it does to everyone else. This paper discusses the obstacles to accessing treatment that doctors with mental ill health face, and goes on to consider potential solutions to these problems. There is a great pool of talent within the field of medicine and those doctors with mental health problems often have increased empathy as well as professional expertise. This article sets out to demonstrate that there are ways of supporting these doctors and enabling them to overcome their illnesses and regain satisfaction in their work.

Stephen Tyrer's commentary on Fair Horizons was generally supportive of the principles underpinning the model, while offering a number of questions and caveats. In this response, we provide responses to the points made and offer further insights into the practicalities of the Fair Horizons model.

The MARSIPAN (MAnagement of Really SIck Patients with Anorexia Nervosa) project was established in response to reports of patients admitted to medical wards and proving refractory to treatment, sometimes dying on the ward. Psychiatrists, physicians and other clinicians in nutrition and eating disorders were brought together to discuss key issues in the assessment and management of such patients. The resulting guidance report, which applies to adult patients over 18, addresses: assessment of risk, where to treat the patient, specialist support for medical teams, key elements of treatment, namely (a) safe refeeding to avoid refeeding syndrome and underfeeding syndrome, (b) management of problematic behaviours, (c) support for the family, and (d) transfer to a specialist eating disorder unit when appropriate and possible.

With an ageing population and expected rise in cases of dementia, driving safety will become increasingly important. Doctors have a professional obligation to identify patients who are unsafe to drive and in cases of dementia this decision is often complex. As a result, many centres in the UK offer driving assessments for people with medical conditions that may affect their on-road performance. I aim to identify a valuable learning opportunity for psychiatrists in training, particularly those working with older adults, to improve their knowledge of driving assessment. I also provide an overview of the Scottish Driving Assessment Service and reflect on my visit there.