Across the UK there are a number of tertiary level affective disorder services, usually based in academic centres, that provide support for the management of patients with complex and treatment-resistant conditions. Such services play a potentially important role in instilling hope into patients, carers and healthcare teams in situations where therapeutic nihilism has often developed. They also provide a valuable reservoir of expertise on the use of medications outside of licensed usage, and new and emerging treatments. To date there is relatively little data regarding patient outcomes after referral to such services; however, what there is does suggest important benefits for both patients and healthcare economies. As ever, more research is needed.

E-learning is an expanding field in which many psychiatrists are active through teaching, training and pursuing their continuing professional development. Much of the benefits of e-learning are due to the implementation of educational principles rather than the medium itself. the College has invested in its own e-learning website as a service for members. However, it should not entirely replace face-to-face lectures, tutoring and mentorship.

The effective psychiatric leader in clinical administration must possess organisational knowledge, financial acumen, negotiation and conflict resolution skills, and a broad knowledge of our field. Team building, motivating others, mentorship, and the ability to hire excellent colleagues are all important attributes of leadership. It is opportune for our profession to promote training and skill acquisition in leadership development.

Public mental health messages have stressed divisions between people who are experiencing mental health problems and those who are not, for example by using slogans suggesting ‘one in four’ individuals have mental disorder. Simple unambiguous messages that convey that ‘we all get stressed, we just react differently’ may be more inclusive and effective at destigmatising mental health problems. This is analogous to the attitude towards physical health problems which are accepted as affecting everyone. Such a theme is scientifically sustainable.

Recent years have seen increased pressures on psychiatrists to work closely with user/survivor and carer groups. We argue that although many groups are happy for this to remain at the level of consultation, there are growing demands from more radical elements of the user/survivor movement for moves towards a more collaborative framework. A number of these groups challenge some of the central assumptions of psychiatry. for productive engagement and collaboration to take place, psychiatry will have to be able to react positively, not defensively, to these challenges. We suggest that this raises questions about how we should think about the nature of science, truth and expertise.

Psychiatric pharmacogenomics is a relatively young field of clinical practice, focused on the identification of genetic profiles determining varieties of metabolic patterns that, in turn, assist in the choice of appropriate medications and their corresponding doses. In psychiatry, the mood disorders area has been the most active in trying to advance knowledge and expertise in pharmacogenomics. the cytochrome P450 system (particularly 2D6 and 2C19 enzymes and their respective codifying genes) and, more recently, serotonin transporter and receptor gene tests are among the most utilised and promising. In spite of encouraging findings, however, there are still many questions related to preciseness, scope, ethnic variations, diagnostic implications, ‘non-biological’ factors, and ethic considerations. the need of algorithms, follow-up studies, and assessment of financial impact, all listed here, require continuous and systematic research. It will not only add to the excitement of pharmacogenomics, but also to the creation of cogent evidence of its benefits.

Therapists differ in their effectiveness in the delivery of psychological therapy. Can trainees who are exposed to similar training in psychological therapy achieve the same standard of competence regardless of professional background? This is a timely question given the planned expansion of psychological therapists to treat common mental disorders in England and Wales and the Scottish initiative to increase access to psychological therapies.

A review of the presentation and the issues surrounding the management of developmental disorders which, while always part of the remit of child psychiatry and learning disability psychiatry, are relatively new to adult psychiatry.

It is possible to tackle exclusion by altering the nature of transactions between individuals and groups, including mental health services. One way to do this is to cultivate ‘social capital’ or interdependence between individuals and groups – as well as giving, each is entitled, but not compelled, to claim something in return. It is difficult, if not impossible, to sustain stigma and social exclusion when people are meeting mutual needs, building trust and helping each other. Mental health providers can foster social capital by creating community cohesion, namely interdependent relationships between individuals and organisations. This approach has been put into practice in the USA, where providers assert that small investments in building social capital return many times the cost. In the UK there is evidence that community development can make a contribution to mental health but it does not fit well with conventional approaches to mental health services – it calls for different skills and a vision that is collective rather than individualised.

The recently published Count Me In 2007 census specifically reported age-standardised admission rates for individuals aged over 65 years from different Black and minority ethnic groups. the standardised admission ratio was higher in the White Irish, other White, White and Black Caribbean, other Asian, Black Caribbean, Black African and other Black ethnic groups; and lower in the White British and Chinese ethnic groups. As this census was undertaken on a single day for all psychiatric in-patients, it measured bed occupancy rather than admission rates and so it was actually referring to standardised bed occupancy ratios. Bed occupancy is a function of admission rates and length of stay. This editorial critically explores factors (including those related to institutional racism) that may affect both admission rates and length of stay, and ultimately bed occupancy, of Black and minority ethnic elders.

The Royal Colleges and other professional bodies could use their clinical expertise, authority and influence with clinicians to improve the quality of regulation of healthcare services. At present, their contribution to regulation in England is ad hoc and informal. Better engagement could increase the impact that professional bodies have on patient care and create a new role for them as arbiters of quality in the organisation and delivery of care. the requirement for healthcare provider organisations to register with the Care Quality Commission from April 2010 and the National Health Service Next Stage Review have created an opportunity for closer collaboration. However, there are problems that must be overcome. These include the ownership of information about the quality of care and the uses to which this is put. It would be self-defeating if closer working with the regulator undermined the trust that clinicians have in quality improvement work led by the professional bodies.

Ireland's Mental Health Act 2001 was fully implemented in 2006 and aimed to bring Irish legislation more in line with international standards such as the European Convention on Human Rights and United Nations Principles for the Protection fo Persons with Mental Illness. the new legislation introduced several important reforms in relation to involuntary admission, independent reviews of involuntary detention, consent to treatment, and treatment of children and adolescents. Although the Mental Health Act 2001 focuses clearly on protecting the right to liberty, it also presents significant challenges in terms of service delivery and resources within Irish mental health services.

Human beings have evolved the capacity to classify everything they perceive and our urge to categorise psychological phenomena is little different. Categories make life easier to manage. However, nature rarely comes wrapped in discrete packages, and as David Kingdon persuasively argues in his editorial, we might do well to avoid the catch-all term ‘mental disorder’ in our public health messages.