“No artist attains total excellence, but the strength of truth and justice is that it lasts and that man can say… this is the heritage of my father.”

Several studies in the United Kingdom have highlighted the lack of knowledge that patients show about electroconvulsive therapy (ECT), both before treatment starts (Malcolm, 1989) and after it is completed (Freeman & Kendell, 1980; Hughes et al, 1981), with only 10 to 15% of patients having a full understanding of the treatment. In an American study (Baxter et al, 1986) patients seemed slightly better informed; this might be because they were given written information. However, subjects who watched a videotape of someone having the treatment did not score higher on a knowledge questionnaire than a control group and the authors postulated a ‘ceiling effect’. Bird (1979) demonstrated that access to media coverage about ECT improved patients' knowledge without increasing anxiety about the treatment.

In the next few months the London Region is expected to publish its strategy for learning disability services in the capital. This will inform the National Service Framework due in the autumn. At the same time, many trusts and health authorities are at various stages of reorganisation and reconfiguration. With the dawning of primary care trusts, single speciality mental health trusts and joint commissioning between health and social services, the debate over where learning disability services are best placed and their interface with mental health services has re-emerged (Barron et al, 2000).

A recent paper by Lewis (1991) found authorship of a publication to be the only variable that significantly predicted whether applicants for a senior registrar (SR) rotation in psychiatry at a London teaching hospital were shortlisted. We have re-examined curriculum vitae (CV) predictors of shortlisting at SR level within a comparable London teaching hospital rotation (University College and Middlesex Medical School, UCMSM), and extended the study to examine applicants for the corresponding SHO/registrar (REG) rotation. We have also compared the two groups in terms of demographic data and academic achievements. Our intention was to replicate Lewis' findings, and to examine in more detail the possible predictive effects of academic achievement and ethnicity.

Telepsychiatry is the delivery of healthcare and the exchange of healthcare information for purposes of providing psychiatric services across distances (Yellowlees et al, 2003). In practice, this most often means an interaction between a patient and clinician who are in different sites, through the use of transmitted live sound and video images. The term telepsychiatry was first used by Dwyer in 1973 who described the use of closed-circuit television at Massachusetts General Hospital for consultations between psychiatrists and patients. However, telemedicine was pioneered at the Nebraska Psychiatric Institute nearly 20 years earlier (Wittson & Dutton, 1956).

The Royal College of Psychiatrists in association with the Royal College of General Practitioners and other relevant organisations launched the Defeat Depression campaign in January 1992. The objectives of the campaign are to reduce the stigma associated with depression, to assist general practitioners and other health care professionals in the recognition and treatment of depressive illness, and to increase public awareness of the extent and treatability of depression.

There has been a rush towards community psychiatry in the developed world in the past few decades (Tyrer, 1998a). In developing countries the concept has been equally popular and various programmes have been described (Burns, 1998; Goldberg, 1992; Issac, 1996). The term ‘community psychiatry’ originates from a peculiar historical background, is based on certain principles and is shaped by the existing pattern of mental health services in many Western countries. Although the term is vague, its application is especially problematic in developing countries. In this article an attempt will be made to highlight the origins of the term community psychiatry and its application in developing countries.

All higher trainees in psychiatry are required to spend one day a week in research or further study. A cross-sectional postal survey was used to investigate how senior registrars use their allocated research time, and to identify specific difficulties that prevent successful research being carried out. The instigation of the specialist registrar grade offers the chance to improve trainees' involvement in research. This has implications for the design and implementation of postgraduate teaching on research in psychiatry.

The Glasgow Media Group, through a combination of media watching and group interviews, has confirmed the importance of media representations of mental illness, with its finding that negative images can outweigh even an individual's direct experiences in this area (Philo, 1996). In one recent summary, Philo concludes: “the results show clearly that ill-informed beliefs on, for example, the association of schizophrenia with violence can be traced directly to media accounts” (Philo, 1997). The origins and strength of this association can be traced to cinema, where powerful images of violent ‘insanity’ endure today. In a questionnaire of 487 people who had a family member with severe mental illness, 85.6% identified “popular movies about mentally ill killers” as the largest single contributor to the stigma of that illness (Wahl & Harman, 1989).

Only a minority suffering from mental illness are treated by the specialist psychiatric service. The majority of psychiatrically ill patients seen in general practice suffer from minor neuroses, personality disorders and situational reactions and can be appropriately treated by the primary care team. However, a significant degree of morbidity, some of it severe, fails to be identified in general practice and the identification and treatment of psychiatric disorder varies according to the GP's interest and attitudes.

When I was appointed to my consultant post nearly 10 years ago I was one of several able candidates. This was the culmination of many years' hard work and I was proud to be working at an inner-city teaching hospital, one where I had trained as a medical student. This was probably the last time that my department was fully staffed, with each year since bringing more challenges. In recent years only one of the specialist registrars I have trained has continued with general psychiatry, with the attractions of old age, liaison and forensic psychiatry seemingly unassailable. My confidence finally reached rock bottom when a senior house officer announced that she no longer wished to continue in psychiatry because the role models we (consultants) set were unattractive. Apparently the image we project is of long hours, unlimited demands, endless risks and little time to practise the art of psychiatry. With the anniversary of my appointment approaching now it seems appropriate to consider why my hard fought for job has all the attractions of the plague.

Eating disorders have the highest mortality rate of any psychiatric condition. Since the COVID-19 pandemic, the number of patients who have required medical stabilisation on paediatric wards has increased significantly. Likewise, the number of patients who have required medical stabilisation against their will as a lifesaving intervention has increased. This paper highlights a fictional case study aiming to explore the legal, ethical and practical considerations a trainee should be aware of. By the end of this article, readers will be more aware of this complex issue and how it might be managed, as well as the impact it can have on the patient, their family and ward staff.

The Mental Health Act (1983) came into being eight years ago but few studies into its use have been reported (West, 1987; Sackett, 1987). The Act provided for the setting up of the Mental Health Act Commission to safeguard the interests of detained patients and to monitor the use of the Act. The Commission visits ordinary psychiatric hospitals on an annual basis and writes a report of the visit. The Commission also submits a Biennial Report to Parliament. These reports address important issues but do not provide detailed information on the use of the various sections of the Act in differing hospitals.

Despite the increasingly widespread use of video consultations, there are very few documented descriptions of how to set up and implement video consultations in real-time practice. This step-by-step guide will describe the set-up process based on the authors’ experience of two real-time National Health Service (NHS) examples: a single health board use (delivered in normal time), and an All-Wales National Video Consultation Service roll-out (delivered during an emergency pandemic as part of the COVID-19 response). This paper provides a simple visual step-by-step guide for using telepsychiatry via the remote use of video consultations in mental health services, and outlines the mandatory steps to achieving a safe, successful and sustainable use of video consultations in the NHS by ensuring that video consultations fit into existing and new NHS workflow systems and adhere to legal and ethical guidelines.