John Skelton's paper (2003, this issue) reminds us that literature can put into words thoughts and feelings which we might otherwise be unable to think or articulate. This is an important attribute and one which we can make use of in our attempts to help patients and families faced with life-threatening illness. It might also help those who have been bereaved to find meaning in what seems like a meaningless experience.

The pace of development and implementation of good information management systems has been disappointingly slow and the potential benefits of using patient information for secondary purposes have not been fully realised. The secondary use of patient data might be at the level of individual practitioners or teams, or at a local-service, regional or national level. Using patient data for purposes other than direct patient care requires an understanding of the principles of case-mix, standards for recording data, the limits of accuracy of data collected in routine practice and of the principles of data security and confidentiality. The alternatives to secondary use of information are to manage the mental health service without information about the people who use it or to gather this information through channels that run in parallel to the process of clinical care.

There are many potential pitfalls in the identification and enlistment of suitable candidates for psychiatric research. The challenges of recruitment are highlighted, detailing impact of study design, characteristics of participants, including demographics and personal preferences, investigator characteristics and collaboration with clinicians. Techniques used in recruitment are discussed, including financial incentives, assertive tracking and communication methods. Ethical issues, methods of data collection, and control participants are also considered. Key issues are: early consideration of the impact of study design on the recruitment process; the participant's perspective; close collaboration with colleagues; the investigator's good interpersonal, communication and organisational skills; and feedback to collaborators, associated clinicians and participants.