This is a brief exploration of the ethical issues raised for psychiatrists, and for universities, schools and wider society, by the demand that they attend mandatory training as part of the UK government's Prevent counter-terrorism strategy. The silence on this matter to date on the part of the General Medical Council, medical Royal Colleges, and the British Medical Association is a failure of ethical leadership. There is also a civil liberties issue, reminiscent of the McCarthyism of 1950s USA. We should refuse to attend.

Suicide has consistently been the most common cause of premature death in schizophrenia. A large 5-year World Health Organization study consisting of the follow-up of 1056 patients exhibiting psychotic symptoms found the most common cause of death in those with schizophrenia was suicide (Sartorius et al, 1986). In their review of the subject Caldwell and Gottesman (1990) found that 9–13% of patients with schizophrenia eventually commit suicide. At least 20–40% make suicide attempts (Meltzer & Fatemi, 1995) and 1–2% go on to complete in their attempt within the next 12 months (Meltzer & Okayli 1995). Therefore, suicide in schizophrenia has long been a major area of concern and research efforts.

Health policy guidelines state that people who use mental health services should be involved in the development of the services they receive (Department of Health, 1999). Examples of good practice in this respect are reported from staff recruitment (Diamond et al, 2003), research (Trivedi & Wykes, 2002) and training (Repper, 2000; Harper, 2003). However, support for user involvement is not universal (Summers, 2003; Soffe, 2004) and, most significantly, there is considerable confusion about what is meant by involvement. The following case study will address these issues by: (a) adding to the evidence regarding the successful involvement of service users in training; and (b) clarifying the process by which involvement can be safely achieved.

The development of psychiatric care in Ghana since the colonial era in the 19th century, up to the present, is described. Distorted planning and limited accessibility to psychiatric services in many parts of the country, coupled with shortage of trained staff of all grades (including psychiatrists and nurses) plus inadequate funding, have adversely affected the establishment of a fully comprehensive psychiatric service. Suggestions for improving services into the 21st century are briefly discussed.

Morale among psychiatrists continues to be seriously challenged in the face of recruitment difficulties, unfilled posts, diagnostic controversies, service reconfigurations and public criticism of psychiatric care, in addition to other difficulties. In this article, we argue that the positivist paradigm that continues to dominate British psychiatry has led to an undervaluing of subjectivity and of the role of emotions within psychiatric training and practice. Reintegrating the subjective perspective and promoting emotional awareness and reflection may go some way towards restoring faith in the psychiatric specialty.

Until recently the provision of health care within prisons was the sole responsibility of the prison service. The Prison Health Service (formerly known as the Prison Medical Service) is the oldest civilian medical service in Britain. In addition to being much older than the NHS the Prison Health Service is much smaller, less well developed and less well resourced. Prison health care was coordinated by the Directorate of Health Care at the Home Office; the Department of Health and the NHS had no direct input. As a result, prisoners were afforded a standard of health care well below that provided by the NHS, and without radical reform there was little prospect of improvement. However, in recent years things have begun to change and last year collaboration between the prison service and the NHS resulted in the creation of a partnership between these two organisations (Joint Prison Service and NHS Executive Working Group, 1999). Although the intention is to improve health care standards for prisoners, the formal nature of this partnership also has the effect of making the NHS more directly responsible for health care in prisons.

During March 1998 we had the privilege of visiting the mental health services in Kumasi, Ghana at the invitation of Dr Yaw Osei, Senior Lecturer at the Department of Behavioural Sciences, School of Medical Sciences, University of Science and Technology.

Lithium is an established treatment for bipolar disorder and an augmenting agent for treatment-resistant depression. Despite awareness of renal adverse effects, including chronic kidney disease, for the past five decades, there has been a lack of research evidence. This has led to debates around the existence and magnitude of the risk. This article discusses the current evidence base regarding the link between lithium and chronic kidney disease, monitoring of renal functions and its clinical implications.

Shared decision-making is a collaborative process in which clinicians and patients make treatment decisions together. Although it is considered essential to patient-centred care, the adoption of shared decision-making into routine clinical practice has been slow, and there is a need to increase implementation. This paper describes the development and delivery of a training intervention to promote shared decision-making in medication management in mental health as part of the Shared Involvement in Medication Management Education (ShIMME) project. Three stakeholder groups (service users, care coordinators and psychiatrists) received training in shared decision-making, and their feedback was evaluated. The programme was mostly well received, with all groups rating interaction with peers as the best aspect of the training. This small-scale pilot shows that it is feasible to deliver training in shared decision-making to several key stakeholders. Larger studies will be required to assess the effectiveness of such training.

Mental Health Review Tribunals (MHRTs) are intended to protect the liberty of the detained patient. In practice, however, they have been said to fall short of providing this safeguard. This is frequently for administrative reasons. We report a systematic examination of the pattern of delays in holding MHRTs. Our main finding is that delay cannot be attributed to a single factor but rather reflects the inherent complexity of some cases.

Six yean ago, Edinburgh's community drug problem service established a model of shared care between drug specialists and general practitioners who were encouraged to prescribe oral methadone and other drug substitutes in an attempt to reduce drug injecting and the spread of HIV in a city with a high seroprevalence rate. Of Edinburgh's GPs, 70% now prescribe for around 1200 drug users who have altered their pattern of drug taking, with a marked shift away from injecting drug use, and towards oral pharmaceutical drugs. HIV rates among new referrals to the service have fallen from 21% to 8%.

The National Service Framework for Mental Health (NSF–MH) is a strategic blueprint for services for adults of working age for the next 10 years. It is both mandatory, in being a clear statement of what services must seek to achieve in relation to the given standards and performance indicators, and permissive, in that it allows considerable local flexibility to customise the services which need to be provided to fit the framework. This paper summarises the process by which the NSF was created, and its content, which became clear when it was published on 30 September 1999 (Department of Health, 1999).

Recent papers regarding failure to keep appointments at child psychiatry clinics (Plunkett, 1984; Gould et al, 1985; Cottrell et al, 1988) suggest from 15% to 50% failing to keep their first appointments. Benson, Novick & Rembar (1981) calculated an attrition rate of 85.4%, obtained by considering cases of non-agreed termination of treatment at any stage of the referral/treatment-uptake process.

“One fine day, after he had joined a fighter squadron, it would dawn on the young pilot exactly how the losers in the great fraternal competition were now being left behind.” (Tom Wolfe)