The escalating cost of medical care in most industrial countries has given impetus to several different strategies designed to impose limitations on cost and introduce efficiency into health care systems. In the United States of America, legislation was passed in 1983 to introduce a system of prospective payment for Medicare hospital expenditures. This change was a departure from the previous cost based reimbursement method and was based upon a categorisation of medical conditions into discrete groups termed diagnosis-related groups (DRGs). The intention of the American Congress in passing the legislation was to encourage hospitals to reduce cost without sacrificing quality of care.

Magon and colleagues highlight a number of relative strengths and weaknesses very reminiscent of those we have seen over the years in the development of similar services for children and adolescents. It is clear that we all have a lot of work to do to improve our approach to the transition from child to adult services. There was clear evidence that adult services can adapt to manage ADHD, but there is also a clear need for increased upskilling of clinicians in the practical management of medication and other treatments. I disagree with Magon and colleagues about the role of primary care and believe that treatment initiation and ongoing monitoring should, for the time being, remain in secondary care and that, because of the volume of work that will come our way, this will need to become a core rather than specialist task. As with other aspects of psychiatric care, there is a clear role for specialist nurses in delivering a significant proportion of the core care.

The Transforming Care national plan for England to develop community services and close hospital beds for people with intellectual disabilities and/or autism was published in October 2015 and is due to finish in March 2019. In this editorial the key plan objectives are evaluated, with particular reference to people with intellectual disabilities and/or autism who offend or are at risk of offending. The conclusion is that, to date, the plan has failed to meet its targets to reduce the number of in-patients with intellectual disabilities and/or autism and to invest in community services, and the number of patients in independent sector beds is increasing.

For almost 20 years planning for the mentally ill and mentally handicapped has focused on a shift of care from hospital to community, the advantages and difficulties of this process generating much discussion and interest. The hospital population of the mentally handicapped is currently at the forefront of this change, planning impetus now being propelled by alterations in funding with budgets being transferred from NHS to local and social services. One consequence is the closure, or planned closure, of large mental handicap hospitals situated at the periphery of urban centres, with residents being moved to small group homes and hostels within the towns and cities the hospitals once served. The change should prove beneficial for a majority of residents although the process continues to generate debate.

“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.”

The coils of operating a psychiatric intensive care unit (PICU) were recorded for a six-month period. There were 110 admissions and 99 discharges. Mean length of stay was 12.3 days. Total costs were £346,516 over the study period, £283.56 per patient-day. Fixed costs comprised 93% of the total, inducing nursing staff ($169,447), overheads ($77,017), medical staff ($48,819), hotel costs (£24,160) and miscellaneous (£1,750). Variable costs included special nursing, (£19,405), treatment of major self-harm (£3,024), drugs (£1,707) and staff time to manage aggressive incidents (£1,188). Reduction of the incidence of aggression could result in valuable cost savings.

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.

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.

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.

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.

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).

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.

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.