A prominent radio news programme reported on escapes from secure psychiatric units in the UK and linked that with subsequent offending by psychiatric patients. The report cited did not distinguish between escapes and absconding but, it is argued here, these are very different activities. The acceptable rate both for escapes and absconding from secure psychiatric units is not defined. A certain level of absconding is a consequence of the therapeutic use of leave, which, as part of rehabilitation, is likely to be linked with a reduced reoffending rate post-discharge.

This paper describes the characteristics of referrals to a new direct access child mental health service for young people in the care of the local authority, during the first six months (n=32). Consistent problems emerged within four areas: their histories within the care service (n=18, 56% had had at least one more previous placement); their individual experiences of abuse (n=23, 72%) and the lack of mental health support provided to redress this; their overall poor educational status; and the psychopathology evident at the time of referral (n=29, 91% had ICD–10 diagnoses, mainly mixed depressive conduct disorders).

Under the Mental Health Act (1983) Mental Hospital Review Tribunals act as a safeguard against unwarranted detention of patients in psychiatric hospitals. Detention, other than in special hospitals, is most commonly under section 2 (assessment order) or section 3 (treatment order) of the 1983 Act. Patients thus detained have the right to appeal to a Review Tribunal, which has the power to order their discharge.

Early intervention in psychosis is a strategy for which there is increasing theoretical and pragmatic justification. Many studies have been published describing the benefits of early intervention as carried out by specialised and innovative projects. The present paper describes how a generic community mental health team (CMHT), covering a population of 50 000, introduced strategies for early intervention with no extra funding. The team worked together to change old attitudes and practices. A style of intervention was developed to engage with and keep in contact with people with recent onset psychosis. This appears to be achievable – and this model may be an alternative to the setting up of specialised teams.

Poverty is strongly associated with mental illness. Access to state benefits can be a lifeline for people with mental health problems in times of hardship and can assist them on their journey of recovery. However, benefit application processes can discriminate against those with mental illness and can result in individuals unjustly missing out on support. Clinical evidence from mental health professionals can ameliorate these challenges and ensure that people get access to financial help.

For a person with mental illness, travelling abroad can be challenging but it can be easier when the traveller and healthcare practitioner have a clear understanding of the likely impact of travel on the illness and of the illness on the travel experience. Travel may also precipitate first presentations of mental illness or unmask previously undiagnosed mental disorders. We propose that mental health problems should receive greater recognition in travel medicine and that psychiatrists should collaborate more closely with travel medicine clinicians to ensure that their patients benefit from the opportunities afforded by international travel.

Proposals for new mental health legislation make the case for using the ‘least restrictive alternative’ (Scottish Executive, 2001) and the ‘least restrictive environment’ (Department of Health & Home Office, 2000) as guiding principles in deciding the management and treatment of the patient. This appears to be the case made for introducing compulsory treatment in the community. The patient living in the community, while maintained on medication, rather than the hospital would appear to be defined as on the ‘least restrictive alternative’. This, however, takes only a limited approach to what is ‘restrictive’, which should be interpreted more widely, including the patient's view as well as that of clinicians and policy makers. Thus, a patient may see it as less restrictive during an acute phase to be in hospital and not on medication, than in the community but on medication. It is likely, given our knowledge of patients' attitudes to medication (Eastwood & Pugh, 1997), that many patients will prefer to be on oral medication rather than depot, which they see as less restrictive.

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.

We examine epidemiological evidence for the central role of inequalities (principally economic) in driving the onset of mental disorders, physical ill health and premature mortality. We locate the search for solutions in current UK contexts, and include known and likely effects of the COVID-19 pandemic. Prevention of mental disorders and adverse outcomes such as premature mortality must begin with efforts to mitigate rising poverty-inequality.

Across academic medicine, including psychiatry, women are underrepresented in senior positions. Various reasons have been put forward, for example the lack of high-ranking female role models or mentors and a reduced rate of career progression for women compared with men. Mentoring has been shown to be a popular and feasible intervention which can improve the success of those perceived as disadvantaged groups (in this case women) by having an important impact on personal development, career guidance and research productivity.