Demands on our mental health services are growing as financial pressures increase. In addition, there are regular changes to service design and commissioning. The current political mantra is ‘more and more, of better quality, for less and less, please’. We suggest that mental health services need to actively respond to these constraints and that clinical transformation is needed to move towards a more sustainable system of healthcare. Emphasis on prevention, patient empowerment and leaner, greener services is required alongside more extensive use of technologies. Focusing on these areas will make mental health services more responsive to the challenges we face and serve to future-proof psychiatry in the UK. Services need to be delivered to provide maximum benefit to the health of our patients, but also to our society and the environment.

This paper reports on a survey of newly appointed consultants in old age psychiatry. The Questionnaire asked for opinions on the adequacy of higher training in a number of areas such as clinical, management, teaching, supervision and research. In addition views were sought on particularly valuable experiences in preparation for consultancy. The results show that overall clinical training was judged to be good, while training in some non-clinical areas, especially management, was found to be insufficient. The importance of management training Is emphasised and some valuable training experiences are highlighted.

Diseases of the brain are generally classified as either neurological or psychiatric. However, these two groups of illnesses cannot be readily separated on the basis of pathophysiology or symptomatology. It is difficult to rationally explain to someone with no prior frame of reference why we have the split between neurological and psychiatric illness. This demonstrates that the division is untenable, which has implications for training in both psychiatry and neurology.

Following the 1983 Mental Health Act, Mental Health Review Tribunals (MHRT) now provide the opportunity for patients to have their detention reviewed and give a right of appeal against compulsory hospital detention or guardianship (Bluglass, 1983).

Standard approaches to the prevention of suicide have concentrated on the rigorous assessment and management of suicidal risk. Using deliberate self-harm as a specific example, we discuss the relative merits of this ‘high-risk’ strategy and compare it with a population-based preventive strategy. We conclude that a combined approach offers the best hope for reducing the rate of suicide, although it may not fit easily with medical models of care.

The Highland Users Group (HUG) is a collective advocacy group run through 13 branches spread throughout the Scottish Highlands. It has over 360 members and has two tasks: (a) to speak out about the lives of its members in order to press for changes to improve their lives and (b) to raise awareness of mental ill health in an attempt to challenge the stigma and discrimination that users face. Our work has been recognised as being of a consistently high quality, both locally and nationally within Scotland.

Effective participation in the work of Mental Health Review Tribunals (hereafter the “Tribunal(s)”) held under the Mental Health Act 1983 (MHA) requires a knowledge and understanding of detailed points of law, and practice. This summary and commentary may be of assistance to new or infrequent participants.

This paper examines the characteristics of a foundation year 2 post in psychiatry from the Leicestershire, Northamptonshire and Rutland foundation programme, where all three of the trainees who occupied the post in its first year were successfully appointed to specialty training posts in psychiatry. We discuss the potential strengths of foundation posts in psychiatry as a possible recruitment aid into specialty training in psychiatry in the UK.

Little advice is offered in the literature for the novice report writer, despite the gravity of the situation, for example, a patient appealing against detention. Section 20, which renews the authority for detention after periods of 6 months or a year, is a useful reminder for clinicians, as it outlines the components that must be present in order for detention to continue.

This audit established guidelines for the completion of reports for Mental Health Review Tribunals and Managers' Reviews. A structure and list of ‘features to be included’ was compiled. This was used to rate the standard of reports prepared in the Warneford Hospital between 1991–1993. Following peer consultation within the hospital, the guidelines were considered acceptable and useful. At re-audit after 8 months the standard of reports had improved in most respects.

Radical changes are taking place in scientific publishing, driven by mandates from major research funders both in the UK and elsewhere. The publishing landscape is changing, and open access is increasingly being seen as a viable alternative to subscription-based business models. Although many issues are yet unresolved, even the large commercial publishers are developing stables of open access journals. To reach a wider audience, and to increase appeal to potential contributors deciding where to publish, the Bulletin has now become an open access journal with effect from this issue.

The Clinical Practice Guidelines (CPG) Steering Group commissioned a survey to find out which areas of clinical practice the mental health community view as priority for the development of clinical practice guidelines (CPGs). Fifty per cent of all professionals and service users surveyed considered the assessment of risk and management of deliberate self-harm and dangerousness' a priority area for guideline development. These findings provided the basis for a successful bid to the Department of Health for the development of The Royal College of Psychiatrists' first CPG.

Optimism is generally accepted by psychiatrists, psychologists and other caring professionals as a feature of mental health. Interventions typically rely on cognitive–behavioural tools to encourage individuals to ‘stop negative thought cycles’ and to ‘challenge unhelpful thoughts’. However, evidence suggests that most individuals have persistent biases of optimism and that excessive optimism is not conducive to mental health. How helpful is it to facilitate optimism in individuals who are likely to exhibit biases of optimism already? By locating the cause of distress at the individual level and ‘unhelpful’ cognitions, does this minimise wider systemic social and economic influences on mental health?