It is impossible to avoid the plethora of clinical practice guidelines and other forms of practice policy and protocols that have been showered on psychiatrists and other mental health clinicians over the last decade. Several motivations lie behind this phenomenon – reducing the amount of unnecessary variation in clinical practice, improving clinician's access to research evidence and summarising available evidence to assist individual patient and clinician decision-making. With the arrival of the National Service Framework for Mental Health, it is timely to take stock of the evidence requirements for developing valid clinical standards.

Substance use has reached endemic proportions. Inevitably, the world of psychiatric wards must reflect issues arising in our society. Given that the populations of psychiatric wards are disproportionately younger, male and socially disadvantaged (quite apart from the impact of patients' problems that prompt admission), one might expect that drug misuse in them would match, if not outstrip, the general trend. Recognition of its impact is a key issue for patients and staff alike.

Deaths of patients under psychiatric care, especially if they are in-patients, have been the subject of a number of retrospective studies (Copas & Robin, 1982; Morgan & Priest, 1991; Modestin et al, 1992; Roy & Draper, 1995; Proulx et al, 1997). They have also been a particular focus of the National Confidential Inquiry (Appleby et al, 1999) as well as many individual inquiries. In contrast, little has been published on how individual psychiatric departments and trusts might best review and learn from local deaths or ‘near misses' of patients under their care. In particular, there is no well publicised or widely accepted model for routinely examining such occurrences.

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).

Cognitive-analytical therapy (CAT) is a time-limited, integrated psychotherapy and its features have been extensively described (Ryle, 1990, 1995). It emerged as a formal psychotherapy method in 1990 and was developed with the aim of providing psychotherapy within the NHS. As the name suggests, the model integrates a wide range of theory and practice (psychoanalytical, cognitive and behavioural) yet retains a distinct method. This paper describes potential applications of CAT to general psychiatric practice and discusses the value of formal training for psychiatrists.

Patients with psychotic disorders are often assumed to be sub-fertile, and when patients do have children, any child care concerns are usually passed on to social services. The children of patients with psychotic disorders may not, therefore, be of major concern to the responsible medical officer, and community mental health services have not been developed with families in mind. Routine statistics on psychiatric patient episodes do not include information on patients' children – a question covering this issue was included in the pilot draft of the Mental Health Minimum Data Set (approved for England by the Department of Health in September 1999), but was dropped because clinical professionals were reluctant to record this information, as they did not consider it relevant in this context (personal communication, G. Glover, 2000).

There is an unprecedented level of interest among the general public, the media and politicians in the quality of treatment and care provided by the NHS. Traditional methods for upholding the quality of medical practice, through professional self-regulation, are under attack. The General Medical Council (GMC) has responded by voting to introduce a process of revalidation for medical practitioners. If this is not seen to succeed, the Government could take this responsibility away from the GMC, and the Medical Colleges and Faculties.