Given my interest in liaison psychiatry, I could feel the passion in Sharpe’s ^{Reference Sharpe1} piece, which he has extended to include the proposed future of psychiatry as a discipline. However, even though he has mentioned patient safety in passing, I would like to urge a wider debate on the fact repeatedly highlighted by several publications of the National Confidential Enquiry into Suicide and Homicide by People with Mental illness. In its last publication, it again highlighted that 72% of those who die by suicide (between 2001 and 2011), had no contact with mental health services in the year before their death. Given the massive variation in funding of mental health services across the country and some viewing it as a Cinderella service, I feel mental health providers and advocates have failed to grasp the nettle in terms of attempting to reach out to that group of individuals who ‘successfully’ take their own life. We are aware that a majority of those individuals could be diagnosed within F43.0 (Reaction to severe stress, and adjustment disorders) of the ICD-10. ³ Yet we fail to invest in services and concentrate efforts on a narrow remit to severe mental illness. With the 2007 amended Mental Health Act 1983 in England and Wales, we have successfully replaced the erstwhile four categories with a single category of mental disorder. Along with it, we have replaced ‘treatability’ and ‘care’ tests with appropriate treatment tests. Yet we do not seem to adequately invest and respond to the above-mentioned category, costing potentially a lot more to the community than accepted under the mental illness umbrella.

I raise this issue again with the hope of extending our roles not only to the ‘Holy Grail’ of reducing costs and improving outcomes, as the editorial focuses, but also to the wider losses our community and society suffer but are unable to react to. On another note, the editorial mentions the RAID model (Rapid Assessment Interface and Discharge). This along with the latest iteration of the National Institute for Health and Care Excellence guidance on schizophrenia, ⁴ which refocuses attention on combined physical and mental healthcare and the mandate around parity with physical and mental healthcare just debated in the English Parliament, ⁵ gives us hope for the future. Psychiatrists are unique in addressing the boundary disputes between specialties and offer value for money even in this economy.