Anxiety disorders in pre-adolescence are probably the most common serious disorder of childhood, affecting around 1 in 30 British children. These conditions are chronic, distressing and impairing, and are treatable, but we are currently doing a poor job of serving these children.

The identification of a reliable and valid severity index for borderline personality disorder has vexed researchers for decades. A simple, clinically intuitive severity index for borderline personality disorder with predictive validity has now been identified. This index could usefully guide treatment planning, but other contextual factors should also determine the need for specialist treatment.

Evaluation of decision-making capacity (DMC) for treatment is challenging. Owen et al, in this issue of the Journal, compare the abilities (understanding, appreciation and reasoning) relevant to DMC in medical and psychiatric patients. Here I discuss three key issues their article raises and that are relevant to the direction of future research.

Research with child soldiers is crucial to improving mental health services after war. This research also can illuminate innovative approaches to treating post-traumatic stress disorder (PTSD) among adult soldiers, veterans and other trauma survivors in high-income countries. A key contribution is the role of social ecology for trauma-healing interventions.

Collaborative care is a well-studied and effective model of integrating behavioural healthcare into primary care medical settings. Despite evidence of its effectiveness, it has been difficult to implement into the US healthcare system. The upcoming reorganisation of US healthcare will rely heavily on adaptations of this model to improve its uptake and cost-effectiveness.

Once again he has to stand guard and watch,

His heart sinks as the crimson torch

Of a glorious sunset,

Heralds the falling night, and the dreaded hours in bed.

Sarró et al report grey matter deficits associated with tardive dyskinesia in schizophrenia. Much evidence suggests that the intrinsic pathophysiology of schizophrenia contributes to predisposition to tardive dyskinesia. The possibility that antipsychotics might play a causal role in the grey matter deficits cannot be excluded, but the evidence is tenuous.

Although anxiety disorders are common in later life, only a minority of patients receive appropriate treatment. The scarcity of clinical trials and decreasing effectiveness of current treatment modalities with advancing age, as shown by Wetherell and colleagues in this issue, argue for more clinical trials and development of age-specific psychotherapeutic techniques.

Service user contributions to mental health conferences are now routine. How effective they are at promoting dialogue is not clear. We report a difficult exchange following a presentation about coercive treatment, with our individual reflections on what we learnt.

Suggestions are made to improve both the clinical practice and the dialogue.

Community treatment orders (CTOs) have been widely introduced to address the problems faced by ‘revolving door’ patients. A number of case–control studies have been conducted but show conflicting results concerning the effectiveness of CTOs. The Oxford Community Treatment Order Evaluation Trial (OCTET) is the third randomised controlled trial (RCT) to show that CTOs do not reduce rates of readmission over 12 months, despite restricting patients' autonomy. This evidence gives pause for thought about current CTO practice. Further high-quality RCTs may settle the contentious debate about effectiveness.