The report was written by a working party of the Royal College of Psychiatrists to describe the roles and responsibilities of general adult consultant psychiatrists in the planning and provision of mental health services for adults with severe mental illness.

In this report the range of roles and responsibilities of general adult consultant psychiatrists is described in terms of two concepts: ‘arenas’ and ‘wedges’. The arenas are the fields of operation that need to be covered between any group of consultants in a trust. While some core skills are essential for all consultants, others are important to be undertaken by at least one consultant within the local trust. This leads to the idea of a wedge, which shows the range of competences that can be applied within these arenas.

In this perspective, general adult consultant psychiatrists can see the range of their possible roles and responsibilities in terms of a number of so called arenas and wedges.

The arenas cover consultant level responsibilities; individual level responsibilities; family and carers; clinical teams; employing organisations; local arenas; and national/regional arenas.

The wedges apply to clinical treatment; clinical management; education and training; operational management; research, audit, evidence-based medicine and clinical governance; joint working; and leadership.

The report sets out under each of these headings the core skills to be expected of general adult consultant psychiatrists and the desirable skills with which they may enhance their clinical effectiveness.

The report concludes that consultant psychiatrists can be actively engaged across the range of arenas, from treating individual service users through to influencing regional and national policies. They can exercise their knowledge and skills in direct therapeutic work, or more indirect managerial or research capacities. It is this range of choice that can provide the consultant with a rich range of options to combine into a stimulating post at any one time, and into an evolving and satisfying career over the years. It is also this multiplicity of working roles and responsibilities that can combine into an unrealistic and unsustainable burden for individual practitioners. This document aims to clarify the range of these roles, to distinguish those that are required from those that are optional, and to support consultant psychiatrists to offer their best possible service to people with severe mental health problems.