There is no need for professional concern about psychiatrists being largely neuropsychiatrists. The family factors, psychodynamic and sociological factors will still be acknowledged by the neuropsychiatrist but treatment of persons where these factors are relevant will be by non-medical professionals, psychotherapists, psychologists and social workers at a much lower financial cost. The neuropsychiatrist will still be team leader and have overall clinical responsibility.

Dr Black makes an interesting point. I may not have been clear enough in my original letter. I believe all consultant adult and child psychiatrists should be trained to about masters level in psychotherapy for the purpose of supervising junior staff in training. The actual face-to-face individual psychotherapy would be done by junior staff and non-medical staff.

Dr Timms mentions the psychiatrist’s role in the ‘interactive process of building trust and establishing a clear dialogue’ with patients. I would have thought this was part of the role of all doctors, including all mental health professionals. Dr Khan writes about the Department of Health’s view of the ‘need for support from consultant psychiatrists in psychotherapy’. There is no doubt that psychotherapists with difficult patients need the support and second opinion of their consultant psychiatrist colleagues, especially with those patients who are not making progress because of missed diagnoses or not being on appropriate medication.