Professor Burns ^{Reference Burns1} is right to draw attention to possible damaging effects of separating consultant responsibility for in-patient and out-patient care. My past experience of both overall and out-patient-only responsibility supports the points he makes. Particularly striking was distress for patients at having to get to know a new consultant and go back over long-term histories at the particularly fraught time of admission, as well as intractable problems of communication between consultants, and misunderstanding of the different impacts of symptoms and behaviour in the hospital and home settings.

Most fundamentally, a return to the earlier psychiatric pessimism about long-term illnesses is likely on the part of hospital consultants who deal only with those who relapse.