Mental health problems contribute 23% to the global burden of disease in developed countries (WHO, 1999). In the U.K., recent legislation attempts to address this by modernizing mental health services so that they provide evidence based, accessible and non-discriminatory services for both serious and common mental health problems. Cognitive behaviour therapy (CBT) has a robust evidence base that fits very well with the thrust of policy. However, CBT's delivery systems are rooted in traditional service models, which pay little attention to the growing evidence base for brief and single-strand treatments over complex or multi-strand interventions. Services characterized by 9-5 working, hourly appointments and face-to-face therapy disenfranchise the majority of people who would benefit from CBT. In this paper we argue that the evidence exists for service protocols that promote equity, accessibility and choice and that CBT services should be organized around multiple levels of entry and service delivery rather than the more usual secondary care referral systems.

Caffeine remains the most widely used psychoactive drug and psychiatric populations tend to ingest more caffeine than the general community. It is important to assess caffeine intake in psychiatric patients as it may distort diagnostic signs and is known to interact with psychotropic medications. A blanket condemnation of caffeine use by psychiatric patients is, however, unwarrranted for while it may exacerbate some conditions (eg. anxiety disorders) it may prove beneficial to others (eg. schizophrenics) when used in moderate quantities. A scale for the estimation of caffeine intake is provided.