The evidence, which is summarised in this editorial, shows that the circumstances in which people are born, grow, live, work and age are powerful determinants of health and of the unfair distribution of health – health inequity. Discrimination against people with mental illness shows how the relation can go the other way: for example, when people with mental ill health cannot get back into work.

A number of pragmatic trials have cast doubt on the concept of ‘atypicality’ in relation to antipsychotic drugs, and some commentators have argued that the dichotomy between ‘typical’ (‘first-generation’) and ‘atypical’ ('second-generation’) compounds is artificial and should be abandoned, leaving the entire class of antipsychotics available for consideration in more individualised treatment planning. However, younger psychiatrists now gain little or no experience in the use of older antipsychotics. This is the first of two articles addressing practical issues for consideration in prescribing the older antipsychotics available in the UK. It covers background, including the fundamental clinical action of antipsychotics, the nature of drug licensing and identification of pharmacological parameters that may be of value in prescribing decisions, and discusses the phenothiazines: chlorpromazine, promazine, levomepromazine, pericyazine, perphenazine, trifluoperazine and prochlorperazine.

This second of two articles on the ‘typical’ (‘first-generation’) antipsychotics covers non-phenothiazines: thioxanthenes (flupentixol and zuclopenthixol), butyrophenones/diphenylbutylpiperidines (including one-time world market-leader haloperidol, and pimozide) and sulpiride, for many years the only substituted benzamide available in the UK. Several tolerability issues ascribed specifically or more frequently to older antipsychotics are also discussed.

Clinical psychiatrists working today owe a great deal to the discoveries of the pharmaceutical industry since 1953, especially in relation to antipsychotic drugs. Yet patients need still better antipsychotics with greater efficacy and fewer side-effects. We should not let nostalgia cloud our judgement.

In this article, we offer an account of how various psychological therapies address dysfunctional mentalisation and identify pitfalls of therapy that could lead to an impasse or even to negative consequences associated with psychological treatment. Some practical recommendations follow from our model, particularly in relation to the careful monitoring of the intensity of the patient's attachment and the use of interventions aimed at promoting mentalising.

Psychiatry predominantly uses an evidence-based way of understanding patients. Over the past two decades, however, the idea has become acceptable that something can also be learned from the arts. This article suggests a precise role for ‘narrative understanding’, but argues that something further can be learned by examining a particular mode of attention – that which an experienced viewer might give to a painting or listener to a piece of serious music. The article articulates the contrast between the detached attention of the scientist and the engaged attention of the artist in terms of two traditions of medicine: Hippocratic and Asklepian. It argues that it is possible to combine these and that the ways in which an informed viewer looks at paintings or listener listens to music can be models for this sort of attention.

Robin Downie provides useful reminders of the broad basis of medical practice. This should encourage the sort of ‘engaged attention’ that he describes – the sort of attention needed to appreciate works of art. But what else is going on in a clinical encounter (as in a work of art)? This commentary suggests that real communication is to be understood in dramaturgical terms as occurring between actors in real time and space. It involves shared understandings, which require empathy but which depend on something ineffable to do with our standing as human beings in the world.

Vascular dementia is associated with a group of diverse pathologies affecting the cerebrovascular circulation and with other dementia pathologies, particularly Alzheimer's disease. It is rather rare on its own. There is a spectrum of severity of cerebrovascular disease ranging from pathology but no cognitive impairment, to mild cognitive impairment to a dementia syndrome (vascular dementia). Where present, cerebrovascular disease can magnify the impact of other pathologies such as Alzheimer's disease. Current criteria for diagnosing vascular dementia are inadequate. Neuroimaging can be very helpful in defining the extent of pathology. Assessment needs to take into account a wide range of issues. Specific evidence-based treatments are limited, but attention should be given to managing risk factors and associated psychiatric problems such as depression.

Appropriate housing and support are essential elements in the care of many people with mental health problems, and housing has a major impact on the quality of their lives. In the post-deinstitutionalised services of most high-income countries, a complex range of supported accommodation is available, mostly in the private (for-profit and not-for-profit) sector. We describe the different forms of accommodation and consider recent trends in policy and practice and the evidence base in this area. We also discuss quality issues and the potential impact of the recovery movement.

Video technology was first used in psychiatric services in the 1950s but came into general use in the 1990s, particularly in North America and Australia. Video has utility across all ages and in a wide range of clinical situations. These include case conferencing for patients with complex problems (e.g. when planning discharge from specialist inpatient units), psychological assessment and treatment, Mental Health Act assessments, suicide risk assessment and work in forensic settings. Potential for benefit may be most obvious in remote locations, but video use is also relevant in urban settings. Lack of training and experience, inadequate access to equipment and insufficient technical support have all limited the take-up of this technology in the UK. This article briefly reviews the literature and outlines technical and cost considerations when using video technology. Three services in Scotland are described to illustrate ways in which videoconferencing can enhance services.