Following devolution, the mental health acts of the constituent countries of the UK are diverging in their provisions. This editorial describes three significant differences between the new Mental Health (Care and Treatment) (Scotland) Act 2003, which came into effect in Scotland in 2005, and the Mental Health Act 2007 for England and Wales.

Healthcare provision in the UK is in a process of continual change. The structures and processes by which people with mental health problems and people with learning disabilities receive support from statutory services have been, and continue to be, subject to many and varied strategic, policy and professional influences. Integrated and collaborative ways of working between generalist (‘primary’) and specialist (‘secondary’) care have become eroded over time and yet they may be needed more than ever. In this editorial we encourage a collaborative approach between practitioners in generalist and specialist care in studying and developing three strands of work: policy and strategy; training; and professional behaviour. Above all, we advocate strongly for a renewed and dynamic dialogue between psychiatrists and general practitioners in working together to provide high-quality mental healthcare.

In 2007, the UK government published a White Paper setting out a framework (revalidation) by which doctors will be assessed throughout their professional careers. Although revalidation is unlikely to be welcomed with open arms by many doctors, its discussion in the White Paper is a measured one in which medical Royal Colleges are given a strong voice in the setting and measuring of standards. The details of the revalidation process for psychiatrists have yet to be determined, but it is likely that it will include strengthened appraisal within which doctors will provide evidence that they have met the standards set by the Royal College of Psychiatrists. These will be laid out in a revised edition of the College document Good Psychiatric Practice.

The Mental Health (Care and Treatment) (Scotland) Act 2003 was implemented in October 2005. This article summarises the main features of the Act and its differences from previous legislation. The Act was intended to provide a more flexible range of interventions, including compulsory treatment in the community. It also introduced a number of new safeguards. These are described and early data on their impact are presented. Some provisions of the Act are time-consuming and cumbersome, but there is evidence that psychiatrists are committed to its principles and this is borne out by early monitoring data. Some aspects of the Act are being reviewed at the time of writing.

The management of anxiety and depression in primary care presents significant issues for workload and understanding the patient in terms of a bio-psychosocial model. There is no shortage of policy in this area, but finding effective and innovative ways of implementing that guidance is only just beginning. This article discusses some of the ways that implementation is happening for adults of working age.

From the standpoint of primary care, mental health services in the UK now appear very fragmented. We have to address the problems of working across interfaces as they continue to multiply. There is now a considerable evidence base relating to what works at the interface between psychiatry and primary care. Psychiatrists should consider the challenge of adopting new ways of working in the management of anxiety and depression in partnership with primary care.

Psychiatrists reporting in criminal cases in England and Wales are now governed by the Criminal Procedure Rules on expert evidence and these will require changes to the format and content of psychiatrists' reports in criminal proceedings. This article sets out the new rules and also draws attention to additional requirements made by the Court of Appeal and, when instructed by the police or the Crown Prosecution Service, by the Crown Prosecution Service. It also draws attention to the report of the Scoping Group on Court Work of the Royal College of Psychiatrists.

It has been clearly established as a matter of legal principle that the duty of expert witnesses is to the court, and not to the cause of those who instruct them. I will suggest that many experts fail to maintain this neutrality, for both conscious and unconscious reasons. If this is so, there may be real dangers in the use of single joint experts, even if there is the benefit of lower costs. In England and Wales, expert witness practice is now seen as part of medical practice by the General Medical Council: the whole profession needs to engage in a debate about how this should be scrutinised and regulated.

Recent highly publicised events have understandably worried some expert witnesses, including psychiatrists. This commentary seeks to encourage those who have invaluable expertise to offer the courts to continue to act as expert witnesses. The Civil Procedure Rules and the Criminal Procedure Rules are helpful to some extent in allaying any fears that expert psychiatrists may have. They are, however, matters of form. More important, it is suggested, are the principles that operate and that, at least in part, lie behind the Rules. Those principles are often, in fact, not unfamiliar ones. Moreover, some of the most fundamental legal principles applied in the courts operate to circumscribe the role of expert witnesses, thus protecting them, provided that they do not go beyond the limits of their expertise.

Workplace-based assessment (WPBA) is becoming a key component of post-graduate medical training in several countries. The various methods of WPBA include: the long case; multisource feedback (MSF); Mini-Clinical Examination (mini-CEX); Direct Observation of Procedural Skills (DOPS); case-based discussion (CbD); and journal club presentation. For each assessment method, we define what the approach practically involves, then consider the key messages and research evidence from the literature regarding their reliability, validity and general usefulness.

This article explores the uses of the terms social exclusion and social inclusion in a mental health context. We briefly describe the origins of the term social exclusion and analyse its connotations in relation to four key dimensions: the relative, multifactorial, dynamic and transactional. We discuss Levitas's three discourses concerning social exclusion (the redistributionist, moral underclass and social integrationist) and present a case in favour of a fourth perspective, societal oppression. Focusing on social inclusion as a remedy for the ills of social exclusion, we discuss implications for contemporary mental health policy, practice and research. We highlight the potential contribution of social psychology to social inclusion theory. We conclude that a better theoretical understanding of causal mechanisms is needed to enable the development of more socially inclusive mental health services.

This article outlines the majority of the adverse physical effects that have been described secondary to the consumption of alcohol at levels above recommended sensible limits. These conditions are cited according to the organ system they belong to. Only brief descriptions are provided because of the vastness of this topic. The underlying pathophysiology of tolerance and withdrawal is touched upon as this is of relevance to the psychiatrist. Definitions of the terms used describing alcohol misuse, and sensible upper limits of alcohol consumption are also mentioned.

A growing body of evidence suggests that late-onset depression (depression occurring for the first time in later life) differs from early-onset (recurrent) depression in terms of clinical features, aetiology, neuroanatomical substrates and prognosis. Some evidence suggests that late-onset depression is more associated with somatic symptoms, cognitive deficits, cerebral structural abnormalities, vascular disease (‘vascular depression’) and poorer treatment outcomes than is early-onset depression. Both general adult and old age psychiatrists face the challenges of managing late-onset depression. In this article we attempt to clarify specific issues relating to late-onset depression in terms of clinical features, aetiology, treatment response and prognosis.