“The reasonable man adapts himself to the world; the unreasonable one persists in trying to adapt the world to himself” George Bernard Shaw, Maxims for Revolutionists.

Over the past 20 years or so, video has become a ubiquitous medium for teaching in psychiatry. It is increasingly being used in both undergraduate and postgraduate teaching. One of the reasons that we wrote this article was that when we wanted to obtain guidance on how to develop the use of video in our own teaching programme, there seemed to be little in the way of concise practical advice available. The focus of the paper will therefore be on the practicalities involved in how feedback from video recordings of interviews can be used to help with the acquisition of clinical skills. We will attempt to give an overview of the variety of different applications for video and give a brief account of the historical development of video feedback in medical training. Appendix 1 is a guide to the practical and technical side of setting up a video recording session. We think that the experiences that we gained while teaching psychiatry in a district general hospital will be useful to all those involved in teaching wherever they are based.

This is a timely and useful start to a major debate that should now be taking place in mental health services. The authors have successfully woven the need for staff support into the themes of clinical governance and the national service framework for mental health and other Government initiatives. While concentrating on the particular stresses of consultants, they recognise that other grades and other disciplines in the field also suffer.

For nearly three decades, closure of large psychiatric and learning disability hospitals has continued and more people with mental health needs remain in the community. With this continuing decrease in hospital provision, there has been an increased focus on the development of systems of safe care and effective treatment for people with significant mental health problems living in the community. Attempts to make this a central plank of mental health care have been reflected in legislation and guidance produced by the Department of Health. The Care Programme Approach (CPA) was introduced in 1991 after the publication of HC (90) 23/LASSL (90) 11 and subsequent guidance from the White Paper Caring for People (Department of Health, 1990).

Stigma is defined as a sign of disgrace or discredit, which sets a person apart from others. The stigma of mental illness, although more often related to context than to a person's appearance, remains a powerful negative attribute in all social relations. Sociological interest in psychiatric stigma was given added vigour with the publication of Stigma – Notes on the Management of Spoiled Identity (Goffman, 1963). More recently, psychiatrists have begun to re-examine the consequences of stigma for their patients. In 1989, the American Psychiatric Association's annual meeting's theme ‘overcoming stigma’ was subsequently published as a collection of articles (Fink & Tasman, 1992), and last year saw the launch of the Royal College of Psychiatrists' five-year Changing Minds anti-stigma campaign.

It is deeply satisfying to all mankind that many ailments, once dangerous, mysterious and worrying, now offer the therapist of today wonderful opportunities for the exercise of his skill; but with recalcitrant distress, one might almost say recalcitrant patients, treatments tend, as ever, to become desperate and to be used increasingly in the service of hatred as well as love; to deaden, placate and silence, as well as to vivify. (Main, 1957, in The Ailment)

During the past decade, increasing attention has been paid to the primary care level of service for children and adolescents with mental health problems. In particular, a number of national reports have advised service commissioners and providers to increase the amount of specialist child and adolescent mental health services (CAMHS) support to primary care colleagues (Department of Health/Department for Education/Social Services Inspectorate, 1995; National Health Service (NHS)/Health Advisory Service (HAS), 1995; Audit Commission, 1999).

The current National Health Service (NHS) approach to commissioning health services is in flux. The purchasing of care from providers by general practitioner fundholders (GPFHs) and health authorities has changed with the new White Papers. GPFHs no longer exist and the commissioning role is being handed over from health authorities to primary care groups (PCGs). An understanding of the reasons for change and current arrangements will aid the consultant psychiatrist in influencing this process.