Mindfulness is an increasingly popular therapeutic approach. Mindfulness-based interventions have been tried out in a wide range of mental disorders, with the strongest evidence for use in depression and anxiety. Mindfulness operates by changing the person's relationship with unhelpful thoughts and emotions. The need for home practice is both a strength and a weakness. Some find home practice too demanding and a barrier to effective utilisation of mindfulness. Others discover a set of practical tools that, once learnt, can be applied to ongoing life difficulties; in this way mindfulness may have a place in promoting recovery beyond the acute treatment of a disorder. Additionally, mindfulness may be beneficial for clinicians to promote well-being and enhance the therapeutic relationship.

An incapacity to make decisions can crucially affect quality of life. Those who lack capacity are vulnerable to abuse from others, ranging from overpaternalism to exploitation, neglect and violence. Historically, those lacking capacity have not been served well by statutory services, with institutionalisation being commonplace. Community care has had its successes and failures; although care provided is often well intentioned and of good quality, abuses of power and trust continue to occur.

Absconding constitutes a significant clinical problem, leading to high levels of anxiety among staff. Ninety-five psychiatric in-patients who absconded from an Irish hospital over a period of 12 months were reviewed retrospectively. Absconders were significantly more likely to be single and compulsorily detained with a diagnosis of schizophrenia or personality disorder when compared to the remaining hospital population for that year. Common destinations included the public house and home, with most returning of their own volition within 24 hours. The rates of self-harm and violence against others are recorded.

A review is made of the anti-psychiatric movement through its major protagonists, Lacan, Laing, Cooper and Szasz. The ideology was set to challenge the concept of mental illness and question the authority of the psychiatrist and the need for mental health institutions. The anti-psychiatric movement received a lot of attention in the 1970s but is now considered to be of the past and of likely interest to the psychiatric historian. However, the impact of the movement on current psychiatric practice requires further re-examination and appraisal.

We audited the use of high-dose antipsychotic drugs in patients admitted to a special (intensive) care unit over two periods. Five out of 57 patients in the first sample and three out of 62 in the second were treated with a single antipsychotic drug above the British National Formulary maximum dose. The proportion of patients treated with antipsychotic drugs such that the total dose in chlorpromazine equivalents was greater than 1000 mg, fed. The audit showed improvements in clinical practice, particularly with respect to the onset of, indication for and outcome of high-dose treatment and in monitoring the patients' physical status.

Concerns about the use of high doses of neuroleptic medication prompted an audit of prescriptions of these drugs in a large psychiatric hospital. Following an initial audit in 1991 of 196 patients, a follow-up of 192 patients was undertaken in 1993. A significant reduction in levels of neuroleptic medication was found, although doses still tended to remain high.

The new system of funding introduced by the National Health Service reforms has led to an increased awareness of financial concerns within the NHS. This was indeed one of the main aims of the reforms, with the expectation that a more efficient and better quality service would result. This may be a realistic aim, as long as clinicians' freedom to make appropriate secondary and tertiary referrals do not become totally dependent upon financial considerations. Yet it has become clear from findings within our own unit, Henderson Hospital, that, in at least 42% of cases, requests for ECR funding for treatment were refused on a purely financial basis (Dolan & Norton, 1992).

The placebo effect is a fascinating phenomenon in clinical practice. Studies have shown that there is a significant placebo effect in a wide range of medical conditions including psychiatric disorders. This article looks at the background of the placebo effect, defines the common terms used, describes the various hypotheses that have been put forward to explain this seemingly inexplicable phenomenon and also covers the issue of using placebos in research trials, highlighting the important ethical dilemmas involved. Throughout, specific emphasis is given to psychiatry.

There has been considerable debate in the UK in recent years about the propriety of using various forms of ‘involuntary out-patient treatment’ for some individuals with serious mental illness (Eastman, 1995; Dyre, 1998; Burns, 1999; Moncrieff & Smyth, 1999; Sugarman, 1999). While most jurisdictions in the US have statutes that support involuntary out-patient treatment (Torrey & Kaplan, 1995), its use remains controversial (Slobogin, 1994; Diamond, 1995; Torrey, 1997). Involuntary outpatient treatment was originally proposed as a solution to the ‘revolving door syndrome’ (Geller, 1996). It has also been recognised, however, that it may provide a solution to the clinical and ethical dilemmas of allowing individuals who are incapable of making treatment decisions to discontinue treatment, with predictable deterioration to the point where they may harm themselves or others (Geller, 1990). This paper provides a review of controlled studies that have examined whether involuntary treatment in the community is effective.

Self-harm is a major international public health concern and is especially prevalent among prisoners. In this editorial, we explore recent trends in prisoner self-harm during the coronavirus lockdown, and consider strategies for improving the prevention and management of self-harm in prisons as we emerge from the pandemic.

Professor Sami Timimi recently expressed concerns about the Improving Access to Psychological Therapies (IAPT) programme. We argue that the concerns are largely unfounded and provide readers with an update on the programme.

Psychiatry is a complex enterprise, requiring the longest training period required of any mental health profession. Yet doctors are playing a declining role in deciding health care policy. It is almost as if while acknowledging they would rather see a doctor than anyone else when seriously ill, lay public and politicians also prefer practically any alternative, other than a physician, when determining who should decide how health care is delivered.