‘Community Care’ has become the psychiatric catch phrase of the eighties. With this burgeoning interest go the difficulties of working not just with a multi-disciplinary team but with Social Services and voluntary agencies, a move from our ‘ivory towers’ which not all psychiatrists will view with relish. Despite initial antipathy more psychiatrists are coming to accept the fact that moving patients out of long-stay facilities is a reality and new ways of working have to be found for these patients as well as acute patients.

What is culturally informed psychiatry? What does it mean, and why is it important? These questions are discussed with a focus on the cultural aspects of the clinical encounter. The DSM-5 Outline for Cultural Formulation was developed as a method of assessing the cultural factors affecting the clinical encounter. It calls for the assessment of the cultural features of the relationship between the patient and the clinician; however, there is a lack of debate about what this means in practice. Clinicians run the risk of withdrawal rather than cultural understanding when facing patients with different cultural backgrounds. Using ethnographic material from anthropological fieldwork, I suggest that the encounter with cultural differences could be a useful point of departure for the clinician to develop cultural understanding. It is argued that recognising the experiences of differences is crucial in strengthening transcultural communication and preventing misdiagnosis in the clinician–patient encounter.

A survey is described of people presenting with psychiatric problems to a north London accident and emergency (A&E) department over three months. Forty per cent presented with deliberate self-harm and 25% of these left before being assessed. Twenty per cent of those with problems compatible with a diagnosis of severe mental illness also left before being seen by a doctor. Differences between presentations ‘out-of-hours' and ‘in-hours' are described. Factors predicting admission were: previous psychiatric admission, symptoms of a psychotic or affective disorder and non-permanent accommodation. The survey has implications for the process of triage in A&E departments and the organisation of mental health liaison services.

This article reviews the literature on research as part of the career of a psychiatrist. Many of the reviewed articles emphasised an interest among psychiatry trainees for conducting psychiatric research. A number of reviewed articles discussed the aspects of research training experiences that lead to a career with a major research emphasis. A few articles described the percentage of time dedicated to research by academic psychiatrists. for those trainees completing their training and who plan to pursue a career as a clinician, there are still ways to incorporate research into clinical practice and continue to maintain some of the research skills that were learned as a psychiatry trainee.

A survey of psychiatrists was conducted to determine their current knowledge of the Driver and Vehicle Licensing Authority (DVLA) regulations and the advice they give to their patients regarding driving with psychiatric illness and/or medication. The results indicate that both knowledge and practices vary widely. In view of the potential risks of driving when not well or fully alert, information regarding driving should be a standard part of the advice given to all psychiatric patients.

Mental health staff may have limited exposure to emergencies associated with obsessive–compulsive disorder (OCD) during postgraduate training. The first time they encounter a person in the midst of severe obsessions, or one who has compulsively self-harmed in response to such obsessions, might be when working on call covering the emergency department. This educational article presents the lived experience of one of the authors as a clinical scenario. The scenario is then used to illustrate the severity of disability and the rates of self-harm and suicide-related mortality caused by OCD. The recognition and assessment of OCD is described, along with what helps in emergency situations. Written informed consent was obtained for the publication of clinical details.

I recently spent 6 months in Namibia as a Fellow of the John Simon Guggenheim Foundation. The purpose of my visit was twofold: the establishment of a database for trauma-related mental health disorders and the development of a validated, self-report screening instrument for mental illness. In the process, I was able to meet with Namibian colleagues and visit a number of health care centres in the country. This article will focus on my impressions of psychiatry in Namibia that were formed during my visit. A brief summary of Namibian history, in particular the country's relations with neighbouring South Africa, will help place my observations in a more meaningful context.

The Working Party on Security in NHS Hospitals (The Glancy Report, DHSS, 1974a) and the interim report of The Butler Committee (DHSS, 1974b) both recommended that secure provision should be made available for the treatment of mentally disordered patients who required greater security than could be provided in a standard hospital setting. They recommended that patients with mild or borderline mental handicap should be treated together with the mentally ill but that “severely subnormal patients” should be treated separately. Later the Royal College of Psychiatrists (1981) largely endorsed this advice proposing that:

1. (a) individuals with borderline and mild mental handicap could be adequately treated in the secure units for mentally ill individuals

2. (b) individuals with moderate mental handicap needed a special secure facility

3. (c) individuals with severe mental handicap did not need high security, and should be managed in high-staffed wards in mental handicap hospitals.

It would be surprising if a public service was tolerated when it was feared by its customers, who are put at risk; unable to show evidence of its effectiveness; very expensive; and paying its staff uncompetitively. It would be astonishing if, nevertheless, such a service could not cope with demand.

Forty of 46 consecutive admissions to a psychiatric inpatient unit were encouraged to read their admission notes and discuss them with the Junior doctor. The offer was withheld for two patients with organic impairment. Twenty-eight patients (including 12 on compulsory admissions) accepted the offer. The 12 who refused were characterised by overall lower educational attainment. Diagnosis raised only a few problems, prognosis and maintenance treatment being the focus of most discussions. There was no evidence of a deterioration in the quality of notes or therapeutic relationships as a consequence of access. Only in one case was the exercise judged ‘harmful’, but ‘useful or essential’ in 22. Possible benefits for both patients and doctor are explored.

The Critical Review Paper (CRP) has been part of the MRCPsych Part II examination for only two sittings and is still fairly uncharted territory. As two people who have separately sat the two papers, we examine whether evidence-based journal clubs (EBJCs) are useful preparation for the exams. We make an argument for changing the format of journal clubs to make them more relevant to the exam, as well as to promote the development of evidence-based practice.