Activity and outcome data for two ‘ward-in-a-house’ projects for new long-stay in-patients are described. The results confirm that up to a third may be successfully resettled providing that good quality sheltered housing is available. However, a similar proportion appear to find such environments too demanding and may be transferred after an acute exacerbation of symptoms or a violent incident. The remainder need high quality, ongoing care.

This paper contributes to a debate about the nature of religious belief and its relevance for the practice of psychiatry. The need for dialogue is recognised not only because of multi-faith UK society but also because mental health services are now more tailored to the expectation of patients. To understand the possible relevance of spiritual and existential dimensions to mental illness, even in a secular society, has become more necessary. Training, service delivery and research issues are briefly addressed.

The Earth's climate is in a complex state of change as a result of human activity. The interface between climate change and physical health has received significant attention, but its effects on mental health and illness are less understood. This article provides an insight into the psychiatric sequelae of climate change, suggests strategies that psychiatrists can use to take action, and argues that it is their responsibility to do so.

A survey of the current practice of lithium monitoring in a general hospital and the general practices it serves revealed erratic and infrequent assessments of serum lithium levels and also of renal and thyroid function. General practitioners, who in this study monitor approximately a third of the patients on lithium, performed worse than psychiatrists, but in neither case was there cause for complacency.

This paper draws upon over 30 years experience of Tribunals as RMO, medical member and independent psychiatrist.

The frequency and content of articles of psychiatric interest in the Irish print media were investigated. Issues of psychiatric interest were commonly featured. Contrary to popular opinion most articles are either supportive or neutral in tone. Where negative imagery occurred it was more frequently associated with articles in the tabloid papers. Mental health professionals, in particular psychiatrists, contributed very little towards articles of psychiatric interest (especially in the tabloid press) and need to become more actively involved in shaping the portrayal of mental illness in the print media. Their involvement is associated with a more positive portrayal of psychiatry.

There is emerging evidence that individuals who are mentally ill are over-represented in the group of defendants prosecuted under the blasphemy laws of Pakistan. This article discusses the background of blasphemy legislation in Pakistan, and proposes causal interactions between underlying mental illness in the defendant and prosecution for blasphemy. It sketches possible legal safeguards for such blasphemy defendants with mental illness in mental health legislation.

Psychotherapy training is mandatory before trainees can gain membership of the Royal College of Psychiatrists. One type of introduction to psychotherapy is via a case discussion group, such as the one pioneered by Michael Balint. Much has been published regarding psychotherapy training, but little describing the Balint method from a trainee's perspective. Our paper outlines trainees' experiences of participating in this type of group. The group encouraged trainees to think about the doctor–patient relationship in their everyday clinical practice. All of those who finished the group described a positive experience, giving a good grounding for further psychotherapy training.

Lithium therapy for affective disorders has been estimated to result in savings of hospital beds in the National Health Service of £23 million each year. In order to maintain and justify this saving we must invest to provide careful monitoring of serum lithium concentrations in patients living in the community. In recent years the advent of lithium clinics has done much to improve the compliance and safety of lithium therapy (Masterton et al, 1988), but we believe that there may be scope for further improvement both in the service to the patient and in encouragement of the patient to comply.

Ninety-six successive acute psychiatric admissions were assessed with regard to dress, level of hygiene, the presence of tattoos, bodily piercing/decoration and surface marks of self-harm. These features were also examined in relation to ICD–10 category diagnosis. One-third were described as ‘dishevelled’, 21% ‘unclean’, 7% had multiple pierced ears and 3% other pierced body parts. Sixteen per cent had tattoos, rising to 34% in the F10–19 (substance misuse) category, and 15% had scars of self-harm. People with schizophrenia and related disorders were more likely to present in an unclean state. Those with personality disorders were no more likely to bear the scars of self-harm, tattoos or body piercing.

Complaints made against doctors are increasingly important given the current emphasis on consumerism in the National Health Service and the publication of the report of the Wilson Committee which reviews complaints procedures. There have also been recent changes in medical indemnity and increased litigation. The origins of complaints made against psychiatrists were studied. Most complaints were made by relatives and advocates rather than the patients themselves and half were made after the patient was discharged from hospital. It was found that most complaints arose out of a breakdown of communication between psychiatrist and patient.

Some names appear to stick to syndromes or diseases like a proverbial glue, regardless of their total inappropriateness. Gross self-neglect in old age characterised by domestic squalor, social withdrawal, apathy, tendency to hoard rubbish (syllogomania) and a lack of shame was originally reported by Macmillan & Shaw in 1966 and subsequently ‘christened’ by Clark et al as Diogenes∗ syndrome in 1975. Post (1982) preferred the term ‘senile recluse’ and argued that this is not a syndrome but merely an end stage of personality disorder. It was usually extremely difficult to help these patients, as one's care and goodwill often met with hostility and blunt refusal to cooperate (Cybulska & Rucinski, 1986). More recent studies, however, have shown a strong association of this condition with frontal lobe dysfunction (Orrell & Sahakian, 1991), thus giving a psychiatrist of old age a somewhat firmer basis for action.

Psychiatry is a branch of medicine, and medicine has its roots in scientific empiricism. Scientific modernism, a product of the Enlightenment, has come under considerable fire from critics, often labelled as postmodern (Muir Gray, 1999; Bracken & Thomas, 2001; Laugharne, 2002). These criticisms include a portrayal of science as a ‘grand narrative’ that reduces reality to a material, measurable world, which follows rational rules, and excludes the non-measurable and non-material. The idea of the objective observer is questioned, because all observers have some interest in what is being observed. Also, multiple views of reality are seen as necessary to understand different perspectives, and the idea that scientific knowledge should ‘trump’ other forms of experience is criticised. This has been described by Bracken in the following way.