Individuals with mental health issues may post information on social networking sites that can provide an insight into their mental health status. It could be argued that doctors (and specifically psychiatrists) should understand the way in which social media is used by their patients to gain a better insight into their illnesses. However, choosing to actively monitor a patient's social media activity raises important questions about the way in which medical students, qualified clinicians and other healthcare professionals obtain information about patients. While this may be framed as a mere form of ‘collateral history-taking’, there are obvious practical and ethical problems with doing so. Here, a case is made against monitoring the social media activity of patients involved with psychiatric services.

Violence in the workplace is of great concern to trainee psychiatrists. A questionnaire was devised to assess knowledge of safety Issues, and precautions available, among junior doctors. The results, which revealed gaps in provision of safety training and facilities in this area, have been forwarded to the relevant directorates with a view to setting standards suitable for audit review.

Accident and emergency (A&E) staff completed a general knowledge and attitude questionnaire related to suicide and deliberate self-harm (DSH) before and after a teaching package. The results showed an increase in general knowledge while attitudes remained the same. Following the teaching package there was an increase in the number of patients who contacted the Specialist Service for DSH.

Recent years have seen a substantial increase in the use of crisis resolution home treatment (CRHT) teams as an alternative to psychiatric in-patient admission. We discuss the functions of these services and their effectiveness. Our research suggests high rates of suicide in patients under CRHT. Specific strategies need to be developed to improve patient safety in this setting.

In most countries, social or behavioural interventions are recommended for autism. However, in France, psychoanalysis is still used, despite objections by patients, families and mental health experts. Supporters of psychoanalysis maintain that the choice of therapeutic approach is a matter of cultural preference, and that objections to psychoanalysis arise from misunderstandings. We argue that more deep-rooted problems are the lack of an evidence base for psychoanalysis and its focus on sexual relationships between children and adults, which demonises mothers and can put children at risk of abuse. Furthermore, psychoanalysis in France is protected from criticism by powerful educational and political networks.

Trainspotting, the “best British film of the decade”, arrived on 23 February 1996. Such were the expectations of the film (1996) that the face of its narrator-hero Renton (Ewan McGregor) appeared that month on the front cover of two influential London-based film magazines, Premiere and Sight and Sound. One year after its release, the film stands as both a critical and commercial success. The total Box Office receipts for Ireland, at IR £800 000 in the first 3 months, were comparable to a major Hollywood blockbuster. The film was still being screened 10 months later in Dublin's north inner city, the heartland of Dublin's heroin epidemic. Given its subject-matter, it is important to examine both the film itself, and its points of contact with the realities of drug addiction. In this respect, three questions suggest themselves: is the film showing anything new (representation), is it doing anything new (technique), and what is the film saying (ideology)?

The role of the accident and emergency department in the care of psychiatric patients has been long recognised. Mindham et al (1973) reported that many psychiatric patients, at their first or subsequent contact, present themselves as emergencies, and therefore a suitable service must be provided for them. It is interesting that a large number of reports describe various aspects of one particular service in London, namely the Maudsley Emergency Clinic. Several recent reports describe emergency psychiatric services in different district general hospitals in the United Kingdom.

Evolutionary science remains an overlooked area in psychiatry and medicine. The newly established Royal College of Psychiatrists' Evolutionary Psychiatry Special Interest Group aims to reverse this trend by raising the profile of evolutionary thinking among College members and others further afield. Here we provide a brief outline of the importance of the evolutionary approach to both the theory and practice of psychiatry and for future research.

General practice fund-holders purchase secondary care for their patients directly, encouraging competition between providers. The scheme now includes almost all community mental health services. Practice counsellors may now be funded from secondary care budgets. Fund-holders may use their purchasing power to influence out-patient policies, have consultant sessions in their surgeries, gain direct referral to community psychiatric nurses, resist sectorisation, or change to a different provider altogether. The implications for mental health teams and their patients are discussed. Mental health workers must define their roles very dearly, and get involved in negotiating contracts now, to influence future service provision.

The demand for child and adolescent psychiatric services outstrips the supply of resources, leaving a large unmet demand. One way of managing this is to prioritise referrals. A sample of Norfolk general practitioners were interviewed face to face. They were asked to prioritise child and adolescent mental health problems that might present to them in the surgery. A high response rate was obtained. Anxiety provoking problems were considered to be of the highest priority. Service provision and prioritisation should take cognisance of the wishes of referrers themselves. Mental health care training priorities in general practice include substance misuse and psychiatric emergencies.

Although we commonly work with patients with emotionally unstable personality disorder (EUPD) in community mental health teams (CMHTs), only some enter evidence-based psychological therapies. Many patients are not considered ready to engage in specialist treatments and remain in CMHTs without any clear focus or structure to their treatment, which is unsatisfactory for patients, clinicians and services. We present a fictional case and synthesise available literature and lived experience to explore readiness and ways to promote it. We highlight relevant issues for trainees to consider in practice. Patients with EUPD who have not received specialist treatment can be considered in terms of the transtheoretical model's stages of change. Identifying a patient's stage can help guide how to increase readiness for referral and decide when to refer. Interventions available to all healthcare professionals which may promote readiness include: psychoeducation, personal formulations, crisis planning, goal-setting, peer support, distress tolerance skills, motivational interviewing and mindfulness.