A multinational pharmaceutical company recently launched a drug for dementia in Pakistan and flew about 70 Pakistani doctors to Bangkok, Thailand for a 3-night all-expenses-paid trip (Khan, 2004). Pakistani doctors were part of a larger group that also included doctors from other countries. A conservative estimate of costs for the Pakistani doctors alone is about 7 million Pakistani rupees (Rs) (£70 000, US$120 000).

Although the majority of people with mental health problems have their treatment needs met within local services, the Department of Health's Specialised Service National Definition Set (Department of Health, 2002) outlines areas that are thought to require specialised services. Complex and/or treatment-resistant disorders (including severe and/or complex affective disorders) are one of ten mental health areas identified.

Have you ever wondered why the well-known Mill Hill Vocabulary Scale was named after a suburb of North London? Little known to most psychiatrists or to local people in Mill Hill, a major part of the Maudsley Hospital was evacuated there from central London during the Second World War. Mill Hill School had been evacuated en masse to St Bees in Cumberland. The vacant buildings were requisitioned by the Emergency Medical Service for the Maudsley Hospital. Much innovative psychiatric treatment and research took place there throughout the war with a star-studded cast, including some outstanding clinicians and researchers. This brief review of historical sources aims to give a flavour of the clinical work of the Mill Hill Maudsley.

Francis Dixon Lodge is a therapeutic community in Leicester with a capacity for up to 15 residents. The Lodge also runs a day and out-patient service. The residential programme runs from Monday to Friday (with residents returning home at weekends), and comprises twice daily community meetings, twice weekly small group psychotherapy sessions, a once weekly art therapy group and a once weekly care-planning group. There is also structured time for recreational activities, housekeeping tasks and involvement in assessment of referrals. In addition to planned groups, a crisis meeting can be called at any time by any community member who feels they or another member are struggling in some way. This involves calling on the community to think about how to manage the situation, and is the way that therapeutic communities challenge impulsive behaviours. Individuals may not be at a stage where they feel able to manage their feelings at the time and are likely to ‘act out’ in self-destructive ways, but others around them may be able to offer advice and support. With time, it is hoped that they are able to develop more elastic impulse control (Campling, 2001).

The training of junior doctors is one of the priorities of the Royal College of Psychiatrists. An essential part of this training happens in multidisciplinary teams, and the ability to work effectively as a member of a clinical team is one of the core attributes of our professional identity as psychiatrists.