It is over 40 years since the principle of informed consent was accepted in the USA and it has been long established in other common law jurisdictions. But for decades English law has been constrained by the Sidaway case, which effectively perpetuated a form of medical paternalism. Nevertheless, a patient-centred approach can be traced to one of the judgments in that case, and in the case of Montgomery the Supreme Court has now adopted an approach to consent which is based on self-determination and autonomy and is more closely aligned to professional practice. It calls for a dialogue between doctor and patient, recognition of the patient's right to make a choice and recognition by the doctor of their duty to provide the comprehensible information necessary for the patient to exercise choice, having regard to what a prudent patient, in that patient's circumstances and with that patient's characteristics, would want to know.

It is time to improve clinical approaches to faith in mental healthcare, particularly in psychotherapy. Understood as a psychological trait, faith has potentially great personal salience and introduces socially desirable biases into human reasoning. Therapies may have faith-informed components, either explicitly, or (as with some forms of mindfulness) implicitly, which may modify the patient's faith as well as producing symptomatic change. In this narrative review, the ethics of faith's inclusion in therapy is briefly appraised. The psychology of faith is discussed, and a model of the influence of the practitioner's faith on therapeutic choice is presented. Finally, faith-informed approaches to practice, including their impact on therapeutic effectiveness, are considered and recommendations made for their optimal implementation.

Quality improvement (QI) offers a route to transforming care delivery at the scale and pace needed to ensure sustainability in the National Health Service. However, it is a complex endeavour with numerous challenges to consider, and it takes time. There are many ways of understanding quality and QI in healthcare, and it is important for doctors to develop knowledge of the core principles of QI, which increasingly feature in clinical settings and in training curricula for healthcare professionals.

Psychiatrists have a role in teaching all medical undergraduates and foundation year doctors generic skills to become good doctors, but they also have to appeal to and nurture the interests of future psychiatrists by maintaining core psychiatric skills/knowledge in their teaching. They must tackle poor recruitment to psychiatry and stigma against both the profession and its patients. Medical students and junior doctors tend to be strategic learners, motivated by passing assessments, and psychiatrists are often guilty of gearing their teaching only to this. This article explores the assessment process itself and ways to optimise it, and presents a case for going beyond teaching how to pass exams in order to address wider issues relating to psychiatry.

Several English prisons contain democratic therapeutic communities (TCs) for personality disordered offenders, and addiction TCs for serious substance misusers. This article describes how these are organised and comments on how they are specifically tailored and accredited for use in custodial settings. It also describes ‘psychologically informed planned environments’ (PIPEs), offender pathways for those with personality disorders and psychopathy which provide additional support for psychological treatment. It ends by explaining how ‘enabling environments’ are assessed, since these are now becoming widely adopted in prisons to reverse toxic environments – which affect staff, the prison and the outside world as well as the individual prisoner – and to counter negative learning found in custodial institutions.

We examine Foreman's assertion that assessing, addressing and utilising a patient's faith is warranted. After a brief background, we examine when faith-integrated therapy is indicated, the need for training, an example of such a therapy, and what to do when the faith of the therapist conflicts with that of the patient. Also emphasised is the need for a clear definition of terms.

The professional regulatory cases of the psychiatrist Dr Richard Pool and the neuropathologist Dr Waney Squier have given rise to concerns among expert psychiatric witnesses, and indeed medical experts in general. Here we restate the law on expert evidence with particular reference to the judgment of the Supreme Court in the case of Kennedy v Cordia. We emphasise that Pool does not change the law regarding ‘what is expertise’; in particular, the case does not establish restrictive, status-based tests governing the admissibility of expert evidence such as according to whether an expert psychiatric witness has undergone higher training, is on the specialist register as a specialist in a particular field or is a consultant. Rather, expertise continues to be legally defined in terms of a combination of qualification, knowledge and experience. Crucially, the test of medical expertise in legal proceedings is a legal test and not one determined within a medical paradigm.

In his early novels, the Icelandic Nobel laureate Halldór Laxness portrayed troubled individuals beset by familial, societal and economic challenges within an unpredictable and often unforgiving landscape; his later work addressed humanistic concerns regarding a well-lived life and the harmony of individual and environment. His 1957 novel The Fish Can Sing lies at the cusp of these preoccupations. Laxness contrasts the economic privations experienced by hard-pressed Icelanders with the ostentatious displays of their Danish colonial overloads; he also portrays individuals afflicted by psychosis, alcohol use disorders and medically unexplained physical symptoms, and delineates the path towards a ‘celebrity’ suicide. The novel warns against self-deceptive vanity and community-endorsed illusions, and celebrates the persistent benefits of nurturing relationships, all within a lyric contemplation of individual adaptive resilience and quotidian domestic pleasures.