Given the marginal nature of psychiatry in terms of Western health priorities, it is always worth reviewing how countries with clearly different political systems treat their mentally ill. The 40-year economic embargo imposed by the USA on Cuba, the effects of which have been compounded by the hardships suffered during the ‘Special Period’ from 1989 onwards when the collapse of the Soviet Union left the island's economy in ruins (Pilling, 2001), is one of the most stringent of its kind. It prohibits the sale of food, and sharply restricts the sale of medicines and medical equipment, which, given the USA's pre-eminence in the pharmaceutical industry, effectively bars Cuba from purchasing nearly half of the new world class drugs on the market (Rojas Ochoa, 1997). Between 1989 and 1993, Cuba's gross domestic product fell by 35% and exports declined by 75% (Pan American Health Organisation, 1999). This has reduced the availability of resources and has adversely affected some health determinants and certain aspects of the population's health status. Despite this, however, Cuba has developed a system prioritised to primary and preventive care, with an infant mortality rate half that of the city of Washington, DC (World Health Organization & Pan American Health Organization, 1997; Casas et al, 2001). Furthermore, biotechnology and family medicine are being developed by Cuba as a human resource for other developing countries. Cuban medical schools also train physicians specifically for many developing countries around the world (Waitzkin et al, 1997).

The College Research Unit is undertaking an ethnographic study to describe life on acute psychiatric wards from the point of view of patients. The project is funded by a generous donation from Jim Birley, former President of the Royal College of Psychiatrists. It aims to bring a new perspective to our understanding of the current state of acute wards. The underlying premise is that solutions to current problems must be informed by a good understanding of what actually happens on the wards and what it feels like to be a patient there.

How many consultants do we need nationally to deliver mental health care? It is a simple question, but it has no simple answer – except that we need substantially more than we have at the moment.

This paper describes the implementation, merits and future potential of the eCPA – a computer-based Care Programme Approach (CPA) system for care planning. The system is designed to improve the quality of information in CPA care plans and, for the first time, to enable the rapid and standardised adoption of evidence-based good practice by all community mental health team (CMHT) staff.

The move from institutional to community care in the second half of the twentieth century arose in a climate in which civil rights became increasingly prominent, and out of which the modern survivor movement grew (Campbell, 1996). Government policy for mental health services, as set out in Standard Five of the National Service Framework (NSF; Department of Health, 1999), requires that care should be provided in hospital, or an alternative in the least restrictive environment, and as close to home as possible. At the same time, Government policy also attaches increasing importance to the involvement of service users and carers in the planning, delivery and evaluation of services. This paper examines alternatives to hospital care from a user perspective. The problem is that the evidence base for the NSF largely consists of quantitative studies designed to answer questions of concern to mental health professionals. This tells us little about the perspectives of the service user, which is the strength and value of user-led research (Faulkner & Thomas, 2002). Much of what follows is taken from this area, but in addition we describe briefly our own experience of home treatment, which the NSF sets out as one of the main alternatives to in-patient care.

The Collegiate Trainees' Committee (CTC) has been in existence for over 20 years and continues to represent the opinions of trainees in psychiatry within their College and beyond. This article briefly summarises the historical development and current role of the CTC, and outlines the activities of the committee throughout the past year.

One of my favourite publications does not even appear on my curriculum vitae because I am not sure how to classify it. It is a photograph of two of my research staff standing beside floor-to-ceiling piles of paper – all the forms that now have to be completed for a local ethics committee before you can get started on a national study. After the butter mountain and the wine lake, it is the paper avalanche.

In spring 2003, the format of the Patient Management Problems (PMP) part of the MRCPsych Part 2 will change. At present, examiners bring their ‘vignettes' to the examination. The Examinations committee believes that the examination should be more structured, and that there should be a ‘bank’ of vignettes. The working group, which I chair, was set up to make recommendations about the best way forward.

“We don't see things as they are, we see things as we are” (Anaïs Nin, 1969)

In the mental state examination, a standard method of describing the clinical encounter is to contrast the patient's supposedly ‘subjective’ account with the doctor's ‘objective’ description. In this model, the doctor is granted a privileged position: the clinician's perspective is taken to be superior to that of the patient. The doctor's objective approach is considered neutral, scientific and representing the truth of the matter. In contrast, the patient's subjective report is regarded as unreliable, distorted and potentially false. The lowly status of the subjective perspective is further emphasised by the frequent use of the accompanying prefix, merely.

This paper describes rehabilitation principles and some specialised practice that could usefully inform the provision of acute in-patient care. A low secure rehabilitation setting is described using a method of case formulation to embed an envelope of care around an individual patient within a therapeutic ward milieu. This increases the collaboration and transparency around individual care planning and the capacity for self-reflection within the multi-disciplinary team, in a manner that may be applicable to other in-patient settings.

Israel is a nation of ancient and contemporary interest. Its population is made up of approximately 5 million Jews, 1 million Arabs and a few other small minorities. As in the Arab world more generally, most Arabs in Israel are Muslim, with a small percentage being Christian (Bin-Talal, 1995). More than 2 million Arabs also live on the West Bank and in Gaza (Abdeen & Abu-Libdeh, 1993), currently under partial autonomous Palestinian rule and the foci for ongoing negotiation of a potential Palestinian State. Close links have historically existed between Arabs and Jews in the Middle East, notwithstanding current military and political conflict (Goitein, 1989). The city of Jerusalem is held in reverence by all three of the monotheistic religions.

‘Doctor, would it be alright to take mum to Cyprus for a family wedding?’ In a cosmopolitan city such as London hardly a month goes by without hearing a similar sort of query. If ‘mum’ has dementia I tend to advise the family against flying. This advice is based on anecdotal observations from past clinical practice. I have witnessed a number of patients experience significant deterioration in cognition following flying. While disorientation in unfamiliar environments may explain some of the difficulties in travelling for a person with dementia, as illustrated by John Bayley in Iris (1998), this may not be the only explanation. On this occasion, I decided to use evidence-based practice to review the situation.

The aim of the defence medical services (DMS) is to maintain the health of those individuals who volunteer for service in HM Armed Forces, in order that they may efficiently discharge their duties.

This paper gives an outline of four research areas examining therapeutic community practice: an international systematic review, health economics cost-offset work, a cross-institutional multi-level modelling outcome study and a proposed action research project to deliver continuous quality improvement in all British therapeutic communities. Results of the first two have been published and are summarised here; the third is under way and the fourth is seeking funding.