The challenges for scientific journals at the beginning of 21st century are exciting but formidable. In addition to reporting faithfully new knowledge and new ideas, each journal, or at least all those aiming for a general readership, has to cater for a potentially huge lay readership waiting at the internet portals, a hungry press eager for juicy titbits, and core readers who, while impressed to some extent by weighty contributions to knowledge, are also looking for lighter material that is both informative and entertaining. In the past this type of content was frowned on as mere journalism, fluff of short-term appeal but no real substance. The lighter approach was pioneered by Michael O'Donnell as editor of World Medicine in the 1970s, who introduced a brand of racy articles, debates and controversial issues in a tone of amusing and irreverent iconoclasm. At this time it was dismissed as a comic by some of the learned journals but its popularity ensured that in subsequent years its critics quietly followed suit, as any current reader of the British Medical Journal and the Lancet will testify.

The Department of Health has emphasised the need for a patient-centred National Health Service (NHS), and the involvement of users and carers in mental health services is often a policy recommendation (Mental Health Task Force User Group, 1995; NHS Health Advisory Service, 1997; Department of Health, 1999a,b, 2001). The Patients' Forum and Consumers in NHS Research are established national bodies concerned with stakeholder involvement. The Commission for Patient and Public Involvement in Health was established in 2003.