This issue of Advances carries two articles from Melbourne, Australia, outlining the rationale for, and implementation of, early psychosis services. Their publication provides an opportunity to address some of the more contentious issues relating to the early psychosis intervention movement.

Early intervention services were established on the basis of a number of fundamental principles, including the notions that intervening in the early stages of psychosis alters illness trajectory and prognosis, that multicomponent interventions promote psychosocial recovery and reduce iatrogenic damage, and that early targeting of non-responders reduces treatment resistance. There is growing evidence of the benefits of specialised early intervention services. These include improved clinical, social and vocational outcomes, reduced in-patient stays and better engagement. Early intervention services can also significantly reduce the risk of a second episode and are highly valued by service users and carers. Duration of treatment appears to determine long-term outcome and there remains uncertainty about how long such intensive intervention should last and whether all patients need the same length of care. Budgetary constraints are pervasive and are particularly likely to affect prodrome clinics and community awareness programmes.

Engaging patients in first-episode psychosis services is critical in maximising the effect of early intervention and establishing a framework for longer-term treatment. Biopsychosocial assessments determine a working diagnosis and inform evidence-based treatment. Atypical antipsychotics should be used at doses that maximise therapeutic benefit and adherence while minimising side-effects. Patients are helped to construct a narrative of their illness, including a shared understanding of the contribution of biological and environmental risks, and early warning signs. Common comorbid conditions, including depression, suicidal ideation, substance misuse and anxiety, should be addressed. Management of comorbid borderline and antisocial personality disorders is difficult; their nexus with psychosis is discussed. Cognitive–behavioural therapy is a mainstay of treatment, with specific interventions developed for problems typical in first-episode presentations. Core psychosocial interventions include psychoeducation, vocational and educational support, family interventions and multimodal group programmes.

Transference reveals the mental state of the other to us through our countertransference. Our emotional responses to the transference relationship are different depending on the degree of disturbance evoked in us. Reflecting on our countertransference can convey emotional insight into the nature and meaning of the transference as a way of understanding the emotional experiences of the other.

We present a narrative review of evidence-based treatment for obsessive–compulsive disorder (OCD), covering first-line pharmacological treatment, augmentation strategies, approaches for treatment-refractory OCD and the management of OCD in special populations (children and adolescents, pregnant and breast-feeding women, and elderly people).

The challenge of managing repeated self-harm and the high risk of morbidity and mortality are compounded in forensic patients, where there are additional risks of harm to others, absconding and security breaches. There is an urgent need for clinically sound, practice-based and theoretically grounded strategies for managing these associated risks. This is essential as available UK guidelines appear inadequate for this group of patients. This article promotes a pragmatic approach to assessing the risk of self-harm clinically to arrive at hierarchical risk judgements. It further suggests an algorithmic approach to managing these risks and provides testable strategies that can be adapted for use in various secure institutions.

In this article it is suggested that empathy is a core component of musical appreciation and particularly of the relationship between the singer and the audience. The brain pathways activated in musical appreciation are outlined and the nature of the empathic process considered with reference to Robert Schumann's songs and his experience of severe mental disorder. The article suggests that listening to Schumann's song cycle Dichterliebe (Poet's Love), or to other great music, is a useful component of continuing professional development and that such experience enhances therapeutic effectiveness and empathy, as well as increasing the understanding of the relationship between creativity and mental health.

The scraps of historical data that exist about Buddy Bolden – a cornet player from New Orleans who influenced early jazz – have evoked curiosity in a wide range of writers, including psychiatrists. The latter are interested because Bolden ‘went berserk in a parade’ at the age of 29 and spent the rest of his life in an asylum. This article is about the novel Coming Through Slaughter by Michael Ondaatje, which is based on Bolden's life. I discuss how the form of the text – including its refusal to comment on where sense is lost – conveys to readers the bewilderment and conviction of Bolden's experience and allows them to share something of this.

This article reviews the recent changes in the law in England and Wales relating to consent to treatment for young people, in particular the Mental Capacity Act 2005 and the 2007 amendments to the Mental Health Act 1983. Using a fictitious case study, it offers a structured approach to the application of these new items of legislation that could be useful to trainers and their trainees.

The article discusses the issues and challenges for mental health services in providing care for adults with attention-deficit hyperactivity disorder (ADHD). Based on work developed in Sheffield (UK), it describes the contribution that services integrated into community mental health teams may be able to provide. Given the likely increase in numbers of referrals of adults with ADHD (both ‘graduates’ from children's services and adults seeking diagnosis) and the pressures on resources, it is unlikely that current specialist services will be able to address the growing demand. A local service that can link with other mental health services and that has close links to primary care is most likely to provide a sustainable service model, but there are still considerable training needs for this model to be put into practice.

Payment by results (PbR) for mental health services is currently being piloted with the aim of arriving at a national tariff for mental health by 2013/2014. The Department of Health has also established two pilot sites to consider applicability of PbR for learning disability services. This article outlines the concept of PbR in learning disability services and describes the progress of the pilot work being undertaken in this area.