The principles of recovery have been supported by UK mental health policy and have been incorporated into policy in several countries worldwide. In this article we examine the ideas, principles and definitions of recovery and their origins. Personal recovery is contrasted with clinical recovery and the nature and development of the recovery movement is outlined. The principal factors influencing personal recovery are hope, control and opportunity. In an accompanying article we discuss the implications of these principles for training and practice.

Most literature discussing the introduction of foundation year 1 (F1) psychiatry posts has focused on recruitment. However, for F1 posts to offer a valuable learning experience and a potential recruitment boost, psychiatrists and employing organisations should be aware of general issues arising in the first postgraduate year. These include the inherently stressful student-to-doctor transition, the need for bespoke induction programmes for new graduates, F1 doctors' specific needs for support, supervision and peer support, and the centrality of the relationship with the consultant supervisor to the new doctor. Understanding these themes will enable psychiatrists and mental health organisations to offer better F1 psychiatry experiences, which may boost recruitment and could maximise the opportunities for F1 doctors to develop skills and qualities that will be of value in their future careers, whatever specialty they end up working in.

Different forms of excessive reassurance-seeking safety behaviours are explored, along with reasons why these unhelpful responses occur across a range of mental health disorders. This short update covers the rationale for reducing and stopping these behaviours and offers interventions to help people understand and overcome the unhelpful impact that excessive reassurance-seeking can have on them and others.

Seclusion is a tool used by psychiatrists primarily to manage aggressive and disturbed behaviour that is presumed to be due to the patient's mental disorder. In most parts of the world there are guidelines to using seclusion that are designed to maximise a patient's freedoms and protect their liberty while providing a safe environment. Arguments against the use of seclusion revolve around the deprivation of liberty, the potential for misuse and the concept of seclusion as a form of social control, and patients generally report seclusion as a negative, coercive experience. There is little evidence that seclusion provides long-term benefits in terms of treating symptoms or reducing aggression, although the literature is mixed in this regard. Expert opinion recommends a combination of national policy, ward management and patient-centred interventions to reduce seclusion rates.

Psychiatric assessment in the community is an important part of both the initial assessment process and delivery of follow-up care in adult intellectual disability services in the UK. This article examines how such assessments can be carried out safely and explores the clinical skills required to perform them effectively. Use of the psychiatric interview and mental state examination to elicit information is discussed. Communication difficulties experienced by people with intellectual disabilities and strategies that may be employed to address these in the assessment process are also explored. The article is directed at psychiatrists, in particular specialty trainees, and other healthcare professionals who work with intellectually disabled people.

For decades society has recognised that children are vulnerable and so it has sought to protect them. However, similar legal protection for adults who may be equally vulnerable has been neglected. The incremental introduction of legislation and reports in the UK, along with guidelines on good practice, now afford adults safeguarding procedures similar to those for children. This article offers a practical overview of these developments. In addition, it highlights some of the dilemmas that face practitioners in this evolving arena, as legislation and policy do not anticipate the diverse scenarios in which mental healthcare professionals may be involved. Decisions made can be subject to legal challenge, so it is important that psychiatrists understand their role as well as the role of their organisation in this complex area.

Young people who cut themselves may do so for reasons that go beyond diagnosis. Relevant processes include responses to trauma, coping, emotion regulation and cultural identification. Some clinicians regard those who self-harm negatively or consider one therapeutic approach to be suitable for all. This article explores the possible mechanisms involved when young people cut themselves and discusses therapeutic approaches in the light of these. Clinicians and researchers are encouraged to refine, develop and research interventions for young people who self-harm by cutting.

Lithium is one of the most effective psychotropic drugs we have, but it is underused because of its low therapeutic index, the need for regular blood tests and perceptions about its adverse effects, including renal problems. The last include urinary concentration deficits and diabetes insipidus, chronic kidney disease (including renal failure), nephrotic syndrome, hypercalcaemia, hyperparathyroidism and distal tubular acidosis. This article reviews these adverse effects with special emphasis on their management.

This article examines the life and work of John Kennedy Toole, focusing on his 1981 Pulitzer Prize winning novel A Confederacy of Dunces. Toole finished the novel in 1966 and, after failing to rework his manuscript to his editor's satisfaction, he shelved the project. Following this, he displayed symptoms typical of paranoid schizophrenia and he took his own life at the age of 31. In his novel, Toole parodies both psychoanalysis and the practice of psychiatry at the time, with a strong overlap with the emerging perspectives critical of psychiatry popularised by figures such as Szasz, Laing and Foucault. Toole's life and work have relevance for psychiatrists interested in the relationship between creativity and mental illness, attitudes towards psychiatry in the 1960s, and the interplay between societal values and judgements of mental health.