In the field of liaison psychiatry, as in all areas of healthcare, there is an essential need for well-organised and consistent collection of information on outcomes, from a range of perspectives. This special article introduces, and describes the development of, the multidimensional Framework for Routine Outcome Measurement in Liaison Psychiatry (FROM-LP). This was challenging owing to the variety of service settings and types of intervention which characterise liaison psychiatry. Similar challenges may be faced by other specialties and this, along with the direct relevance of much of the eventual content of the framework, will broaden the interest of this article.

Personal health budgets (PHBs) were piloted in the National Health Service (NHS) in England between 2009 and 2012 and were found to have greater positive effects on quality of life and psychological well-being for those with mental health problems than commissioned service, as well as reducing their use of unplanned care. The government intends to extend PHBs in England for long-term conditions, including mental health, from April 2015. Given the importance of engaging clinicians in the next phase of PHB development, we provide an overview of the approach, synthesise the evidence from the national pilot and debate some of the opportunities and challenges. Balancing individual choice and recovery with concerns for risk, equity and the sustainability of existing community services is the central tension underpinning this innovation in mental health service delivery.

Service development is guided by outcome measures that inform service commissioners and providers. Those in liaison psychiatry should be encouraged to develop a positive approach that integrates the collection of outcome measures into everyday clinical practice. The Framework for Routine Outcome Measurement in Liaison Psychiatry (FROM-LP) is a very useful tool to measure service quality and clinical effectiveness, using a combination of clinician-rated and patient-rated outcome measures and patient-rated experience measures. However, it does not include measures of cost-effectiveness or training activities. The FROM-LP is a significant step towards developing nationally unified outcome measures.

The UK government's Prevent programme affects professionals and the people who rely on their services across the public sector, particularly now that workers are legally bound to report their concerns about individuals they believe to be at risk of radicalisation. This article discusses the risks that the strategy presents to the work of teachers and the bonds of trusts between staff and students.

This is a brief exploration of the ethical issues raised for psychiatrists, and for universities, schools and wider society, by the demand that they attend mandatory training as part of the UK government's Prevent counter-terrorism strategy. The silence on this matter to date on the part of the General Medical Council, medical Royal Colleges, and the British Medical Association is a failure of ethical leadership. There is also a civil liberties issue, reminiscent of the McCarthyism of 1950s USA. We should refuse to attend.

End-of-life care has been given increasing importance within healthcare settings. In June 2014, the Leadership Alliance for the Care of Dying People published One Chance to Get it Right. This nationally accepted guidance replaces previous end-of-life care pathways such as the Liverpool Care Pathway and outlines how dying patients should be managed irrespective of setting. Increasingly, patients with mental health problems are entering their final days of life within psychiatric in-patient or acute hospital settings, and psychiatrists need to be aware of the new guidance and ready to implement it within psychiatric practice.

Leros became infamous worldwide in the 1980s because of a scandal in its mental institution, the Leros asylum. The scandal provoked universal outrage and the international pressure triggered the Greek mental health reform. Under the reform projects Leros I and Leros II (1990–1994), numerous interventions took place in the Leros asylum as part of deinstitutionalisation. Following that, the Psychargos programme advanced developments for community-based services. Deinstitutionalisation and development of community mental health services have advanced significantly since the 1980s. However, this reform is still incomplete, given that sectorisation, adequate primary care policies, inter-sectoral coordination and specialised services are under-developed. This problematic situation is further complicated by the severe impact of the current financial crisis.

Since the Liverpool Care Pathway has been withdrawn in the UK, clinicians supporting the palliative needs of patients have faced further challenges, particularly for patients with dementia who are unable to go to a hospice owing to challenging behaviours. It is becoming more important for different services to provide long-term palliative care for patients with dementia. Mental health trusts should construct end-of-life care policies and train staff members accordingly. Through collaborative working, dying patients may be kept where they are best suited. We present the case study of a patient who received end-of-life care at a psychiatric hospital in the UK. We aim to demonstrate how effective end-of-life care might be provided in a psychiatric hospital, in accordance with recent new palliative care guidelines, and highlight potential barriers.

Online health information is increasingly popular and may bring both benefits and potential harm to users with mental health problems. The encouragement of harmful behaviour among this population is a particular concern. The website healthtalk.org provides the benefits of shared experience by publishing excerpts from rigorous research interviews with patients, contextualised with medical information. This article sets out evidence for the positive and negative effects of online mental health information and describes the methodology behind healthtalk.org, with an overview of the mental health information it provides and how it can benefit patients and health professionals.

The predictable pharmacokinetic drug interaction between clozapine and rifampicin is listed in most standard reference texts but little detail is given or emphasis on its clinical significance. The interaction is based on theoretical knowledge of both drugs; to date just two case reports have been published. This article describes a third case demonstrating the significance of this interaction. This was potentially devastating for the patient who required an extended psychiatric admission. The enzyme induction was so potent that the dose of clozapine had to be increased approximately sixfold. Careful management of this significant interaction is essential for effective patient care.

The move to a digital health service may improve some components of health systems: information, communication and documentation of care. This article gives a brief definition and history of what is meant by an electronic health record (EHR). There is some evidence of benefits in a number of areas, including legibility, accuracy and the secondary use of information, but there is a need for further research, which may need to use different methodologies to analyse the impact an EHR has on patients, professionals and providers.

The excitement about the application of mindfulness meditation in mental health settings has led to the proliferation of a literature pervaded by a lack of conceptual and methodological self-criticism. In this article we raise two major concerns. First, we consider the range of individual differences within the experience of meditation; although some people may benefit from its practice, others will not be affected in any substantive way, and a number of individuals may suffer moderate to serious adverse effects. Second, we address the insufficient or inconclusive evidence for its benefits, particularly when mindfulness-based interventions are compared with other activities or treatments. We end with suggestions on how to improve the quality of research into mindfulness interventions and outline key issues for clinicians considering referring patients for these interventions.

Borderline intellectual functioning is an important and frequently unrecognised comorbid condition relevant to the diagnosis and treatment of any and all psychiatric disorders. In the DSM-IV-TR, it is defined by IQ in the 71–84 range. In DSM–5, IQ boundaries are no longer part of the classification, leaving the concept without a clear definition. This modification is one of the least highlighted changes in DSM–5. In this article we describe the history of the classification of borderline intellectual functioning. We provide information about it and on the importance of placing it in the right context and in the right place in future DSM editions and other classification systems such as the International Classification of Diseases.