Psychiatry is one of the key medical specialties, and has close relationships with non-medical mental health disciplines, with biology and with primary care medicine. Psychiatry has to demonstrate its effectiveness in dealing with mental illness and distress, and the role of the psychiatrist has to include educating the public, other physicians and legislators as well as employers. Psychiatry has to rise above the ‘psychobabble’ of pop psychology. The role of psychiatrists has changed dramatically in the past 50 years or so as the services have evolved and changed.

In the 1950s psychological therapies, biological pharmacological innovations and social psychiatry influenced the way psychiatry was practised. In the 1960s, specific neurotransmitter hypotheses led to an expansion in biomedical clinical investigation in psychiatry. In the 1970s and 1980s, although newer forms of psychotherapy emerged, the challenges to service development led to closure of mental hospitals and a shift towards community-based services, with community mental health teams as the focus for service delivery. In the 1990s the introduction of sub-specialisation based upon employer-/government-led initiatives, such as home treatment, continuing care and crisis resolution, held sway.

Various aspects of being a good psychiatrist include psychological mindedness (understanding the patient'sand the trainee'ssubjective responses; objective approach to behaviour; ability to make contact with psychiatric patients; understanding of signs, symptoms and syndromes; ability to conduct and organise investigations and treatment methods using physical, psychological and social approaches; and an understanding of the self; Walton, 1986). These characteristics remain important for the psychiatrist after more than two decades.

Good Psychiatric Practice (Royal College of Psychiatrists, 2004) lists attributes of a good psychiatrist in the areas shown in Box 1.1. The core attributes of a good psychiatrist listed in Good Psychiatric Practice are given in Box 1.2. It is clear that there is a tremendous area of overlap in qualities of an individual psychiatrist as well as the characteristics of a service that will be acceptable to the patients and their carers.

The consultant of the future will have to have a range of competencies in clinical care, management, teaching, and research. The essential roles and key competencies are given in Box 1.3 and the attributes of a good consultant psychiatrist are shown in Box 1.4 .