On a recent visit to Japan, I saw some good quality care of patients with chronic schizophrenia in a rural mental hospital. The Japanese staff were keen to hear about community care alternatives being developed in Britain. However, being a strong protagonist of community care, who has managed the closure of three English mental hospitals, I found myself recommending caution. There are lessons for Japan from the mistakes we have made; and there may be lessons for us in the ways Japan manages delivery of its mental health services.

The images of other people we see on a daily basis in the media invite us all to compare ourselves with, identify with, or aspire to be like whoever is shown. Mostly this activity is of little significance and hardly touches our lives, but the further we know ourselves to be different from the norm then the more challenging those differences become to us.

Consultation is an important means of service delivery for child and adolescent mental health teams, and this is recognised in a number of recent national documents. For the past 6 years, a formalised training opportunity with a local child and family social work team has been in place on the West of Scotland higher specialist training rotation. The consultation process is described, highlighting the mutually beneficial relationship that has developed for both agencies.

After many years of hard work and training, the transition from trainee to consultant is potentially challenging. Having successfully negotiated the hurdles of preregistration training, the MRCPsych examination and the specialist registrar (SpR) interview, trainees have to pass one final signpost to mark the end of their formal training – securing their first substantive consultant psychiatrist post. Despite overall vacancy rates of about 12% for consultant psychiatrists in the UK (Royal College of Psychiatrists, 2002), competition can be intense for some posts.

Dr Jan Wise is right to raise the question of College activities as a key issue for job planning, and to test the commitment of members and employers in this regard. College members employed within the National Health Service in England should look at the comprehensive Job Planning Handbook (http://www.wise.nhs.uk/cjpt/job.htm) as a very useful and up-to-date guide to the process.

Buprenorphine is prescribed as a treatment for opioid dependence (Barnett et al, 2001; Lintzeris et al, 2002). Methadone substitute prescribing is the primary maintenance treatment in Britain and is well established (Ward, 1997). Despite the advantages of methadone maintenance there are associated disadvantages, including potential death following overdose, the inconvenience of daily dosing, the risk of the drug being used by others and stigma (Walsh, 1994).

This article focuses on the complex issues surrounding the need for adequate training in medical education for all clinicians. Many recent landmark papers, including guidance from the General Medical Council, have expressed the importance of formal training. Although the article points out that the majority of clinicians will probably not need to attend such courses, a few generic skills in teaching large and small groups may be of benefit to most. The authors call for the recognition of teaching duties in psychiatrist's contracts and discuss the wider implications of sound medical teaching for the recruitment and retention crisis in psychiatry.

Personal opinion and experiences are shared around the issues of being a service user working in mental health services, supporting others who do the same.

Postgraduate medical education has recently been the subject of major and fundamental review. The four UK Health Departments have set out the underpinning principles in Modernising Medical Careers (Department of Health, 2003), which sees the adoption of a number of trends that have emerged in medical education. One such trend is an emphasis on learning and the development of skills, including continuing professional development, with a move away from the apprenticeship model towards more structured and systematic training. This also means that structured training programmes that have defined curricula and show clear quality assurance processes will become the norm. The aim is to have a flexible, trainee-centred approach within which individuals can develop at their own pace and take increasing responsibility for their own training in a variety of clinical settings.

It fell to me to review the services we provide in our hospital library in Perth, which in turn lay behind my decision to stand for election to the post of Librarian of the Royal College of Psychiatrists. This has involved oversight of developing services for our members and others, and this paper is a response to a request often made to us – what advice can we give to those reviewing their own services? This paper is far from being a solo effort, the professional staff of the College Library and Information Service, and what we dubbed the Virtual Library Committee (colleagues representing faculties and other interests, who have advised us in cyberspace), deserve much of the credit.

Motto: With perseverance a blade of glass splits rocks

(Chinese proverb).

Over 3 years ago a former in-patient of mine walked quietly into my clinic and asked my opinion in respect of her desire to put something back into the system which helped her to recover. I instantly thought that this was a brilliant idea; a support group run by the patients for the patients! People around me remained sceptical about this project and simply thought the project was doomed to failure from the start as there was no known long-term successful precedent. Then I thought of the idea behind the enormously successful Alcoholics Anonymous self-help organisation founded in the USA by two alcoholic men, a surgeon and stockbroker. The result was impressive – I only wish that this project would find deep resonance in a few dedicated hearts and spread nationally. For those who want to read further about this against-all-the-odds journey, I stop myself and let Sandra tell the story about the origin of the Staywell Support Group.

The Postgraduate Education and Training Board (PMETB) was established by the General and Specialist Medical Practice (Education and Qualifications) Order, approved by parliament on 4 April 2003 to develop a single, unifying framework for postgraduate medical education and training across the UK. The Order placed a duty on the Board to establish, maintain and develop standards and requirements relating to all aspects of postgraduate medical education and training in the UK.

As I was celebrating my 50th birthday in March 2003, I was serving out my notice in the job I had held for 17 years as a consultant in old age psychiatry for a population of 18 500 and latterly as trust deputy medical director for elderly mental health.

Many studies recently have highlighted the role of neuroimaging in the diagnosis and management of patients with psychiatric disorders (Lewis, 1996; Costa et al, 1999; Longworth et al, 1999). In old age psychiatry, a diagnosis of dementia is facilitated by structural and functional imaging, both of which have been shown to increase the accuracy with which a diagnosis of Alzheimer's disease can be made (Zakzanis et al, 2003). There is also a role for neuroimaging in the differential diagnosis of organic brain syndromes, which are often referred to the old age and liaison psychiatric services. The usefulness of neuroimaging has extended further into the area of the major functional psychiatric disorders by contributing to our understanding of the aetiology and pathophysiology of these illnesses. Despite this, image interpretation has not yet been incorporated into the training of psychiatrists, at junior or senior level. In this, we differ from other specialist areas of medicine where the ability to interpret images is an integral part of training. At present, the Royal College of Psychiatrists is developing a competency-based curriculum for senior trainees that will lead to the certificate of completion of training (CCT). This will replace the existing CCST (certificate of completion of specialist training; http://www.rcpsych.ac.uk/traindev/postgrad/ccst.htm). In order to obtain the CCT, a series of ‘general competencies' will be recommended for all senior trainees, which will involve the trainee developing expertise in a number of roles identified by the College. These include the roles of clinician, researcher and educator, among others. Specific key competencies will be further recommended in the development of these general competencies, with variations in some key competencies according to the sub-specialty.

Physicians caring for people with severe learning disabilities are frequently faced with the problem of self-injurious behaviour, which often takes a chronic course. Among neurotransmitter systems the serotonergic system in particular is thought to be involved in the initiation and maintenance of self-injurious behaviour, and pharmacological treatment with serotonin enhancers or serotonin reuptake inhibitors has been shown to reduce impulsive aggressive behaviour.