The Royal College of Physicians' Palliative Care Services: Meeting the Needs of Patients and the Department of Health's End of Life Care Strategy are important reports that signify a national and international determination to address the needs of people who are nearing their time of dying, and their families, with positive, well-informed professionalism. Despite the advances of medicine and improved social conditions, death will eventually supervene. Psychiatrists and other mental health workers encounter death, in anticipation of its coming and in its aftermath. They need to be aware of developments in the field of end-of-life care and contribute to developments which are occurring, as well as learn and assimilate better practices.

Spirituality and religion, in our secular age, are subject to what Charles Taylor calls ‘closed world structures’ which make disbelief in transcendence appear incontrovertible when in fact, rationally speaking, it is not. It is arguably an effect of these closed world structures on psychiatric practice that excludes from the clinical consultation spiritual matters which patients themselves wish to discuss with their psychiatrist. In fact, the evidence base suggests that spirituality and religion should be routinely assessed in psychiatric practice and that the possible beneficial influence on outcome of spiritual practices and faith communities should be considered when formulating treatment plans.

There has been renewed interest in the concept and diagnosis of bipolar affective disorder in recent years. Previous epidemiological studies have reported the prevalence of the disorder in the USA at 1–2% but further studies have shown that the disorder is underdiagnosed and the true prevalence may be as high as 11%. Despite the stigma attached to mental illness, we have noticed in our clinical practice a new and unusual phenomenon, where patients present to psychiatrists with self-diagnosed bipolar disorder. Here, we explore the background to this phenomenon, the diagnostic challenges and the implications for our patients and practice.

Universities are the main provider of medical student education in the UK; however, its delivery, especially the clinical years but increasingly also the pre-clinical years, often takes place in National Health Service hospitals. Trusts are paid for this privilege through service increment for teaching (SIFT). Developments in clinical governance structures have meant that there is now increased scrutiny and transparency in the funding of clinical services. Lack of similarly robust educational governance structures has led to the risk of educational funds being used to deliver clinical services. This paper examines the current role of SIFT funding and the possible ways forward, using a case study.

The Mental Capacity Act deprivation of liberty safeguards have been criticised for their complexity and unclear interface with existing mental health law. The new legislation, which was implemented in April 2009, is likely to pose a challenge to clinical teams.

Clinicians in all specialties may encounter patients who are in the process of seeking asylum in the UK. This article outlines the practical realities of this process, particularly the legal, social, and economic challenges faced by applicants, and the long wait for resolution. These are highlighted as factors that may have an impact on the psychological health and social functioning of patients. This social and economic context is of particular interest to mental health professionals involved in the care of asylum-seekers; assisting in the process of case formulation, risk assessment, care planning, and the preparation of medico-legal reports.

Deception is commonplace and a discipline such as psychiatry, so often reliant upon subjective accounts, may be susceptible to its effects (especially in the fields of military, liaison, medico-legal and forensic practice). However, psychiatric trainees receive little formal teaching on the subject of medical deceit. Here, I review some recent books on deception, emphasising those works that cast tangential light upon everyday psychiatric practice. Useful sources of reference include those concerning the philosophy of deceit, the recent rise of political lying and the clinical problem of feigned illness. A clinically helpful distinction emerges: that between truth (accuracy) and truthfulness (sincerity).

This paper reports on the last 8 years in the development of a child mental health learning disability service. The growth, challenges and pitfalls faced by the service are charted here. The paper also shows how a service can cope with rising demand without the development of waiting lists and how a specialist service can be embedded within a generic child and adolescent mental health service (CAMHS) as a tier 3 team, thus creating synergies and commonalities of purpose, while avoiding service gaps that inevitably arise from separate services with specific referral criteria. This is a healthy service model that meets the needs of local children with moderate to severe intellectual disabilities and concomitant child mental health problems.

The Royal College of Psychiatrists' Fair Deal campaign provides a welcome guide to the values and priorities for mental health practitioners and services in promoting service users' recovery. It was developed in consultation with service users and carers. This paper presents an alternative interpretation of the Fair Deal, a parallel manifesto of aspirations and ideals that can enhance the spirit of concord and partnership between service users and mental health professionals.

Research suggests that contact time between clinical team and clinical librarian can have a direct and positive impact on patient care through encouraging a more rigorous approach to information retrieval and appraisal of the evidence base. This commentary focuses on the findings of a specific clinical librarian pilot project in a mental health trust. It discusses how clinicians could be better supported to develop improved information literacy skills through initiatives in higher education and what impact this might have on the model of clinical librarianship proposed by the project.

In 2005 the Royal College of Psychiatrists, the NHS Confederation, the National Institute for Mental Health in England and the Department of Health jointly produced the first edition of the Joint Guidance on the Employment of Consultant Psychiatrists. This was integral to the New Ways of Working initiative and outline different professional roles within mental health services. Four years on the document has been extensively revised. The new 2009 edition emphasises achieving viable and satisfying consultant posts through effective job planning and good team functioning. It also contains guidance on recruitment processes with useful examples of templates, flowcharts and good practices.

The staff and associated specialist grade in psychiatry represents a large proportion of the non-consultant career grade workforce in some areas of the UK, with no direct equivalent worldwide. The advent of separate funding for continuing professional development (CPD) in England offers an opportunity to commission bespoke educational resources for a group of doctors who deliver front-line clinical care. This article details the background to the UK staff and associated specialist grade workforce and describes a model of CPD delivery that has attempted to meet training needs, with a view to improving patient care. Also at the heart of this model is the acquisition of consultant-level competencies through personal and professional development.