Psychological medicine is an interesting way to describe an attractive field (Reference Lloyd and MayouLloyd & Mayou, 2003). The patients are generally interesting and engaging, the work is usually consensual and professionally rewarding. However, when mental health services are attached to general hospitals, liaison psychiatry is merely one of an array of specialties competing for funds. Commissioners may find that more acute, high-profile services that are better supported by the public take priority when it comes to the annual funding round.

A failure to secure sufficient funds in this situation can lead to psychiatric wards and facilities appearing neglected and shabby compared with general medical wards in the same hospital. When coupled with a staff that is liable to feel undervalued, the quality of care can suffer and the stigma of mental illness is compounded.

The appearance of specialist trusts in many different areas of medicine should allow the strategic, systematic development of a comprehensive range of specialist services. Lloyd & Mayou should welcome the opportunity to develop their field in such a focused setting along with other psychiatrists with different interests. By seeking to ‘make itself [liaison psychiatry] more acceptable to medical colleagues’ they could be distancing themselves from the ‘psychotic patients [historically] housed in large asylums’. These are the very patients that suffer the greatest amount of stigma and social exclusion, that form the bulk of most psychiatrists’ case-loads and that are the least visible to general hospitals.

All psychiatrists should have the opportunity to develop their skills by caring for this group of patients as part of their training. It would be a pity if the views of Lloyd & Mayou were taken to their logical conclusion and ‘psychological medicine’ divorced itself from mainstream psychiatry and sought to become recognised as a sub-specialty with our esteemed colleagues at the Royal College of Physicians.