Recently, Magnes (Psychiatr Bull 2008; 32: 458–60) conducted a survey of patient attendance posing the question ‘Are out-patient appointments a necessary evil?’ The need for out-patient appointments was both queried ^{Reference Killaspy1} and robustly defended. ^{Reference Holloway2} Frequently, when discussing the role of such appointments the focus is on attendance. ^{Reference Mitchell and Selmes3,Reference Kelly4} However, research addressing other aspects would greatly benefit psychiatry.

We believe that the following issues could be considered: what is the purpose of out-patient appointments? (possible responses: (a) review mental state, adherence, risk, etc.; (b) opportunity for the patients to ask questions; (c) update the GP and/or other services involved; (d) consider referral to other members of the multidisciplinary team or other services); how often should we see patients and for how long? Furthermore, guidance on appropriate discharge procedures would be very helpful.

Finally, we would like to echo Holloway's ^{Reference Holloway2} suggestion that ‘a more nuanced discussion’ on that ‘necessary evil’ is urgently required.