Until 2003 the long case was the clinical component of the two summativeexaminations for the Membership of the Royal College of Psychiatrists(MRCPsych). This changed to an Objective Structured Clinical Examination(OSCE) format, initially for the Part I examination, and more recently tothe Clinical Assessment of Skills and Competencies (CASC) at the end of 3years of basic training. Although there are distinct advantages to theobjective, competency-based assessment, questions remain on its validity.The expectation that formative workplace-based assessments would fill in thevoid left by the loss of the long case has not materialised. The options forretaining the advantages of the long case within the CASC framework whileminimising the shortcomings of the CASC are suggested as a way forward.

The growth of specialism in a field can be considered a healthy response to emerging evidence, technology and skills, yet it risks creating unhelpful barriers to collaborative working and fragmented patient pathways. Mental health services in England have experienced this tension in recent years through the national implementation of local specialist community teams that aim to reduce the need for in-patient admission through a focus on crisis resolution, early intervention and assertive community treatment (ACT). In response to the results of studies assessing its effectiveness, there has been disinvestment in ACT. This risks marginalising people with severe and complex mental health problems by depriving them and their families of the intensive support they need for successful community living, as well as discouraging researchers from undertaking further high-quality studies that can inform the intelligent evolution of the ACT model within different contexts.

Patterns of drug use are changing, with an increase in the use of a new group of psychoactive substances known as ‘club drugs'. Comprising both legal and illegal drugs, many club drugs can be purchased online, increasing their availability. The harmful consequences are now emerging and include severe affective and psychotic symptoms as well as physical symptoms such as ketamine-induced ulcerative cystitis. Psychiatrists need to consider club drugs as a precipitating factor for psychiatric presentation. This editorial will describe the more common substances and their effects.

The community placement of people with serious mental illness has focused on assimilation. The broad community, however, seems largely unwilling to support and include them. The result is programmes to help people maintain their community lives mainly through the support of formal mental health services. The social and economic development of ‘identity communities' of people with serious mental illness is an alternative model to assimilation. An identity community consists of people with shared interests, beliefs, experiences or needs which affect the identity of the participants and the cohesiveness of the group. Such communities can be economically sustainable and offer members more ways of having meaningful lives. Examples of this recovery-friendly approach are provided as a viable way of enhancing community support without additional expense.

The experience of rejection of an article submitted for publication to a scientific journal can be particularly anxiety provoking, especially when the furtherance of an academic career or the gaining of a permanent post might be riding on getting it published. Many papers fail to get past the first hurdle and are not sent out for peer review, often as a result of the most basic of errors: the results are not generalisable, the paper adds nothing new to the subject, there are flaws in the study design or inappropriate statistics were used. Attention paid to formulating a clear research question and the adoption at the outset of a doable, interesting project will often help to avoid disappointment.

Standards and the pursuit of excellence are vital in healthcare and scientific investigation. Researchers must seek the most efficient, rigorous and robust methods available. Scientific journals acting as information distributors should only publish quality studies; such an ideal has become increasingly difficult to attain. To compete in the imperfect market of scientific publishing, The Psychiatrist will be open access from January 2014 and articles will be freely available ahead of print. There will be no publication costs to authors for at least the first 12 months and the journal will be re-launched under its old familiar name – the Psychiatric Bulletin.

This editorial focuses on a psychosocial application of psychoanalytic thinking to the processes which are in place to investigate serious events in psychiatric healthcare. It argues that the structures and processes in place can be understood with reference to organisational defences and to the ‘actor–network theory’. A common reason for such an investigation is a completed suicide. It is suggested that defensive processes may occur in response to the anxieties associated with serious events such as suicide and are of concern in terms of psychiatric care retaining a capacity for emotionally involved practice.

In the USA, DSM-5 is scheduled for publication in 2013. It is likely to include some substantial changes to the diagnosis of substance use disorders and pathological gambling. This paper reviews the proposed changes to these diagnoses and their potential impact on diagnosis, treatment and research of these disorders in the UK.

Consumer participation in mental health services has grown in recent years. Preceding this, a very productive collaboration in another area – the emerging crisis of HIV/AIDS – built a coalition of service users, researchers and clinicians which had a decisive impact on research and saved many lives. There is much to learn from this for the mental health field, where, at present, partnership between service users, caregivers, researchers and clinicians is not such a productive force. This editorial outlines the respective histories in these two areas and the lessons to be learnt for consumer involvement in the mental health field.

The current emphasis on improving the quality of dementia services is welcome, but it treats dementia as if it were separable from complex comorbidities, disability and frailty. As a consequence, dementia can overshadow other problems, from heart failure to multisystem failure at the end of life, which may be poorly managed. Three ways in which old age psychiatrists can reconnect dementia with the diseases and disorders of later life are described in this editorial. The first is to improve skills in general practice so that general practitioners (GPs) can take on the bulk of the clinical work of both diagnosis and management of dementia and its comorbidities, while specialists retain complex decision-making and management tasks. The second is for old age psychiatrists to function as consultants to social enterprises run by GPs for the purpose of managing almost all patients with dementia in general practice. The third is for community geriatricians and old age psychiatrists to work together in integrated organisations that take full clinical responsibility for older people with dementia.

Psychiatrists rarely recognise or treat problem gambling, despite its high comorbidity among psychiatric patients. Early interventions, as in other psychiatric disorders, offer the potential for improving outcomes in problem gamblers. In this editorial, we make the case for why psychiatrists should do more to help problem gamblers, and discuss in detail how they can offer screening and brief psychological interventions.

Current UK policy on drugs does little to reduce the potential harms to young people using drugs and in some ways can exacerbate them. The dramatic increase in the number of new psychoactive substances available in the UK carries the risk of increasing those harms and demands a new approach to drug regulation. The All-Party Parliamentary Group for Drug Policy Reform calls for an independent drugs classification body, the introduction of a new category for psychoactive substances whereby their supply can be regulated and a review of the government lead for drugs to ensure a health focus. The Group's proposal and supporting evidence are set out in full.