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Consideration is given to the extent to which the DSM and ICD approach to psychiatric case definition and treatment supports clinical activity. Their validity as a way of defining ‘mental illness’ is found wanting and they do not, in themselves, usefully guide treatment. These conclusions are set in a critical realist approach to ‘mental illness’, which draws attention to the legitimacy of several differing perspectives, each reflecting their own sets of interests and allegiances. DSM‐V and ICD‐11 are due to be published in 2012 and 2014 respectively, and their architects are called upon to be clear about which of these constituencies they are representing.

Recent years have seen the emergence of the recovery perspective. However, as yet there is no overriding theoretical framework which supports our understanding of recovery and its counterpart, stigma. In large part this is because discourses concerning mental health remain dominated by the medical model and an illness ideology, even though there is growing interest in more socially defined determinants of disability. We propose symbolic interaction as a theoretical framework which might address this shortcoming. Published literature concerning the use of this approach in the mental health field is reviewed and we discuss the implications and ways forward for future research on mental health, stigma and recovery. In particular, we consider how this approach can help identify ways in which contemporary practices and conventions might inadvertently hinder recovery and contribute towards a disabled self.

This position paper focuses on the current tensions and challenges of aligning inpatient care with innovations in mental health services. It argues that a cultural shift is required within inpatient services. Obstacles to change including traditional perceptions of the role and responsibilities of the psychiatrist are discussed. The paper urges all staff working in acute care to reflect on the service that they provide, and to consider how the adoption of new ways of working might revolutionise the organisational culture. This cultural shift offers inpatient staff the opportunity to fully utilise their expertise. New ways of working may be perceived as a threat to existing roles and responsibilities or as an exciting opportunity for professional development with increased job satisfaction. Above all, the move to new ways of working, which is gathering pace throughout the UK, could offer service users1 a quality of care that meets their needs and expectations.

Critical psychiatry appraises and comments upon psychiatric services as they are usually provided. This article, prompted by the publication of a recent book, considers the place of critical psychiatry historically and in the context of contemporary mental health care and treatment.

The purpose of this paper is to explore the issues surrounding a long planned expansion of Payment by Results (PbR) into mental health services and to highlight the factors responsible for the delay.

PbR relies upon “standardisation” of conditions and treatments. This depends upon a scheme of classification that can realistically predict resources required to execute treatment of any one case. Plans to fund NHS mental health services on the basis of tariffs derived in this way have been delayed, and a key reason is the lack of high-quality data. This would require effective “standardisation-to the-average” of both a system of classification and a repertoire of costed treatment pathways. This paper investigated the delay implementation by exploring the difficulties in applying standardisation principles to service provision and tariff calculation.

The paper identified the fundamental difficulty with PbR’s implementation in applying “standardisation” to practice. This is defining the mental disorder that the patient is suffering and designing care pathways at clinical level considering the balance between practical applicability and conceptual/constructional validity. This is necessary to enable the calculation of a national tariff. The conceptual flaws of the Health of the Nation Outcome Scale led to the constructional shortcomings which compromised the credibility and validity of Mental Health Clustering Tool regarding making accurate classification in a standardised way. The validity and credibility of calculating a national tariff thus became contentious on the basis of this inaccurate clinical classification system.

This paper explored the driving factors of delay in implementing PbR in mental health through connecting the recent reform with the fundamental assumptions of “standardisation-to the-average”, which provided another perspective to illustrate the current obstacles.

The purpose of this paper is to explore the ways in which “mental health” difficulties are approached in low-income countries, using a case study of Uganda focus down upon the issues.

The study involved two phases. The first was the collection and analysis of documentary evidence and interviews with policy makers in Uganda. The second involved interviews with health staff, traditional healers and the public in the Buganda Kingdom of Uganda. Interviews were conducted in English or Luganda and translated as necessary. No external sources of funding to declare.

There are differing perceptions of mental health and illness in Uganda and there exists culturally accepted sources of support for distress. This highlights the important role of traditional healers and the paper argues that they should be recognised for their work in mental health care.

The paper is a small-scale study of one area of Uganda (Buganda Kingdom), the extent to which it can be generalised is therefore very limited. However, the research is sufficient to indicate the benefits of traditional healers in mental health care and supports an argument towards a public mental health model.

The paper argues for a move in priority away from a focus upon a biomedical model of mental health support towards a public health model and the meaningful engagement of traditional healers. This would also necessitate a refocus of spending in the wider society.

The paper poses a challenge to the Global Public Health movement and questions the relevance of expanding biomedical psychiatry in low-income countries. The paper also adds weight to emerging literature on the value of a public health approach to mental health and illness, especially in the developing world.

THE ABOVE advertisement appeared in The Cambrian of 20th August 1875, and in the two following editions of this weekly newspaper. Swansea had adopted the Public Libraries Acts at a lively and rather stormy meeting in October 1870. Until December 1874, the matter of establishing a library service lay in abeyance. Then after mounting criticism, particularly in the local press, over the long delay in implementation of the Acts, the Town Council appointed a Library Committee which held its initial meeting on 8 January 1875. Their first important duty was to appoint a librarian.