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Purpose – There is a paucity of research that examines how diagnostic decisions are made by psychiatrists. Moreover, previous work in the area tends to be grounded in labeling theory, which highlights the conflict-based nature of diagnosis. The goal of this research is to examine the utility and benefits of diagnosis to psychiatrists' everyday work.

Methodology – Using institutional ethnography (IE), I undertook a small-scale interview-based study that documented the diagnostic processes of three psychiatrists in Calgary, Alberta, Canada. The IE-based goals of the study were to: (1) identify what texts were employed during the diagnostic process, (2) map sequences of action and text that coordinated psychiatric decision-making, and (3) theorize the utility of diagnosis for the everyday work of psychiatrists.

Findings – The analysis demonstrates how diagnosis can be understood as a valuable work process that produces a standardized diagnostic story in order to bring an individual's experiences of distress into relation with psychiatrists' daily practices, and institutional discourses more generally.

Limitations – Although IE-based research does not depend on large sample sizes for analytic accuracy, results from the current study need to be replicated because of the limited number of interview participants and to examine whether the diagnostic process is generalizable to other settings.

Social implications – This research challenges the idea that standardization through diagnosis is a negative process and highlights the value of diagnostic decision-making in the daily work of psychiatrists.

The purpose of this paper is to consider four recent articles relating to how included service users are in decision making about their medication in mental health services.

One article describes conversations between a psychiatrist and service users about medication. The second paper describes a study in which young people were supported with the aim of developing their confidence to challenge medication decisions. The third paper reports on interviews with both professionals and service users about medication decisions. The fourth paper presents a theory of how the wider context can affect medication decision making in mental health.

The first paper shows how a psychiatrist can persuade service users to accept medication decisions. The second paper shows how some young people can challenge medication decisions if they have the right support. The third paper illustrates how both professionals and service users may doubt service users’ ability to decide about medication, and pessimistically suggests that shared decision making may be unrealistic. In contrast to this, the fourth paper offers hope of changing how mental health services are organised in order to enable service users to be more empowered about medication decisions.

A model of shared decision making is being imported into mental health from physical health. These four papers illustrate problems with a simple transfer from physical to mental health. The present paper points to differences in apparent awareness of different clinical researchers of the need to tackle service users’ disempowerment in mental health care, showing how some researchers are tackling this.

Begins from the premiss that job satisfaction among caring professionals is important not only for its own sake, but also for its effect on service outcomes. Presents empirical results, from four very different countries, which suggest that management‐influenced variables can help to ameliorate job dissatisfaction arising from factors such as resource constraints. Develops the thesis that cross‐cultural comparisons are a valid instrument for assessing the effect of management efforts which contribute to psychiatric satisfaction and feelings of autonomy. Establishes the need for more cross‐national investigation of the relationship of management to worker job satisfaction.

In most cases job satisfaction serves as a protective factor against burnout and the negative consequences of stress at work. Psychiatrists are reported to experience high prevalence of burnout yet their ability to enjoy work and derive satisfaction from it appears not to be impaired. This paper examines this anomaly and the factors that may affect job satisfaction. The consequences of job satisfaction on variables such as staff retention is examined and a comparative account of various rating scales for job satisfaction is presented.

This study aims to explore the perspectives of psychiatrists with lived experiences and what their considerations are upon integrating the personal into the professional realm.

As part of a qualitative participatory research approach, participant observations during two years in peer supervision sessions (15 sessions with 8 psychiatrists with lived experiences), additional interviews as part of member feedback and a focus group were thematically analysed.

Although the decision to become a psychiatrist was often related to personal experiences with mental distress and some feel the need to integrate the personal into the professional, the actual use of lived experiences appears still in its early stages of development. Findings reveal three main considerations related to the personal (3.1), professionality (3.2) and clinical relevance (3.3) comprising 11 facilitators and 9 barriers to harness lived experiences.

This study was conducted locally and there are no similar comparable studies known. It was small in its size due to its qualitative nature and with a homogeneous group and therefore may lack generalisability.

Future directions to further overcome shame and stigma and discover the potential of lived experiences are directed to practice, education and research.

Psychiatrists with lived experiences valued the integration of experiential knowledge into the professional realm, even though being still under development. The peer supervision setting in this study was experienced as a safe space to share personal experiences with vulnerability and suffering rather than a technical disclosure. It re-sensitised participants to their personal narratives, unleashing its demystifying, destigmatising and humanising potential.

The purpose of this paper is to ascertain the current competencies and training needs for being an expert witness of trainees (CT3, ST4-6) and career grade psychiatrists (consultants and staff grade, associate specialist and specialty doctors) in a UK health and well-being Trust.

This was completed through an online survey, developed by the authors, of all career grade and trainee psychiatrists within the Trust.

Only 9 per cent of respondents reported that they felt they had adequate training to feel competent as an expert witness. Despite low levels of training and confidence, 73 per cent of respondents had written an expert report. As well as shortage of training opportunities for psychiatrics acting as expert witnesses, the findings indicated increasing fear of litigation and lack of direct experience of court proceedings during training.

Doctors need to be offered formal training opportunities including simulated training, ideally organised within Trust, Continuing Professional Development (CPD) committees or Education committees. Implementation of the RCPsych report guidance into speciality curricula and CPD opportunities for doctors would ensure a robust curriculum-based delivery of these essential skills.

A wealth of guidance is available for expert witnesses, but no previous study had identified the specific training issues and overall confidence in competency to act as an expert witness amongst psychiatrists. It will be valuable to all psychiatrists involved in court work and organisations involved in training psychiatrists, especially in light of recent relevant court cases and removal of expert witness immunity.

Findings from a 1987 survey of work satisfaction among 193 consultants and junior doctors in psychiatry in Yorkshire are reported. While nearly two‐thirds of doctors report they are generally satisfied, a substantial number of consultants and junior doctors are dissatisfied with their resources, status and autonomy, and professional relationships. Regression analysis suggests that controlling for psychiatrists′ personal and professional characteristics and variables related to district management are important in explaining differences in perceived clinical autonomy and work satisfaction among psychiatrists. Opportunities for district management to help improve psychiatrist satisfaction are proposed, and the relevance of the recent White Paper Working for Patients is examined.

The New Ways of Working national programme was started by psychiatrists (through the Royal College of Psychiatrists) when it became apparent that the roles they were being asked to carry out were unrealistic in their demands. This had contributed to a drop in recruitment and early retirement for psychiatrists in post. The New Ways of Working programme led to a reconfiguration of mental health services in many areas and an increase in the numbers of psychiatrists as well as improved levels of job satisfaction.This paper describes some of the challenges that still need to be met if New Ways of Working is to be fully implemented.

This study aims to explore current attitudes among doctors working in psychiatry, with regard to their perceived role and their confidence in managing their patients’ physical health problems.

A 20-item electronic questionnaire was distributed to doctors working in psychiatry within two large UK mental health trusts in 2018. Quantitative analysis was conducted, alongside qualitative analysis of free-text comments made by participants.

Many participants perceived their physical examination skills to have deteriorated since working in psychiatry (78 per cent). Participants were questioned on which professional group should hold responsibility for managing the physical health of patients under psychiatric services. A minority felt it should be psychiatrist-led (5 per cent), followed by general practitioner (GP)-led (42 per cent) and then shared responsibility (47 per cent). The majority felt there should be more focused training on physical health in the Core (72 per cent) and Advanced (63 per cent) psychiatry training. Key themes from a framework analysis of qualitative data included potential barriers to shared care, psychiatrists’ concerns regarding their experience and confidence in managing physical health, reasons in favour of shared responsibility, ideas for training and suggestions for improving the current situation.

Psychiatric patients may engage less well with health services, yet psychiatric medication often impacts significantly on physical health. In this context, there is often a blurring of role boundaries between a psychiatrist and a GP, and there is considerable variation between individual teams. There is a consistent call for more physical health training opportunities for psychiatrists and for mental health services to more proactively promote the physical health of their patients.

The aim of this paper is to ascertain the attitudes and experiences of psychiatrists, nurse prescribers, and service users with regard to the prescription of antipsychotic medication, the route of administration, and the extent of service users' involvement.

A total of 26 psychiatrists and 12 nurses agreed to be interviewed in phase one of this study, concerning general aspects of prescribing. In phase two, 11 of the psychiatrists and five nurses from the first cohort took part in follow‐up interviews that focused specifically on their most recent prescribing experiences. In phase 3 of the study, 18 service users (14 male and 4 female) were recruited, during which their experiences of having medication prescribed was explored.

This interview‐based survey found that though there was some agreement between the attitudes and perceptions of prescribers and service users, there were also some important differences including differences with respect to the purposes of prescribed medication, when to prescribe, and under what conditions depot medication produces optimal results. It is not always clear to service users as to why certain medicines were prescribed nor is the information provided always understood. A considerable amount of prescribing practice is based on assumptions.

Even though medication (both oral and depot) has been shown to be useful in certain situations, nevertheless, the type of medication, dose and mode of administration continues to be idiosyncratic and inconsistent. This paper seeks to contribute to the debate by identifying in which pharmacological interventions for people with severe mental health problems could be improved.