Deliberate practice (the seeking of situations in which one's skills arechallenged and thus improved) is key to the acquisition of clinicalexpertise. This editorial outlines the philosophy of deliberate practice andpotential difficulties in making use of it in psychiatry.

I discuss the productive interface between psychiatry and the arts in the20th century and ask whether such an interface is likely to remain asvibrant into the 21st. I review how new models of mental functioning thathave an impact on current psychiatric practice have a wider culturalrelevance. This editorial looks forward to a series of articles in futureissues of APT which will explore some of these ideas inmore detail.

People turn to poetry and to psychotherapy when in states of heightenedemotion – love, elation, despair, death and loss. Through the analysis of aparticular poem this article suggests that there are formal similaritiesbetween poetry and psychotherapy that can illuminate the workings of thelatter. Perhaps the most overarching of these is mentalisation: the capacityto ‘think about feelings’ or to be ‘mind-minded’. Finding the ‘right wordsin the right order’ is a task for therapists and their patients as well asfor poets, since the appropriate image or metaphor can mirror or evokefeelings in the listener in a way that facilitates empathic attunement. Iffeelings can be objectified, their power to distress or overwhelm ismitigated. Thus, poetry and psychotherapy are similarly concerned withprocesses of repair of the human experiential and communicative fabric.

Choice, responsibility, recovery and social inclusion are concepts guidingthe ‘modernisation’ and redesign of psychiatric services. Each has itsadvocates and detractors, and at the deep end of mental health/psychiatricpractice they all interact. In the context of severe mental health problemschoice and social inclusion are often deeply compromised; they areadditionally difficult to access when someone is detained and significantaspects of personal responsibility have been temporarily taken over byothers. One view is that you cannot recover while others are in control. Wedisagree and believe that it is possible to work in a recovery-oriented wayin all service settings. This series of articles represents a collaborativedialogue between providers and consumers of compulsory psychiatric servicesand expert commentators. We worked together, reflecting on the literatureand our own professional and personal experience to better understand howchoice can be worked with as a support for personal recovery even incircumstances of psychiatric detention. We were particularly interested toconsider whether and how detention and compulsion could be routes topersonal recovery. We offer both the process of our co-working and ourspecific findings as part of a continuing dialogue on these difficultissues.

We consider the value of dialogue between healthcare professionals andmental health service users with severe mental illnesses. Discussion withthe service user before, during and after a psychiatric crisis should helpservices to offer choice even to individuals under compulsory detention.

We outline how the values-based approach adopted in training materialssupporting the Mental Health Act 2007 for England and Wales will complementrecovery-based practice in compulsory psychiatric detention.

We have developed this succession of articles as a series of iterativesteps, each seeking to uphold the recovery values of co-working andcollaboration, looking for agreement and commonality but valuing equallydiverse viewpoints and difference. Our conclusion is that this is thebeginning of a creative dialogue on choice as a route to recovery for peoplewho are psychiatrically detained. We commend our method of engaging with theinevitable tensions and dilemmas by: clarifying the story behind difficultinteractions, identifying the relevant guiding principles and jointlyworking to explore from different viewpoints what can be done to promoterecovery.

This article focuses mainly on issues regarding doctors' clinicalperformance (capability) and behaviour (conduct), and is aimed at medicalmanagers who deal them. It covers identifying problems and how to managethem, describes typical underpinning (disciplinary) frameworks and sets outthe role of the UK's National Clinical Assessment Service and other externalbodies in more serious cases.

It takes courage, leadership and planning to successfully implement asmoke-free policy in mental health settings. The content of the policy iscrucial in setting parameters for implementation. Management and cliniciansshould work closely together to develop and coordinate the implementationstrategy, ensuring that resources are effectively used and deadlines aremet. Key success factors are effective management at both central and locallevels, as well as consultation with service users, carers and staff to gainsupport for the policy and obtain suggestions for improvement. Otherimportant factors are advance planning, recruitment of experienced staff,effective communication and extensive training of staff in smoking cessationsupport. Local teams should develop appropriate procedures based on thepolicy. They should work closely with the central management team. Theresources developed and obtained by local teams should be shared throughoutthe organisation and should be tailored to meet the needs of particularservices.

This article reviews the current literature regarding treatments for smokingcessation in both the general population and in those with mental healthproblems. The gold-standard treatment for the general population ispharmacotherapy (nicotine replacement therapy, bupropion or varenicline)coupled with individual or group psychological support. This is alsoeffective in helping people with mental illness to reduce or quit smoking,but care must be taken to avoid adverse medication interactions and tomonitor antipsychotic medication in particular as cigarette consumptionreduces.

Smoking is the largest single cause of preventable illness in the UK. Thosewith mental health problems smoke significantly more and are therefore atgreater risk. The new Health Act (2006) will require mental healthfacilities in England to be completely smoke-free by 1st July 2008. Thisarticle reviews the current literature regarding how smoking affects boththe physical and mental well-being of people with mental health problems. Italso considers the effects of smoke-free policy in mental healthsettings.

A good medical history is an essential starting point in ensuring that thephysical health needs of people with severe mental illness are addressed.Psychiatrists have an important role in helping to tackle the general illhealth, excess of undiagnosed physical illness and reduced survival ratesamong their patients. To do this they need to use their medical training,communication skills and regular contact with patients. Assessments shouldinclude family history, past and current physical health, medication,lifestyle, healthcare and physical symptoms. Some groups of patients willneed more detailed assessments.

Intellectual and other more specific neurocognitive impairments inschizophrenia are important for understanding the aetiology of the conditionand its likely outcome. However, these impairments are not usuallyconsidered important for supporting a diagnosis in suspected earlyschizophrenia. IQ testing is widely available and probably acceptable tomost people likely to be experiencing the early stages of psychosis and whomight be unable or unwilling to disclose details of their history and mentalstate or to cooperate with more comprehensive neuropsychological assessment.Although in general IQ tests have only limited diagnostic value inschizophrenia, the finding of a substantial decline in IQ score from theestimated premorbid level may be helpful in supporting a provisionaldiagnosis of early schizophrenia in cases without organic signs in which theclinical picture is unclear or incomplete. More important, the results of IQtests may contribute to a better understanding of patients' impairments andassist clinical management in a number of ways, as illustrated here by threefictional case studies.