Peter Kennedy and Hugh Griffiths (2001) have convened a timely debate on the role and responsibilities of consultants in general adult psychiatry. They provide an analysis of difficulties in fulfilling this role, including inappropriate general practitioner (GP) referrals, excessive caseloads and increasing stress leading to premature retirement. They provide the jobbing consultants with two models of out-patient practice, both relative to the community mental health team (CMHT). However, they have not considered the potential effect of change currently underway as summarised below.

Records were obtained of all suicide and open verdicts in York (n=127) between 1990–1994 inclusive. Those with no past or current contact with psychiatric services were identified (n=67). The extent and nature of this group's general (i.e. non-psychiatric) hospital contact in the months prior to death was established. Thirteen per cent (9/67) of these received general hospital input in the month before death with eight out of the nine aged over 65. Five of the 67 suicides showed evidence of depression. General hospital practitioners are in a position to make a small but important contribution in reducing the suicide rate.

We select the letters for these pages from the rapid responses posted on bmj.com favouring those received within five days of publication of the article to which they refer. Letters are thus an early selection of rapid responses on a particular topic. Readers should consult the website for the full list of responses and any authors' replies, which usually arrive after our selection. Obesity Stop all further research-and act How many studies into obesity does it take to build one cycle path for children to get to school on? I believe we have now reached saturation point as to how many studies and articles it takes to convince us that we are too fat as a nation. 1 2 What good does it do to advise people that they need to walk/cycle/ swim when the infrastructure is doing its best to prevent exactly this? Given all the suggested health assessments, dietitians' advice, government guidelines, and supermarket labels there is something missing: action to force planners, developers, councils and local authorities to end totally unsustainable, fat-making practices. These practices include building roads without cycle lanes (or trying to get away with painting a thin white line on a 70 mph road and declaring it a cycle path) and putting up a nice little "walk to health" road sign beside a traffic jammed road heavy with exhaust fumes. Councils have "cycle to work days"-knowing that the best that cyclists can hope for on most roads is that they have a decent, soft ditch to fall into. The worst is to run out of cycle path and find yourself between a bus lane and two lanes of heavy traffic. I suggest that all research stops now, all advice stops now, and all infuriatingly patronising labelling stops now. The money must now be spent on buying land from private owners, farmers, developers-and on building cycle paths. The only way we will be able to tie our laces in the future and not need cardiopulmonary resuscitation at the age of 35 is to demand and build a functioning, cyclist and pedestrian centred, integrated, reliable public transport network. Having witnessed the government's transport policies in the last decades, I would say: fat chance.

Interface activity between primary and secondary care is being increasingly seen as an essential feature of high‐quality, safe mental health services. In this article, Dr de Silva compares a proactive community mental health team (CMHT) approach with that of a mental health polyclinic for the assessment and triage of new referrals for depression, cognitive problems and medically unexplained symptoms, with reference to the model used in his own service in Whitby. Copyright © 2009 Wiley Interface Ltd

Peter Kennedy and Hugh Griffiths (2001) have convened a timely debate on the role and responsibilities of consultants in general adult psychiatry. They provide an analysis of difficulties in fulfilling this role, including inappropriate general practitioner (GP) referrals, excessive caseloads and increasing stress leading to premature retirement. They provide the jobbing consultants with two models of out-patient practice, both relative to the community mental health team (CMHT). However, they have not considered the potential effect of change currently underway as summarised below.