Aims and method To establish an initial conceptualisation of how psychiatrists understand and use formulation within adult psychiatry practice. Twelve psychiatrists took part in semi-structured interviews. Transcripts were analysed using a constructivist grounded theory methodology.Results Formulation was conceptualised as an addition to diagnosis, triggered by risk, complexity and a need for an enhanced understanding. Participants valued collaborative formulation with psychologists. Multiple contextual factors were perceived to either facilitate or inhibit the process. Barriers to formulation led to a disjointed way of working.Clinical implications Findings contribute to an understanding of formulation within psychiatry training and practice.

Denman et al's paper 1 was thought-provoking and of vital importance given the current difficulties in recruiting to psychiatry training schemes. However, it is our opinion that the authors made a significant omission in not assessing the effect that Mental Health Officer (MHO) status has had on applications to training schemes.Certain members of staff who were members of the National Health Service pension scheme before 6 March 1995 were eligible for MHO status. 2 This enabled them to take retirement aged 55 with no reduction in pension benefits. MHO status was withdrawn in March 1995.Financial incentives have become almost a taboo subject, but one which we feel should be revisited. MHO status recognises that, owing to the particular stresses in the