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Several recent events have again highlighted the issue of workplace stress in psychiatric hospitals, the most dramatic involving staff suicides, including doctors both qualified and in training. These issues have been approached simultaneously from several different angles, including looking at the effects of the latest hospital reforms on the relationship between practitioners. Confronted by reorganizations driven by measures to improve efficiency figures, the challenge could be to define the operating principles consistent with the ethical and collegial commitments of doctors, and this within a framework that protects against the deleterious influences of institutional reforms. The office of the Hospital Psychiatrists’ Union (SPH) is currently grappling with this question.