The clinical assessment and management of suicide risk depends primarily on face to face contact with the individual who presents the risk, and aims to predict behaviour in the very near future. Whether or not clinical intervention prevents suicide depends a great deal on the clinician's skill in reaching out to the individual patient. This poses a dilemma, because much of what has been written about predicting suicide has been based on averaged data concerning long-term outcome in large cohorts of patients.

The proceedings of a mental health review tribunal involve two psychiatrists – one to be found among its members and the other (having care of the patient) who appears before the tribunal as the responsible medical officer (RMO). Both have a very important role to play and the juxtaposition of two psychiatrists guarantees a lively debate at many tribunal hearings.

Children, like adults, can directly experience or be witness to interpersonal violence either within or outside the family, on one or repeated occasions. Intra-familial violence may result in the death or serious disablement of a parent or child, or may be experienced as child sexual abuse or chronic domestic violence. Non-familial violence includes urban violence now endemic in some communities, war and civil conflict, and vicarious violence such as in films and on television. Traumatic events can also occur by natural forces, for example, earthquakes, volcanic eruptions, hurricanes. This review will focus mainly on the effects on children of witnessing severe or repeated violence, sometimes resulting in death, occurring to a member of their family, perpetrated either by a parent, step-parent or cohabitee or by a person or persons unrelated to them, although it will draw on studies of other traumatic experiences where relevant.

The present case study describes a typically complex clinical presentation of chronic post-traumatic stress disorder (PTSD) suffered by a Second World War veteran and advises on multi-disciplinary out-patient management extending to acute hospital care. Limited symptomatic impact of psychological and psychopharmacological therapies is discussed, and related to patient reports of satisfaction with therapeutic outcome.

It is a sobering fact that the average age of the surviving veterans of the Second World War is now close to 80 years. The available information indicates that the prevalence of post-traumatic stress disorder (PTSD) in all Second World War veterans is slightly higher than the 15% lifetime prevalence found in Vietnam War veterans, although there are few reliable studies on which to base this conclusion. It is, however, consistent with the finding that combat stress, based on casualty rates, during periods of the Vietnam War was equivalent to the severity of combat stress in the Second World War. There are several epidemiological studies (Beebe, 1975; Tennant et al, 1986) of more specific Second World War veteran groups such as Far East prisoners of war and, predictably, they show higher PTSD prevalence rates, ranging between 30 and 50%.

From the 1991 census (Office of Population Censuses and Surveys, 1993) it is estimated that 5.9% of the total population of England and Wales belong to an ethnic minority, and that 3% of this ethnic minority population are aged 65 years and older. This compares with 17% aged 65 years and older in the indigenous population. Although the numbers of elderly people from ethnic minorities are small in absolute terms, these groups are growing rapidly, and mental health professionals working with elderly patients will increasingly need to be equipped with the necessary services and skills to meet their specific needs. The elderly ethnic minority population of the UK is extremely diverse; the largest groups originate from the Indian subcontinent and the Caribbean, but there are also significant communities of Chinese, Somali, Vietnamese, Eastern European, Mediterranean and Irish origin, all of which require consideration when planning and providing services, whatever their numbers. This diversity is also important when considering the various factors that influence the presentation and diagnosis of mental disorders in these groups.

There is a myth that people with mental disorders comply poorly with treatment. In fact, psychiatric patients are no more likely than patients in other medical specialities to go against the advice of their doctor. However, it is easy to find instances where psychotropic medication is refused by the supposed beneficiary. The value of neuroleptic treatment in schizophrenia is now widely accepted, and failure to take such treatment is associated with relapse. Relapse may endanger the patient and other people. Despite this, people with schizophrenia frequently fail to take their treatment. One-third of patients leaving a general adult psychiatry ward can be expected to be non-compliant within two years (Buchanan, 1992).

I have enjoyed reading Buchanan's paper very much. It is clear, thoughtful and contains much valuable information. As I read it, I began to think it would make a good foundation for a short factual leaflet for carers. However, they are unlikely to read it in its present form, since many would find the scientific style and wording hard going. Words such as compliance, drugs and intrusive have connotations and need to be used with care by professionals. The National Schizophrenia Fellowship uses the term adherence instead of compliance.

Traditionally, delusions have been viewed as false, unshakeable beliefs which arise out of internal morbid processes and are out of keeping with a person's educational and cultural background (Hamilton, 1978). Primary delusions appear to arise without understandable cause, and secondary delusions appear more understandable in relation to the prevailing affective state or cultural climate (Sims, 1995), for example. However, during the cognitive therapy process we would expect that even primary delusions might become more understandable as the patient's life history and belief profile are gradually disclosed.

Turkington & Siddle's article is written in a way that most helpfully allows comment from a range of perspectives; indeed, I was specifically invited to ‘broaden its scope’. They clearly describe to readers the useful techniques by which cognitive therapy can diminish the power and domination of delusions in some patients with schizophrenia.

This article considers the use of the Mental Health Act 1983 (MHA) and application of common law principles with respect to patients with behavioural disturbances in NHS general hospitals in England and Wales. Legal issues do not apply across national boundaries; in the UK there are two other Mental Health Acts currently in force: Scotland's (1984) and Northern Ireland's (1986).