This review considers the place of psychiatry in the complex area of management of the sexually abused child. A model is described in order to guide psychiatric perspectives in the field of child sexual abuse, before describing an approach to management in mental health teams.

Electroconvulsive therapy (ECT) is a long established form of treatment for specific, serious mental disorders, but one which is still surrounded by much misunderstanding and fear. The use of electrical current administered to the brain to ‘treat’ illness remains a barbaric concept to many people. Much research has been conducted to establish the efficacy of ECT, which is now widely accepted. However, the working principles of the ECT machine itself are little understood, and more research remains to be done to establish, more scientifically, which is the ‘best’ way to administer the electrical stimulus. With the recent introduction of the concept of “stimulus dosing” (for a review see Lock, 1994), the need to be aware of the ECT machines available and their abilities and limitations is important.

For centuries the conditions existing in institutions have been a cause of concern. Accompanying this has been a drive to improve the quality of care in such places. Until the second half of this century younger patients constituted the majority of the mentally ill residing in institutions. Now the balance has shifted and considerable numbers of elderly people, particularly those suffering from dementia, are residing in institutions (hospitals, nursing and residential homes). Perhaps never before has the question “What makes a good environment for the demented?” been so important.

Healthcare organisations are currently in the midst of a period of fundamental change. Mental health services in particular have moved away from institutional care towards a complex inter-related community health social and voluntary model of service delivery, involving a diverse range of care professionals and commissioners.

Medical and nursing staff in acute specialities spend up to 25% of their working lives collecting, analysing, using and communicating information (Audit Commission, 1995). It is likely that staff delivering mental health care, which often involves services and staff based in a number of locations and inter-agency collaboration, spend just as much of their time on these activities.

Mental health care is a complex undertaking. It involves care providers of many disciplines, administrative support staff, managers, funding bodies and of course carers and patients themselves. Each group has their own information needs; each, however, is primarily concerned with other things, and the importance of minimising the effort involved in amassing and accessing dependably accurate information cannot be stressed too highly.

Formal care plans extend the functions of traditional psychiatric case assessments by specifying more of the operational details of case management practice. They usually include descriptions of case management problems and objectives, the planned case management interventions, and who is involved in providing care.

It has been known for some time that the majority of adult mental health problems within any community are seen within general practice, making up a fifth to a quarter of the general practitioner's workload (Shepherd & Clare, 1981). Most patients are not referred to specialist services. It is therefore the primary care team and not the psychiatric specialist who assumes the major burden of responsibility for the care of mental disorder. Hence, more attempts are now being made to improve the quality of psychiatric care within general practice. Most of the research on mental health morbidity within primary care has been in the field of adult mental health and it is only relatively recently that equivalent information on child mental health morbidity has become available. In parallel, an increasing number of studies examining the effectiveness of interventions in primary care have been undertaken and different models of mental health service provision within this context have been described (Strathdee & Williams, 1984). There are few evaluated studies of interventions in primary care focused on child mental health. Most guidance for the development of such services has to be obtained from the adult mental health literature, or from work with other types of childhood disorder, often in non-general practice settings.