Night-time confinement, currently imposed as a blanket restriction on all patients on wards in UK high secure hospitals, constitutes an arbitrary restriction of liberty, not being based on any therapeutic purpose for those so restricted, nor serving a need for the protection of others. Its imposition constitutes a form of ‘degrading’ treatment as well as an unjustified restriction of ‘residual’ liberty. Persons who are vulnerable, especially those who are involuntarily detained as in this case, are particularly at risk of suffering human rights abuses. A compelling case can be made, based on ethics, law and accepted practice standards, for ruling out night-time confinement as an acceptable measure.

The number of psychiatric beds in Friern Hospital in North London was steadily reduced in line with plans to close the hospital in 1993. Meanwhile some discharged patients deteriorate, most of whom have schizophrenia, with significant and multiple disabilities of a chronic nature and are service dependent as described in the recent report of the Royal College of Psychiatrists (1993). Return to their accommodation may be prejudiced by their relapse and the attendant disturbed behaviour. The poor employment prospects too are unhelpful in rehabilitation, particularly since we are running down and closing probably one of the best industrial rehabilitation facilities in the world. The combined effects generate great pressures on the remaining beds and there are increasing numbers in prison.

We have previously reported on the formation of a large regional registrar scheme covering 11 health districts in the South Thames region (Herzberg & Watson, 1991) and highlighted educational principles which we considered important for registrar training. The purpose of the present paper is to review those principles in the light of experience to date in running senior house officer (SHO) and registrar training schemes.

Independent sector psychiatrists believe that they work hard for the benefit of vulnerable people. Differences between them and National Health Service colleagues are not clear cut in terms of motivation or quality of care. However, unfair generalisations are made about the diverse ‘private sector’, with selective comparison such as with the worst of US healthcare. Although there are many examples of excellence in the UK state, commercial and charity sectors, global economic changes are bringing risk of care failures from which no area can be immune. We should all be working together to protect our patients from the mistakes of others.

Following the establishment of the College, the Public Policy Committee held its first meeting in March 1972. It evolved from the Parliamentary Committee of the RMPA and at that meeting its terms of reference were agreed and are still current. They are: ‘That it shall take note of and consider legislation, existing and prospective, and departmental, regional and local administrative practice with a view to commenting on matters touching upon the affairs of the College. In this respect it is empowered to take immediate action, if public statements about psychiatric affairs are urgently required, but normally will report to Council any measures which it recommends. It shall concern itself with the education and enlightenment of the public in matters relating to the prevention and treatment of mental disorder and the work of the College and its members.’

It is in the nature of Health Services that there should exist a balance between the general and the specialised; between the treatment of common conditions with generally applicable techniques and the handling of more unusual diseases. Services which require scarce skills and treat less patients who need more time are expensive. In a cost-driven situation, these skills are likely to be constrained in favour of more generally applicable, lesser standards which are cheaper.

The main aim of this pilot study was to identify factors influencing acute psychiatry bed use. The reasons for occupying a bed vary with time, so patients in the study were assessed on a weekly basis to monitor the changes in the factors thought to be responsible for continued stay. The reasons for bed occupancy also are often only known to those professionals directly involved in day to day care of patients, and it is suspected that the reasons often have little to do with manifest psychiatric illness. The reason for this study was to investigate this question.

Although pharmaceutical companies report side effects that may occur with use of their medications, little data on specific groups of patients that may be at risk of particular side effects is available (Katz et al, 1991). Patients with diabetes mellitus form an important group for psychiatrists since the occurrence of depression is relatively common with this group and guidance on its treatment is lacking.

When I reached Seychelles to start my new job with the Ministry of Health as a consultant psychiatrist at the Victoria Hospital I had hardly any idea about the islands, let alone its mental health service. But I decided to take the job partly out of curiosity and an interest to see what psychiatry would be on a tourist island in the middle of the Indian Ocean.

Mark Jones continues this occasional series by examining Verdi's Macbeth of 1847 in the light of David Pountney's new production for the English National Opera premiered at the London Coliseum in April.

The ten year period 1840–1850 saw the appearance of ten operas by the young Giuseppe Verdi which now constitute his ‘early’ musical output. Not all the operas were equally successful and Verdi later acknowledged their inconsistencies; but here was the work of a genius who was to become the greatest composer in the Italian tradition, and at this time was thought of as a worthy successor to Rossini, Donizetti and Bellini.

As long-stay patients move into the community, the relationship with the psychiatrist gets diluted. One reason is the logistical problem of visiting widely spaced residences, but another is that patients are primarily under the care of general practitioners (GPs) who provide physical care in the majority of cases. The way in which psychiatric care is delivered is variable (Horder, 1991). For the system to function a modus vivendi has to develop between GPs, psychiatrists and care staff. This study looks at current practice in Gloucester.