The 1983 Mental Health Act introduced new powers for courts to remand mentally disordered defendants to hospital. The provisions came into operation in October 1984, and were preceded by a Ministerial statement that the new arrangements were becoming available because the Government believed.

That a hospital in an African country has just celebrated 25 years of its existence may not seem a particularly newsworthy event but I hope that the story I have to tell will prove to be interesting and maybe even instructive for many more colleagues than those having a special interest in Africa. My own qualification for recounting the story is that I have worked at Chainama Hills Hospital since September 1964, just 15 months after it was opened.

During my training I have had the relatively unusual experience of two placements in community psychiatry—one at registrar, the other at senior registrar level. These placements were in many respects quite different. One was in an Emergency Psychiatric Service based in a London teaching hospital and the other was in a domiciliary-based Crisis Intervention Service in a district general hospital. A feature shared by both services was a multi-disciplinary team. The move towards community psychiatry is going hand in hand with the multi-disciplinary approach, and this leads inevitably to some re-evaluation of the role of the psychiatrist as other disciplines contribute more to clinical assessment and management. From my own experience as a member of these teams I have noted the relevance of two overlapping issues; these concern attitudes to the practice of psychiatry and the distribution of responsibility within the team.

The issue of sexuality and the mentally ill provokes an uneasy reaction in many people. The lay person possesses inaccurate notions, for instance, about the level of sex drive or the expression thereof. Public interest and anxiety was recently fuelled by the case of Jeanette, the mentally handicapped woman for whom sterilisation was requested. Less understandable is the reaction of the more informed carers of the mentally ill. Being in such a position of responsibility raises a challenge, though the usual attitudes are of either ambivalence or denial. It was not then without some reservations that we organised a group for young people with psychotic conditions, with the aim of tackling sexual issues in relationships.