At a time of increasing emphasis on community care for the mentally ill and of mounting concern about its adequacy, questions arise about the necessity for asylum and its optional provision. The term ‘asylum’ was first used in relation to institutions for the insane in the late 18th century and it became the ‘in’ word in 19th century lunacy terminology. It took over from ‘madhouse’, which a contemporary observer called “an opprobious epithet, only suited to the horrible ideas formerly deservedly associated with such places”. In turn, it was superseded officially by ‘mental hospital’ under the 1930 Mental Treatment Act, in an attempt to jettison the negative connotations of ‘lunatic asylum’, and to suggest a parallel curative function with general hospitals.

The major novelists of the Victorian era enjoyed a large readership amongst the general public. They dealt with the pressing social issues of the day and their work both reflected and shaped society's attitudes to contemporary problems. The 19th century saw fundamental changes in society's response to the mentally ill with the creation of purpose-built asylums throughout the country. The Victorians were ambivalent in their reaction to the mentally disturbed. Whilst they sought to segregate the insane from the rest of the population, they were also terrified by the prospect of the wrongful confinement of sane people. The trial of Daniel McNaughton in 1843 for the assassination of Sir Robert Peel's Private Secretary, and the subsequent legislation, provoked general public debate about the nature of madness.

Sigmund Freud spent the last year of his life at 20 Maresfield Gardens, an impressive redbrick Hampstead residence. The house was bought by his friends after the penniless psychoanalyst and his family fled from Vienna in 1938. His personal assets had been extorted from him by the authorities following the Anschluss of Austria to the Third Reich. When the family took up residence, Freud's daughter, Anna, organised his new study to resemble his Viennese consulting rooms. Before her own death in 1982, Anna arranged for the house to become a museum in honour of her father. Once again the study was refashioned to Freud's original specifications. This time capsule was opened to the public in July 1986.

If you have been referred a sex offender recently, you will probably still be conscious of how difficult it is on an individual basis to provide a comprehensive treatment approach. Indeed, in our area, as in nearly all areas, there has been little therapeutic help available for sex offenders outside the special hospital system, and certainly little for those in the community.

With the accelerating drive towards the running down of large psychiatric hospitals and the trend towards the care and management of psychiatrically ill people in the community, it is inevitable that a small proportion of these people will be unable to cope with this change. Some patients may have a long history of violent behaviour which has been coped with in hospital. Others may have been able to cope within the ‘asylum’ environment but, when placed in a community which is little better able to cope with them than they are with it, regress to violent behaviour when faced with unaccustomed stress.

The Bethlem and Maudsley Hospital item sheets (B-MIS) are summaries in coded form which are completed for every patient admitted or readmitted to the joint hospitals. The Part 1 item sheet contains information which is included in the Part 1 case summary, as described in Notes on Eliciting and Recording Clinical Information, and is completed at the same time as the summary is prepared; that is, usually within a fortnight of the patient entering hospital. Similarly, the Part 2 item sheet contains information normally found in the discharge summary, and is completed at the same time that this summary is prepared; shortly after the patient has left hospital. The item sheets are restricted to pieces of information which can be readily coded by the registrar. Thus, of necessity, they concentrate on relatively ‘hard’ data.

Wilson's disease (WD) is an autosomal recessive disorder of copper metabolism with an incidence of about 30 per million (i.e. fewer than 2,000 in the UK). Nevertheless, it is important for two main reasons: its manifestations are protean and may lead it to present to a range of specialists; and its otherwise lethal course can be halted by treatment with chelating agents such as penicillamine and trientine. Published cases and systematic study have shown that neuropsychiatric symptomatology is important in a high proportion. In fact, about one-fifth either present psychiatrically or are at least seen by a psychiatrist before WD is diagnosed.

Psychiatric services for the elderly are evolving rapidly. The Government has recently reiterated that this area needs special attention. The reasons for upheaval are well-known: the changing age structure of the population, the historical neglect of the elderly mentally ill and a growing emphasis on community-based approaches in place of traditional institutional solutions. In the London area and elsewhere, adjustment has been complicated by geographical transplantation from old suburban mental hospitals to locally situated units, often within district general hospitals. New specialist services also suffer from the effects of financial stringency and inadequate recruitment. These and other changes have ensured that the process of restructuring services has been difficult. Planners have had few precedents to fall back on, and have been heavily dependent on available guidelines. There has been comparatively little information available about how effectively services work in practice.

Many westernised countries have introduced Quality Assurance (QA) into their process of health care. The UK has lagged behind other countries and psychiatry has lagged behind other specialities.

Treatment of the mentally ill by the Aboriginal Awaraks of Jamaica and the other Caribbean islands was first described by a Spanish monk in 1540: ‘Lunatics’ who were called ‘mind riven’ were treated in the community with salvent herbs, which were blended with food and left to hang on fruit trees for those who wandered, and by the administration of unguents and lavings while singing. This record indicates that the mentally ill were treated by the indigenous Indians without restraints, and with rudimentary attempts at pharmacology and cultural therapies. But this enlightened but primitive mental health system was destroyed with the advent of the Spanish conquerors who, according to Las Casas, “in about eight to forty years have unjustly put to death about twelve million Indians without distinction of quality, sex or age”.

During a recent visit to China, which included meetings with psychiatrists in Beijing, Shanghai, Xian and Hohot, I noted that many of the political constraints of the Cultural Revolution on psychiatry had been removed. Clearly, Chinese society was still strongly influenced by Marxist doctrine, but there was greater academic and clinical freedom for the reinstated professionals who had previously been considered ‘elitist’. Western textbooks and journals were available, and the very fact that Chinese psychiatrists were able to communicate freely with me was in sharp contrast to the enforced isolation of the previous decade.

An international workshop on Epidemiology of Mental and Neurological Disorders of the Elderly was held in the Medical University of Beijing in the People's Republic of China from 16–20 November 1987. The workshop was organised jointly by the Beijing Institute of Mental Health and the WHO Collaborating Centre for Research and Training in the Neurosciences, Milan, Italy.

The history of health services in Nigeria shows that the earliest services were provided for sailors and slaves. Later, government services were introduced mainly to cater for European civil servants and military personnel. Since the introduction of these rudimentary services, the health services in Nigeria have undergone a series of developmental epochs.

There was a time when overseas psychiatrists considered themselves fortunate to come to this country to be an assistant in one of the well-known postgraduate departments. If they showed perseverance they could learn enough to obtain an English postgraduate qualification, and they could participate in the training of English psychiatrists. The more entrepreneurial of them could obtain full-time jobs in psychiatry, but otherwise hands on experience of patient care was limited.

For several years members of the University Department of Psychiatry and post-membership trainees have organised an informal exam workshop for the final part of the Membership examination of the Royal College of Psychiatrists. This is in addition to existing postgraduate courses in the Region. The workshop concentrates on examination technique rather than on teaching the basic knowledge required. Trainees from within the Mersey Region due to sit the June or November sittings of the final MRCPsych are invited to attend by formal and informal means and the workshop is currently held on a weekly basis over six weeks. According to guidelines laid down by the College, the majority of trainees have access to postgraduate training at a university department of psychiatry; usually by day-release courses. However, these vary widely in their immediate relevance to the Membership examination; and the amount of experience in examination technique. Consequently, several residential pre-examination training courses and workshops that give this experience have flourished.

In 1986 I was awarded the Squibb Travelling Fellowship by the Royal College of Psychiatrists. The funding this provided, combined with funding provided by the Henry Hutchinson Stewart Scholarship in Psychiatry awarded by Trinity College, Dublin, enabled me to spend a three month period in the summer of 1987 at the Children's Hospital Medical Center, Boston, doing research in the area of emotional adjustment in adolescents with chronic physical illnesses. The research will be the subject of a future paper. The purpose of this communication is to outline some of the steps en route between winning the Fellowship and starting on the project at Children's Hospital. The amount of paperwork involved was time consuming, confusing and, at times, overwhelming, and I hope that other doctors planning to travel to the United States to carry out research will benefit from my expeience.