Section 136 of the Mental Health Act (MHA) 1983 authorises the police to take a mentally disordered person from ‘a place to which the public have access’ to a place of safety in order to be assessed by a doctor and an approved social worker. The person may be detained in the place of safety for up to 72 hours. Despite increasing controversy, the provision survived a heated parliamentary debate virtually unchanged from the 1959 Act. During the passage of the Mental Health Bill through Parliament, concern was expressed about the considerable variation in its use. Psychiatric examination of the provision has often been in comparison to compulsory admission provisions and the research populations have generally been confined to persons admitted to one hospital only. Although some researchers have recognised the variations in the way the provision operates, there has been no systematic examination of these variations. An important question is whether these variations result in differences in patient care and this question is largely unexplored. In the first part of a three part study of s136∗ the researchers set out to examine this question.

The use of seclusion in psychiatric hospitals has been declining over the last century due to the development of other methods of managing disturbed behaviour and more successful treatment of illnesses predisposing to disturbed behaviour. Pressure from society has come in the form of the ‘open door’ movement and legislation such as the Mental Health Acts of 1959 and 1983 and may also have promoted less restrictive management of patients or simply produced a shift of the site of management from hospitals to prisons. Guidelines from the Mental Health Act Commission have recently been formulated and may continue this process.

This is a report on a project which offers long-term day hospital patients a training which will lead to paid employment on the open market. Lack of work compounds the low self-esteem of chronic psychiatric patients. They experience multiple disadvantages, including loss of status, purpose, personal identity, social contacts outside the family, and a time structure to the day. Many of these disadvantages are known to be experienced by unemployed people in the general population. In most surveys, a fifth of the unemployed report a deterioration in their mental health since being unemployed, with an increased frequency of deterioration proportional to length of time without work. Work enhances self-esteem by decreasing the degree of dependency and by allowing identification with non-patients and may influence perceived locus of control. Work provides social participation and is ‘a visible measure of normality’ for former patients.

In parallel with more open political access for Westerners to China over the last decade, there has been a proliferation of interest in Chinese psychiatry. The pre- and post-liberation developments of the specialty have been reviewed. Further, increasingly detailed and balanced first-hand accounts by Western psychiatrists of visits to Chinese facilities have appeared.

From the back of the school hall a boy spoke: ‘If you agree to play cricket you can hardly complain when they put the fast bowlers on against you.’ Eighty of his fellow sixth-formers laughed, but his view differed little from most of theirs. The discussion was about ECT.

Depot Clinics or ‘Moderate Clinics’ tend to be similar. They are usually regarded as ‘low priority’ and often staffed by clinical assistants with only a limited training in psychiatry. Typically a large number of patients turn up each week, and there is little time for a detailed assessment of their needs. The clinic is often seen as ‘a chore’ by medical and nursing staff who may feel that the long-term care and support of patients with chronic disabling illnesses lacks excitement. One gains the impression that the patients with the less attractive personalities or those presenting repetitive management problems are more likely to be referred.

The Royal College of Psychiatrists has always been keen to promote research by psychiatric trainees. Trainees are becoming increasingly aware of the need to produce research in order to enhance their promotion prospects and to widen their own knowledge and experience. At the University Department of Psychiatry in Liverpool we have taken an active role in its promotion within the region and in the spring of 1986 we decided to conduct a survey into research activity by psychiatric trainees in Mersey Region.

Prior to the 1983 Mental Health Act (MHA), Mental Health Tribunals (MHRTs) did not have the power to order delayed discharge of a patient appealing against a section, although there was evidence that tribunals used the power of adjournment to allow time for follow-up to be arranged. This power was used more often with patients in special hospitals where the option of remaining on an informal basis did not exist. Hepworth and others advocated giving tribunals the power of delayed discharge. This was supported by the White Paper (1978) and subsequently became part of the 1983 MHA, together with some increase in the responsibility of the local authorities to provide after care for Section 3 and 37 patients. But the new Act also allowed the appeal of patients on Section 2, while giving no responsibility to the local authority for their after-care. It was difficult to see how delayed discharge could be implemented as an after-care safeguard for Section 2 patients who would often have only two weeks or so of their Section to run in any case. With this in mind, I studied all cases appearing before the MHRT in a general psychiatric hospital in the two years following the new Act.