Despite some general interest in the development and evaluation of continuing education for health professionals, the voluminous research literature on the subject is unfortunately equivocal as to exactly what approaches work and in which situations. In 1977, Bertram and Brookes-Bertram reviewed 113 studies of continuing medical education (CME): they found that three out of the eight studies which they judged as acceptably designed showed persistent positive effects. More recently, of six studies which examined the effect of CME upon the quality of care, half reported positive effects and half reported no effect, although all the studies demonstrated cognitive improvements.

A personnel manager told me of a father who said of his son who had had some mental illness, “I didn't know what a nice son I had until he got a job.” Even the most apparently dreary work may be a life saver for someone with chronic psychiatric problems. On the other hand, an able young man in one of the work projects I discuss here was outraged by the boring packing work he had had earlier in his illness. But clearly a whole constellation of problems, stemming from the person concerned and from society, provides obstacles to getting work, interesting or otherwise, and keeping it. Many approaches have been evolved over the years in the provision of work as therapy, with graded work, detailed assessment, and perhaps psychological methods, and of later work with support as necessary. However, it is still all too common for these people to sit at home doing absolutely nothing.

With this contribution I would like to give a general account of new attempts in the Federal Republic of Germany (FRG) to provide suitable jobs for emotionally handicapped people. It concerns jobs in enterprises on the general labour market which have been especially created for the emotionally handicapped in order to make social access possible for them. Just as certain physical changes in environment, transport, building etc. allow social access to public life for the physically disabled, the above mentioned group of people need certain social places which take their special needs into account.

The importance of rape crisis programmes in the United States is that they provide a service for rape victims that does not exist in Britain: a hospital-based service providing physical, psychological, emotional and practical help for the rape victim and which regards this work as a crucial part of health care provision.

Regional Secure Units are already in operation in many Regions in England and Wales and in others secure units are either in the planning stage or are being built. Interim units are available in most of the Regions without a permanent unit. Almost all these developments appear to favour the mentally ill, and the placement of mentally impaired patients is not receiving sufficient consideration.

Current government policy and the need for higher standards of training are leading to reductions in registrar posts and more emphasis on ‘consultant based’ services. My first consultant post was in such a service. I hope that a description of some of the difficulties encountered will assist informed debate.

There had been repeated staff dissatisfaction with the community meetings. Particular concerns included staff interrupting each other; frequent changes of theme; insufficient time for adolescents to speak or answer questions before the next staff intervention; some staff, particularly the more experienced, tending to fill the time with their questions or contributions. Repeated discussion of the meetings resulted in transient improvements lasting only until the next period of competition between eager therapists, or the next assertion of ‘need to know’ by the oncoming shift.

It was felt that Members of the College would be interested to see the comments of the British Medical Association and the Joint Co-ordinating Committee (The Medical Protection Society, The Medical and Dental Defence Union of Scotland and the Medical Defence Union) on the Mental Health Act 1983 Draft Code of Practice. The comments of the College were published in the Bulletin, August 1986, 10, 194–195.