The continued existence of ‘psychopathic disorder’ in the Mental Health Act of 1983 ensures that well into the next century individuals thus categorized will be detained in Special Hospitals and elsewhere. In this paper I want to consider the problem of ‘psychopaths' in the Special Hospitals, as I see them, both for the patients and the institutions, and I will pay special attention to the way such patients are detained. More specifically, I will argue that greater use should be made of treatment orders during the course of a prison sentence, rather than at the time of conviction. In other words, let there be more use of Section 72 of the 1959 Act (to become Section 47 of the new Act), as opposed to Sections 60 and 60(65), which in the new Act become Sections 37 and 41 respectively. At the end of 1982 only seven out of about 150 ‘psychopathic disorder’ patients in Broadmoor were detained under Section 72. The great majority were held on Section 60(65).

There is increasing interest in services for younger brain damaged persons (acquired in adult life as a result of trauma or illness). However, there is uncertainty about the type of service needed and to whom the medical responsibility belongs.

Over thirty-five years have elapsed since Dr Joshua Bierer opened the first psychiatric day unit in London in 1946. Following a somewhat tentative start in the early 1950s, day hospitals expanded rapidly during the latter 1950s, ‘60s and into the ‘70s, and are now regarded as an established part of the psychiatric services. However, it is probably a truism that many of the staff working in psychiatry know little more about the philosophy, practice and effectiveness of day care than their colleagues did a generation ago.

Here is a good teaching case:

Mr Watene, aged 25, was put in prison for seven days on a charge of offensive behaviour, with a charge of robbery pending. On the third day he was recommended for transfer to a psychiatric hospital because he was sullen, depressed and uncommunicative; he had barricaded himself in his cell because he was scared of other prisoners, and he carried a knife for his protection, as he said. Two doctors wrote the order. One noted: ‘It is very difficult to gain his attention. He cerebrates slowly, and replies to repeated questioning are in the main irrelevant.’ The other said: ‘It is not really possible to have a conversation with him, but he does indicate his fear of being left alone in the cell and wished me to stay with him. Says he is mixed up.’

The Statutory Registration of Psychotherapists is a continuing issue which remains to be resolved. Various parties have been interested for all sorts of reasons, such as the raising of training standards, the protection of patients, the avoidance of VAT for lay psychotherapists in private practice, or the establishment of a new professional identity which would enable the employment of lay therapists within the NHS (comparable to child psychotherapists). For all these and other reasons active debate continues. The College at least needs a view. If it actively and unanimously speaks in favour of Registration, government time might be provided for a Bill. If we do nothing, or are against, other bodies will probably proceed and another Private Member's Bill may sooner or later succeed. So are we to be involved or not, and if so in what role?