The first step towards the establishment of an independent body to supervise standards of care for psychiatric patients was taken with the appointment in 1774 of Commissioners in Lunacy with the responsibility of licensing and inspecting private madhouses in London. It consisted of five physicians elected annually by the Royal College of Physicians. They were replaced in 1828 by a body of Metropolitan Commissions, consisting of fifteen members appointed by the Home Secretary, of whom only five were physicians and most of the rest were Members of Parliament. Their powers included (with respect to London) the supervision of 'subscription hospitals for the insane’ in addition to private madhouses (but with the exception of Bethlem). For a short period from 1842 their jurisdiction widened further to include provincial hospitals as well as those in the Metropolis.

The aim of this article is to inform College members about the role and function of this important committee which has been in existence since July 1978. It is of interest to appreciate the events which led to its establishment.

The Royal College of Psychiatrists recommends the formation of a Mental Health Commission or Commissions. These will be independent bodies to look after the welfare of individual mentally disordered persons. They may be the appropriate bodies to deal with matters of individual patient care which are not the responsibility of other bodies, such as the Health Advisory Service, which deals with hospitals and some community services, Mental Health Review Tribunal's which are concerned with detained patients only, the National Development Team which deals with the mentally handicapped and the Court of Protection which is concerned with the administration of patients' affairs and property.

Since I started to work for the College Bulletin the fan mail I have received about this column has been a pleasant bonus. It is heartening to receive letters of support, and I am glad to have them all. There is no higher reward than the approbation of one's colleagues expressed in monetary terms, so I would like to very warmly thank those of you who send me their admonitions written on the back of a postal order.