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 number of drug abusers in this country has increased over the past 20 years, and the pattern of drug taking has also changed. More people now take drugs on a recreational basis, and a smaller proportion of addicts show the full-blown picture of physical and mental deterioration associated with addiction in the past. Where such deterioration is present, pregnancy rarely occurs because of suppression of menstruation and ovulation and reduction of male fertility. Perhaps because of this change, the number of pregnant drug addicts has also increased. They now create a significant problem in the obstetric departments of hospitals in major population centres where addicts tend to congregate.

The year 1887 is memorable in medical history for the painting depicting ‘Une leçon du Docteur Charcot à la Salpêtrière’ by André Brouillet (1857–1914), a pupil of Gérôme. Lithographs by Eugene Pirodon of this painting were much reproduced and Sigmund Freud hung a copy in his consulting room. In fact, Freud had travelled from Vienna to Paris, in October 1885, to observe the work of Jean-Martin Charcot at the Salpêtrière. Charcot's views about hysteria and hypnosis were to have a formative and enduring influence on Freud, who returned home, four and a half months later, as one of Charcot's unqualified admirers and champions. It is timely, exactly a century later, to reflect on Charcot's work and influence, when his career was at its zenith and, in particular, to consider his impact on British psychological medicine.

Only a minority suffering from mental illness are treated by the specialist psychiatric service. The majority of psychiatrically ill patients seen in general practice suffer from minor neuroses, personality disorders and situational reactions and can be appropriately treated by the primary care team. However, a significant degree of morbidity, some of it severe, fails to be identified in general practice and the identification and treatment of psychiatric disorder varies according to the GP's interest and attitudes.

In 1978 the Section for Social and Community Psychiatry of the Royal College of Psychiatrists set up a working party to reconsider the DHSS guideline of 0.5 beds per 1,000 population for acute psychiatric units and to develop a new approach which would enable planners to adopt an appropriate bed provision figure according to the needs of different district psychiatric services. This followed the realisation that Health Authorities were beginning to set arbitrarily their own norms for bed provision, often based on one or two examples within their region, despite the fact that there is a two to three fold variation between districts in the number of beds provided for acute psychiatry. For example, in 1981 Worcester used 0.19 acute beds per 1,000 population and Camberwell used 0.76.

At a time of financial stringency, it may seem perverse to speculate about the ideal. Nevertheless, recent experience of working in the psychiatry emergency room (ER) of a large teaching hospital in Texas set me thinking about the requirements for a really satisfactory emergency psychiatry service (eps); one which would run smoothly and be acceptable to the clients, their families and the agencies involved in making referrals; one the staff running it would feel comfortable with and get satisfaction from working in; one which would provide a comprehensive and really adequate service, rather than just a finger in the dike.

This paper gives information about people attending a counselling centre and a psychiatric out-patient clinic in London. Data were collected in order to clarify the extent to which the counselling centre deals with people with significant psychiatric morbidity, rather than people with distress and life problems not amounting to illness; and also to define groups in society currently using the counselling services, by systematically recording socio-demographic information about them.

The promotion of interest in research has long been one of the objectives of psychiatric training, reaching its zenith in the now defunct academic DPM. The successor, the MRCPsych, has retained a research option even though the main stress is on clinical and scientific knowledge. The 1980 Handbook for Trainees and Inceptors noted that “The aim of the research option is to encourage trainees to acquire more searching and critical approaches and to foster interest in clinical data, literature, the teaching of psychiatric practice, and research.” Although the option has been used by “only a relatively small number of people”, who have as a rule been “exceptionally able and energetic candidates”, it has been retained in the newest version of the examination.

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.

Kempe, in an address to the International Association for Child Abuse and Neglect in 1979, drew the professional communities' attention to ‘the serious plight of sexually abused children’. He described this as the final stage in the communities' recognition of patterns of child abuse. This cycle had commenced with his recognition of ‘The Battered Child Syndrome’ in the early 60s.

The popular perception of the business world is that dog eats dog, with the executive expecting material rewards to compensate for high levels of stress and risk taking. If you fail—too bad—you had it good for a while. A caricature of course, but like most caricatures it contains a kernel of truth. Sympathy for business colleagues who do fail is not a facility prized by competitively striving senior managers, viz Robert Maxwell's statements on the launch of the second London newspaper, “It's the law of the jungle—the survival of the fittest”.

In recent years there has been increasing emphasis on community-based psychiatric services. If these facilities are to be comprehensive they must include ways of assessing and managing crises and avoiding unnecessary hospitalisation. One way of meeting these needs is to provide small walk-in clinics in the community. A number of clinics have been established and more are planned. Although clients may refer themselves, access is usually limited to office hours and often only to a few hours each day.

General adult psychiatric services in Nottingham operate on a sector basis, with clinical teams having responsibility for the psychiatric care of all patients resident in a defined area. Sectors, which are conterminous with two or more social service areas, are not of equal population size, but comprise populations likely to give rise to similar demands for psychiatric services. The Social Services Department responded to the introduction of full sectorisation of hospital services in 1982 by allocating social workers to sector teams where possible, aiding the development of multidisciplinary teams.