In its present state the law has little to contribute towards the solution of the problems arising from the medical treatment of mentally incapable, but informal patients. This is because there are no relevant rules; there is no legislation governing the situation because Parliament has not acted; and there are no Common (i.e. judge-made) Law rules because these problems have never come before a judge for decision.

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.

The roots of the modern mental retardation service can be traced to the federal legislation introduced by President Kennedy in 1963. Shortly after he took office in 1961, he appointed an expert panel to study the issues and problems and to propose a plan of action. This signified complete separation between mental health and mental retardation services.

For more than a decade psychiatrists have paid lip service to the idea that peer group medical audit might be valuable, but few have initiated regular audit meetings. This could be due partly to fear of criticism from colleagues and partly to a feeling that we can well do without additional, possibly time wasting, meetings. We in the Department of Psychiatry of the Royal South Hants Hospital have held monthly audit meetings for the last three years. We would like to report our experience of these, as we have found them to be supportive rather than threatening—despite our initial apprehension—and we believe that they have resulted in improvements in our service.

The lot of a senior registrar starting higher specialist training is not always a happy one. At least that is what our experience suggested when we began our careers in forensic psychiatry.

Despite recent advances in the understanding of Huntington's Chorea, treatment remains, at best, symptomatic and many sufferers end their days in institutional care. A recent survey established the prevalence of Huntington's Chorea in South Wales as 7·65 per 100,000. From this figure, 4,000 or more sufferers of this condition are living in the United Kingdom at present of whom 20% are in hospital or other institutional care. Although some studies have looked in passing at the degree of disability of Huntington's Chorea sufferers in hospital and found it to be considerable, staff and relatives often feel that long stay psychiatric wards are inappropriate or unnecessarily restrictive settings for these patients. This study looks at the disability of Huntington's Chorea sufferers in hospital and other institutions in order to determine the suitability of their placement and to see whether their physical and psychological needs are being met.

The 1983 Mental Health Act made a requirement under Section 58 for a second opinion by an Appointed Doctor when a detained patient either did not understand the nature, purpose, and likely effects of a treatment or did not consent. The present study is confined to second opinions relating to ECT (electric convulsion therapy) and extended medication. It was noted in the Mental Health Act Commission's Biennial report that requests for second opinions varied in numbers between different hospitals and psychiatric units. In 200 personal visits by the author a Treatment Plan by the Responsible Medical Officer (RMO), which is an indication of good practice in the operation of the Act, was written in the case notes in only 66 cases (33%) and then most often by a junior doctor. This finding has been reported generally. It seemed appropriate, therefore, to explore the opinions of Consultant Psychiatrists on the legal requirement for second opinion.

It is some years since Dr Henry Rollin published, in the Prison Medical Journal, an address he gave to prison doctors on the Role of The Psychiatrist on the Parole Board. Since then, there have been changes in policy and practice, and it may be opportune now to bring the work up to date, and to the notice of a generation of psychiatrists who might some day have the privilege and pleasure of serving on the Board.

After some 13 years of pale-faced exile in England I returned with some excitement to Australia, eager to share in its psychiatric development and perhaps to benefit a little from the fruits of what appears as the international rapacity of Murdoch, Holmes a Court, Elders IXL et al. The second more furtive wish suffered early set-backs as I discovered that the Australian economy was dipping alarmingly and that the Australian dollar, once to my mind as solid as Ayer's Rock, was sinking rather than floating against other currencies. This has meant cut-backs in government expenditure, health included, threatening my first wish as well.

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.

In the 19th century doctors threatened to go on certification strike unless they were given a measure of legal immunity. Provision was accordingly made in the Lunacy Act 1890 and that provision was the ancestor of S. 139 of the Mental Health Act 1983.

There is currently considerable interest in liaison psychiatry and recently a Royal College Special Interest Group has been set up in this field. Although few psychiatrists are employed full-time in this sub-speciality, it appears that much time is spent by psychiatrists in doing liaison work and this is likely to become more important with the increasing movement of psychiatrists into the District General Hospital (DGH). There is ample evidence to suggest that there is a high prevalence of psychiatric morbidity in a DGH population which can be seen as representing potential for expansion. However, there is no consensus as to the scope of liaison psychiatry, whether expansion would indeed be desirable and whether psychiatrists possess suitable skills for the job.

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.

Section 136 of the Mental Health Act 1983 is a controversial section. It authorises a police constable, often with no psychiatric training, to take a mentally disordered person from a public place to a place of safety, usually a hospital or a police station, so that he or she may be assessed by a doctor and a social worker within a 72 hour period. There have been several studies looking at this section from the point of view of psychiatrists, social workers, and other interested parties, in particular MIND. The aim of this study was to find out from the police whether or not problems arose during their dealings with people whom they had placed on section 136.

The recent substantive report Guidelines for the Training of General Psychiatrists in Psychotherapy makes explicit the expectations of the College in regard to psychotherapy training for trainees in general psychiatry. The report points out the particular difficulties in providing such psychotherapy training outside the teaching centres. This paper is a description of the organisation of psychotherapy training in the periphery of the Northern Region and of what may be achieved with limited resource.

On several occasions in 1979 a GP member was consulted by the father and brother of a young man because they were concerned about his violent and aggressive behaviour. The GP arranged for a consultant psychiatrist to visit the patient at home on three occasions, although once he was not in and on the other two refused to see the psychiatrist and threatened him with violence.

The evolution of general psychiatry in India has for many years followed the British pattern, stage by stage. Child psychiatry has followed much the same path and British influences are much in evidence.

The exercise of hospital accreditation by the Royal College of Psychiatrists has resulted in a significant improvement in the standards of psychiatric training in this country.1 The North West, more than any other region, adopted the policy of District General Hospital psychiatry2 in the sixties which had the effect of creating small psychiatric units, unable to muster enough resources, to provide comprehensive training programmes by themselves. These developments have highlighted the problems of organising viable rotational schemes for training in psychiatry.3,4,5