On 19 June, 1987 the North-East Division of the College combined with the Newcastle University Department of Psychiatry to pay a conference tribute to Professor Sir Martin Roth as he approaches his 70th birthday. The Teaching Centre of the Freeman Hospital, Newcastle was an appropriate setting for such an event for Sir Martin spent 21 years as Professor of Psychiatry in Newcastle and the large attendance indicated the affection he still evokes there 10 years after his departure to Cambridge. Several generations of former colleagues spanning the past 30 years were present and the eminent positions they had reached in psychiatry, both at home and overseas, demonstrated what an intellectual power-house this small provincial department became under Sir Martin's direction.

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.

At the recent sixth international conference of the Pakistan Psychiatric Society (11–14 December 1986) in Lahore, it seemed appropriate to give an account of the state of psychiatry in that city half a century ago. Such an evaluation, granted the circumstances of history, might be expected to start with a comparison with English psychiatry at the time. That association had not worked altogether to the advantage of the speciality in a city such as Lahore. Progressive ideas about the care of the mentally ill in the thirties percolated very slowly into a central administration, far removed from the local community and occupied with other urgent issues of public health.

This is a report on a project which offers long-term day hospital patients a training which will lead to paid employment on the open market. Lack of work compounds the low self-esteem of chronic psychiatric patients. They experience multiple disadvantages, including loss of status, purpose, personal identity, social contacts outside the family, and a time structure to the day. Many of these disadvantages are known to be experienced by unemployed people in the general population. In most surveys, a fifth of the unemployed report a deterioration in their mental health since being unemployed, with an increased frequency of deterioration proportional to length of time without work. Work enhances self-esteem by decreasing the degree of dependency and by allowing identification with non-patients and may influence perceived locus of control. Work provides social participation and is ‘a visible measure of normality’ for former patients.

Severalls Hospital is a large psychiatric hospital, established in 1913 and originally designed for about 2000 patients. With the changes in attitudes to mental health over the last 70 years the hospital's aims and objectives have altered several times. Now, with the number of in-patients already reduced to approximately 650 and the movement to run down large hospitals such as this, preparation needs to be made for the shift to the community as the main future base for psychiatric services. Over the years the hospital has recognised the importance of preserving close links with the patient's home and has always maintained that regular activity and work is vital in the process of re-establishing patients in the community and in employment.

According to the recent Commons Report on Community Care, psychiatric patients are being discharged to inadequate community care. One of the reasons given for this situation is the lack of communication between professional groups, leading to bad planning of care.

A national survey in 1980 drew attention to the wide variation in frequency with which electro-convulsive treatment was being used. Yorkshire Region was at the top of the league with three times the level of the Oxford Region which had the lowest rate. Since then a good deal more research has been published on the effectiveness and limitations of ECT.1–3 Other factors which might have influenced clinicians in their prescribing of this treatment include much stricter conditions in the 1983 Mental Health Act for giving ECT compulsorily, plenty of media comment which may have reduced its acceptability, the increasing confidence of general practitioners in prescribing antidepressant drug therapies, and the greater emphasis on community care.

In parallel with more open political access for Westerners to China over the last decade, there has been a proliferation of interest in Chinese psychiatry. The pre- and post-liberation developments of the specialty have been reviewed. Further, increasingly detailed and balanced first-hand accounts by Western psychiatrists of visits to Chinese facilities have appeared.

Fifteen years ago the College published guidelines for the training of general psychiatrists in psychotherapy and these have now been reconsidered in the light of subsequent developments. (Bulletin, October 1986, 10, 286–289). However there is considerable doubt as to the extent to which the previous guidelines have been effective and those responsible for training schemes should consider whether they are providing or can provide the training suggested.

Since 1984, Nova Scotia has had a programme to bring a small number of senior trainees in psychiatry from Britain or Ireland to undertake one year of clinical work plus continuing medical education here. This programme is sponsored by the Nova Scotia Provincial Department of Health in collaboration with the Dalhousie University Department of Psychiatry.

At the initial interview the doctor should assess just what the patient means by ‘impotence’. If present, its speed of onset, its duration and whether or not the patient has libido are important factors to consider. Do morning erections occur? Is ejaculation normal? It may be retrograde, premature or retarded. The presence of chronic disease, e.g. rheumatoid arthritis, hypertension, diabetes or depressive illness, may adversely affect potency, as may the drugs used in the treatment of these conditions.

The Central Mental Hospital, Dundrum opened its doors for business in 1850. We cannot be sure why our English masters at the time considered it more urgent to open a security hospital in Ireland before planning and constructing Broadmoor. Were the Irish, as a race, sick and dangerous, or does an old institution like Dundrum reflect the views of the colonists on the colonised!

Over recent years Central Manchester GPs have supplied over 50% of the referrals to the Gaskell House Department of Psychotherapy. Yet there is no formal channel for feedback from these GPs concerning the services provided and for opportunites for realistic enhancement of the relationship between them and the predominantly hospital-based psychotherapists. It would appear that this communication gap applies to many psychotherapy centres in the UK though Tyson and Reder1 have specified the opinions of GPs as one variable to be considered when planning psychotherapy service.

In 1947 Britain had its severest winter since 1881, starving sheep came off the hills looking for sustenance in the towns, and the snow went on until April. That was when I boarded the MV Batory, later renowned or infamous for its espionage traffic, to be decanted into an early heat wave in New York. Times Square was hot and hectic, the steaks were two inches thick instead of two ounces a week, so my wife and I pushed on to our destination in Hartford, Connecticut where I had been appointed psychiatrist after an impressive series of transatlantic cablegrams. Hartford was a dignified and prosperous town, ‘the insurance city of the world.’ The Hartford Retreat had been founded in 1822, one of the earliest American hospitals to be devoted to mental illness; it had undergone a radical change in the 1930s under the entrepreneurial genius of Dr Charles C. Burlingame and was re-named the Institute of Living.

Infant psychiatry research pursued over the last two years was presented at the International Conference of the Association of Child Psychology and Psychiatry and Allied Disciplines in Paris, July 1986, and the value of early intervention was underlined at the Third World Congress of Infant Psychiatry, Stockholm, August 1986.

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.