Chance meetings in public between psychiatrists and their clients are not usually relished by either. At its least embarrassing, the encounter can pose to both parties the dilemma: Should we greet each other and risk revealing to the public our special, but stigmatised, relationship? Or, should we ignore one another and risk one (or both) of us feeling rejected? The more embarrassing encounters are well known in psychiatric covens and sometimes even revealed to outsiders in the course of ethanolic abreaction at intimate dinner parties. However, hitherto they have not found a place in conventional psychiatric literature, with its scientific emphasis and basic assumptions in the journals of smoothly flowing professionalism and the normality of the psychiatrist.

Prior to the 1983 Mental Health Act (MHA), Mental Health Tribunals (MHRTs) did not have the power to order delayed discharge of a patient appealing against a section, although there was evidence that tribunals used the power of adjournment to allow time for follow-up to be arranged. This power was used more often with patients in special hospitals where the option of remaining on an informal basis did not exist. Hepworth and others advocated giving tribunals the power of delayed discharge. This was supported by the White Paper (1978) and subsequently became part of the 1983 MHA, together with some increase in the responsibility of the local authorities to provide after care for Section 3 and 37 patients. But the new Act also allowed the appeal of patients on Section 2, while giving no responsibility to the local authority for their after-care. It was difficult to see how delayed discharge could be implemented as an after-care safeguard for Section 2 patients who would often have only two weeks or so of their Section to run in any case. With this in mind, I studied all cases appearing before the MHRT in a general psychiatric hospital in the two years following the new Act.

‘The number in each room rarely, if ever, exceeded ten. Here, I generally found several of the patients engaged in some useful or amusing employment. Every class seemed to form a little family … I incline to think, that the probability of recovery is greater, where a moderate number of patients associate together … I incline to think the number ought in no case to exceed fifteen’.

Today the practice of psychiatry often involves a multi-disciplinary team comprising doctors, nurses, psychologists, social workers, occupational therapists, community psychiatric nurses and physiotherapists. Each discipline has its own contribution to make to the planning of care programmes for patients in the context of a team approach.

“No artist attains total excellence, but the strength of truth and justice is that it lasts and that man can say… this is the heritage of my father.”

“We are confident that at least 10% of children have been engaged in sexual activities with adults…” opens this important trilogy of teaching videotapes on sexual abuse of children, “… and of children alive today in the UK., 1,117,000 will have been sexually abused by the age of 15”.