“That is unusual.” “What?” “That young men like you take up consultant posts in mental handicap. I thought it was a job retired psychiatrists returned to, to avoid the boredom of inactivity.”

Clinical experience suggests that accident and emergency departments are increasingly adopting the role of primary health care providers, particularly those departments situated within the inner cities. Previous studies have shown that there is a high rate of psychiatric morbidity contained within the group of patients attending accident and emergency departments. The question arises as to how adequate provision for serving such patients can be made. Traditionally these patients have been referred to a duty psychiatrist for assessment or have been discharged from the department without a specialist psychiatric opinion having been sought. This approach has its drawbacks as an inappropriate emergency referral creates unnecessary work for an already busy duty psychiatrist. On the other hand no referral at all may result in serious psychiatric disorder remaining undetected and untreated with possible tragic consequences.

Large psychiatric hospitals are notoriously resistant to change. Their size and organisational complexity inevitably hinder their capacity to keep pace with trends. The serious consequences of a system that has ceased to adapt have been documented many times. Stereotyped routines and practices combine with rigid and bureaucratic management structures to produce the phenomenon of staff ‘burn out’, the “I've seen it all before and it doesn't work” syndrome.

With the accelerating drive towards the running down of large psychiatric hospitals and the trend towards the care and management of psychiatrically ill people in the community, it is inevitable that a small proportion of these people will be unable to cope with this change. Some patients may have a long history of violent behaviour which has been coped with in hospital. Others may have been able to cope within the ‘asylum’ environment but, when placed in a community which is little better able to cope with them than they are with it, regress to violent behaviour when faced with unaccustomed stress.

Where patients are suffering from mental disorder, one of the early questions asked is how best their financial affairs can be managed. Very often, in the case of elderly people, bills have been left unpaid, letters unopened and even court summonses unattended to. They may need to move to a nursing home or other residential care and their house or flat may need to be sold to pay fees. Until 1986, the only valid way of arranging for patients' financial affairs to be looked after (except in the simplest of cases) was by application to the Court of Protection, who could appoint a receiver to stand in the patient's shoes or make a ‘short procedure’ order to cater for patients whose assets were small and easily-managed.

In Autumn 1987 the new Part I Membership examination was held for the first time. The format was changed in response to the Royal College of Psychiatrists Working Party, who recommended that it should become an examination in basic clinical psychiatry. It was felt to be important that clinical skills were assessed early in training.

This paper outlines a three-year controlled study, funded by the Department of Health and Social Security, which started at the Maudsley Hospital in October 1987. The research will compare seriously mentally ill patients maintained outside hospital on the daily living programme (DLP) with standard hospital-based care, and devise a multi-disciplinary training course in DLP for mental health care providers. It will be the first UK attempt at controlled replication of successful controlled studies from North America and Australia, and the first anywhere to devise systematic training in the approach.

On 21 September 1977, the first British ‘hostel ward’ was opened. In this paper we review the thinking behind such a concept and evaluate its successes and failures. This is not simply of value as an introspective exercise since it is also crucial that service planners and providers who are moving towards the closure of mental hospitals should consider the value for their district of such a service.

The Bethlem and Maudsley Hospital item sheets (B-MIS) are summaries in coded form which are completed for every patient admitted or readmitted to the joint hospitals. The Part 1 item sheet contains information which is included in the Part 1 case summary, as described in Notes on Eliciting and Recording Clinical Information, and is completed at the same time as the summary is prepared; that is, usually within a fortnight of the patient entering hospital. Similarly, the Part 2 item sheet contains information normally found in the discharge summary, and is completed at the same time that this summary is prepared; shortly after the patient has left hospital. The item sheets are restricted to pieces of information which can be readily coded by the registrar. Thus, of necessity, they concentrate on relatively ‘hard’ data.

The South Camden Schizophrenia Survey was started in 1985 with Regional Funding through the Locally Organised Research Scheme. Its overall aim is to explore the disabilities and needs of those individuals recognised by the services within an inner-city area as suffering from schizophrenia. The survey has also been the first step towards setting up a computerised case monitoring system, named ‘Safety Net’, which is being developed as a means of keeping track of the needs and progress of these vulnerable individuals. This enterprise will develop a community-wide perspective directed at targetting the deployment of services to those most in need. This article gives a preliminary account of the progress so far and highlights our experience of carrying out research within the community.

The first British day hospital was established by Bierer in 1946; by the end of the 1950s there were 45 and during the next few years the number trebled. With the trend towards community care, day hospitals and centres have continued to increase in number.

The clinical examination is an artificial but unbettered assessment of the candidate's ability to assess a patient humanely, produce a formulation and treatment plan and speak knowledgeably on random aspects of psychiatry. It is the most important single part of the Part II examination and it must be passed. The emphasis is on general psychiatry. The new MRCPsych Part I also has a clinical component and the same administrative principles apply.