Many westernised countries have introduced Quality Assurance (QA) into their process of health care. The UK has lagged behind other countries and psychiatry has lagged behind other specialities.

The final page of this manuscript was inadvertently omitted and the full Comment section is printed below. We regret this omission.

Recent attention has been focused on divergent practices in the implementation of Section 136, problems in its practice encountered by the police, and possible means of improving the service and reducing unnecessary detention. In these studies, doubts have been raised about the justness of the section, both in principle and in practice, and about the efficiency and efficacy of its implementation. In the context of the closure of the large psychiatric institutions it seems probable that these issues will become increasingly acute. The purpose of our brief study was therefore to investigate the trends of admissions to Friern Hospital, not only of patients under Section 136, but of all patients accompanied by the police.

Treatment of the mentally ill by the Aboriginal Awaraks of Jamaica and the other Caribbean islands was first described by a Spanish monk in 1540: ‘Lunatics’ who were called ‘mind riven’ were treated in the community with salvent herbs, which were blended with food and left to hang on fruit trees for those who wandered, and by the administration of unguents and lavings while singing. This record indicates that the mentally ill were treated by the indigenous Indians without restraints, and with rudimentary attempts at pharmacology and cultural therapies. But this enlightened but primitive mental health system was destroyed with the advent of the Spanish conquerors who, according to Las Casas, “in about eight to forty years have unjustly put to death about twelve million Indians without distinction of quality, sex or age”.