The fourth Forensic Psychiatry Specialist Section Conference of the College was held at Stratford-upon-Avon on 1 and 2 February 1985. The theme was the Homicide Act and the wider context of insanity legislation in theory and in practice. Not difficult to predict that so many differing ‘expert’ opinions would be expressed—a mirror of the ‘ritual dance’ of experts in court perhaps—but not so predictable that the papers should be so clearly expressed and mostly rigorous as they were, and that some degree of consensus should emerge. I shall attempt to summarize parts of the contributions and some of the suggestions made for change.

The second AUTP conference took place at University College, Oxford from 12 to 14 April 1984. The themes were the theory and teaching of psychotherapy, and the place of personal experience in training. In addition to the plenary meetings the conference divided into small discussion groups; in this report I deal only with the former, of which I had a complete record.

In reply to a question on 12 February, Mr John Patten said that patients leaving mental illness hospitals had the same right as anybody else to choose where they live. The full range of community resources is available. The Department is not responsible for accepting or rejecting individual homes, but the Registered Homes Act 1984 has tightened the conditions for the registration and inspection of such homes by local social service authorities. The DHSS commended a code of practice for residential care, ‘Home Life’, to registration authorities last year; it contains a section specifically about mentally ill people and their rehabilitation.

The community approaches which can be used in psychiatric practice are not so often in evidence in academic departments of psychiatry. One of us (BJM), on commencing as a Clinical Research Fellow within the Department of Psychiatry, St George's Hospital Medical School, was keen to spend his clinical time (set aside for training purposes) in a community-orientated way.

Mauritius is a 720 sq mile island situated in the Indian Ocean. It has a population of about a million, made up of various racial backgrounds: Indian, African, European and Chinese. Those of Indian descent belong to the Hindu and Muslim faiths; those of African and European descent belong to the Roman Catholic faith (by and large), as do most of the people of Chinese origin. The economy rests on the export of sugar and tobacco, making the country an agricultural one. Diversification of the economy is under way.

Community psychiatry means different things to different people. Since the 1970s the American model of community psychiatry based on mental health clinics has attracted heavy criticism, whilst the UK concept of rooting community psychiatric services firmly within primary health care has gained increasing support. The need for community-orientated psychiatric services is generally agreed upon but definition of community and the mode of delivery are not. In Australia both free and private health care are available; community health centres and community mental health clinics exist (sometimes literally) side by side.

Cognitive therapy (CT) is now widely recommended as an effective form of psychological treatment for a variety of psychiatric disorders, particularly depressive and anxiety states. The therapy itself consists of a specific treatment ‘package’ derived from the cognitive theory of psychopathology and seems to have developed because of a growing dissatisfaction with dynamic psychotherapy on the one hand, and a strictly behavioural approach to the patient's difficulties on the other. A further factor has been the unwillingness of some patients to continue for long periods on psychotropic medication and the unwillingness of medical practitioners to prescribe it in patients who have expressed suicidal ideas, or have not previously responded well to medication. The main thrust of the CT is problem orientated, and treatment itself is an active, moderately directive, time-limited, structured approach set in the present in which the patient and therapist work in collaboration to relieve the patient's symptoms.

During some recent research for a project in the history of psychiatry, I had the opportunity of studying the first hundred years' Annual Reports of Glasgow's Gartnavel Royal Mental Hospital dating from 1814. I was struck at how applicable some of the comments were in modern psychiatry and was interested in some of the phraseology used and ideas expressed. Some were quaint, some entertaining and surprisingly few abstruse.

Suggestions have been made that the Preliminary Test for the Membership of the College should be modified in the direction of a reduced theoretical and enhanced clinical content. I would applaud such a move. Behind it is the idea of testing, early in a junior's career, his or her talents for the processes central to the practice of their chosen specialty. This sort of test has for too long been lacking throughout the profession of medicine. There is no reason why psychiatry should not now, with the advantage of modern technology, set the pace by combining an element of aptitude testing in the earlist hurdle on the road to specialist status.