Professor Lynch was born in Dublin in 1922. From 1953 to 1961 he was Staff Psychiatrist, St Patrick's Hospital, Dublin, and Consultant Psychiatrist to Meath Hospital, Dublin. He was Resident Medical superintendent at St Otteran's Hospital, Waterford from 1961 to 1968. From 1968 to 1990 he was Professor of Psychiatry, Royal College of Surgeons in Ireland. He has been Chairman and Clinical Director of the Eastern Health Board, Chairman of the Irish Psychiatric Training Committee and Chairman of the Irish Division of the Royal College of Psychiatrists. He was a member of Council of the Royal College of Psychiatrists from 1980 to 1984, Junior Vice-President of the Royal College of Psychiatrists from 1981 to 1982 and Senior Vice-President from 1982 to 1983. He served on the College's Court of Electors from 1983 to 1988.

Service initiatives such as the decentralisation of adult mental health care by way of multidisciplinary patch teams have wide-ranging implications for professional practice. The successful development of community based services demands that staff adopt different roles from those appropriate to the hospital setting.

Community psychiatric nurses (CPNs) fulfil an important role in caring for people with mental disorders in the community. They provide a monitoring and information service for patients and relatives and form a link between general practitioners (GPs) and psychiatrists. Some CPNs provide advice to GPs about prescribing psychotropic drugs. We studied the extent of this activity in a geographically-defined district and the views of GPs, CPNs and psychiatrists towards it.

Since the late 1960s the number of psychiatrists choosing to specialise in old age psychiatry has increased dramatically (Wattis, 1988) and in 1989 the Royal College of Psychiatrists recognised the specialty's status. Recent recommendations of the Royal Colleges of Physicians and Psychiatrists (Report of a Joint Working Party of the Royal Colleges, 1989) have considerable implications for the continued development of cooperation between psychogeriatricians and geriatricians and for senior registrar (SR) training in both specialties. This study attempts to describe the availability of and attitudes towards training in psychogeriatrics (PG) of geriatric SRs.

Occupational stress is frequent among individuals whose work brings them into close contact with other people. One putative means of preventing or alleviating such stress is meditation (West, 1987). A six week course in meditation was recently held for staff in the Drug Dependence Service based at University College Hospital, London. The idea for the course came from the head of the unit who had personal experience of meditation. The course and its acceptability to staff are described below.

A series of papers looking at the work of the walk-in psychiatric emergency service based at the Maudsley Hospital have been reported in the literature (Lim, 1983; Mindham et al, 1973; Brothwood, 1965). This clinic was established in 1952 and is one of the oldest in Europe. A similar clinic the Emergency Assessment Clinic (EAC) was introduced to Whitchurch Hospital, Cardiff in 1970.

The Royal College of Psychiatrists' Working Party on Medical Audit has emphasised the multidisciplinary nature of patient care in psychiatry (Royal College of Psychiatrists, 1989). Much has been published on individual audit topics and on definitions of the various aspects of audit such as peer review, performance indicators and quality assurance. The essential element of audit is its systematic nature and little has been written concerning an overall structure for clinical audit within an individual psychiatric setting. It is not sufficient to start with ‘a simple project with minimum of cost in terms of both time and money expended’, as recommended by the Royal College of Psychiatrists' Working Party. What is needed is an overall structure for regular review so that the systematic nature of the process is not lost and that recommendations from audit meetings are reviewed regularly for their usefulness and level of implementation.

I have just finished a one-week non-residential course on management skills for senior registrars. Like many of the people who attended the course I had put my name down in order to get a better idea of what the post-1-April era would mean for my professional practice. We had by and large no major interest in a career in management and yet we were keen to acquire ‘management skills’ in order to ‘produce’ what was required of us by the ‘cultural’ changes affecting the NHS.

Informal discussions between psychiatric trainees reveal frequent difficulties and frustrations in providing adequate medical care to psychiatric patients. Our writing this article was prompted by the death of a patient who had been referred to casualty with behavioural and physical problems, and who, once labelled as a ‘psychiatric patient, did not receive the medical attention he required. Other trainees will have their own similar examples, at best resulting in only inconvenience to the junior doctor. This may seem surprising given the knowledge that people with psychiatric problems suffer increased physical morbidity. We were all taught as medical students that a physical presentation may mask a psychological problem and vice versa, and that both problems may co-exist. However, this knowledge does not always impinge on hospital clinical practice. From the viewpoint of junior psychiatrists, cross-specialty referral and consultation, and the provision of adequate medical care to our patients can be difficult. In this discussion, we will deal briefly with the contribution of ‘physical’ medicine to this state of affairs and then turn in more detail to the influence of psychiatry. Recommendations for improvement are made.

The Italian Reform Act (Law 180) has been considered one of the most revolutionary Mental Health Acts in Western countries and has been the subject of considerable attention since its promulgation in May 1978. Interest in the Italian model of community psychiatry has been reflected in the number of articles, special supplements and letters, published in noteworthy European and American journals. However, for a better understanding of the meaning of Law 180 (now part of Law 833 concerning general health measures) the political and sociocultural climate surrounding the enactment of the Italian Mental Health Act should be considered.

“to neglect the study of history is not prudent”. Samuel Johnson. (Quoted by Hunter and Macalpine in the preface to their Three Hundred Years of Psychiatry)

I am grateful of the honour the President and the College has bestowed on me in accepting the presentation by Lundbeck Pharmaceuticals of my bronzes of Henry Maudsley and Erwin Stengel, as part of the 150th Anniversary Celebrations. Special thanks are due to Professor Hugh Freeman for his assistance in this regard.

Section 48 of the Mental Health Act, 1983 (MHA) permits the Secretary of State to authorise the removal to hospital of an unsentenced prisoner who is ‘suffering from mental illness or severe mental impairment of a nature or degree which makes it appropriate for him to be detained in a hospital for medical treatment and that he is in urgent need of such treatment’. (Mental Health Act, 1983). Its common usage in the past has been in transfers of unsentenced prisoners from prison to hospital.

“Little as we know about the way in which we are affected by form, by colour and light, we do know this, they have an actual physical effect.” Florence Nightingale, Notes on Nursing