The care programme approach has been introduced to improve the delivery of services to people with severe mental illness and minimise the risk that they lose contact with mental health services. Its essential elements are assessment of health and social need, a written care plan, nomination of a key worker, and regular review. It requires interprofessional collaboration and negotiation of care plans with users and carers but individual patients vary in their needs for multidisciplinary involvement and review.

A survey of mental health professionals in a Bristol NHS trust found that most had experience of therapeutic work with sexually abused patients and over half were currently engaged in such work. Supervision was variable and often considered inadequate. Few responders routinely enquired about historical abuse in the course of psychiatric assessment. The findings indicate a need for agreed strategy involving training, supervision and inter-agency co-operation to deal with this increasingly common problem.

The concept of computer diagnosis in medicine is not new. As early as 1971, a computer program was demonstrated to be more accurate than a senior clinician at diagnosing acute abdominal pain before surgery. In psychiatry, however, the problems surrounding diagnosis and classification are more complex than in other branches of medicine, depending as they do on the clinical interview and some agreed classificatory system in the absence of external validating criteria. Reliability has been improved by the application of standardised interview techniques and by the use of operationalised diagnostic criteria but such tools are lengthy and their use requires specialist training. Consequently they tend to be reserved for research purposes rather than routine clinical use. The potential contribution of computer technology to the vexed question of psychiatric diagnosis is here evaluated.

Fifty-two mental health workers in South Manchester were asked to complete a survey to try to identify patients with chronic mental health problems who would benefit from home-based rehabilitation. These patients were known to the services but were unwilling to attend activities in the day hospital or day centre or come into hospital for in-patient rehabilitation. Seventy per cent of the mental health workers who comprised psychiatrists, social workers and community psychiatric nurses completed the survey. Overall 68 patients were identified. Negative symptoms or defect state were the most frequently reported problems with difficulties with engaging or poor compliance being the next most frequently reported problem. There were some differences in the ranking of the order of problems by different professional groups.

The care programme approach was developed to ensure that patients in the community receive the health and social care they need. It pre-empted the philosophy and practice of care management and can form the core. There are several strengths to this approach in that it permits a response to individual needs that may change over a period of time, and co-ordinates the contribution of all care agencies to make effective use of the available resources.

General audit of psychotherapy services is slowly becoming a more regular part of practice in psychotherapy departments. Parry (1992) in her key review article states that “unmonitored practice is no longer defensible”. Audit specifically targeted at the quality of psychotherapy performed has been recommended (Fonogy ft Higgitt, 1989) but it is not often reported in psychotherapy (although a notable exception is Feldman, 1992). The beneficial effects of an ad hoc audit of the quality of psychotherapy using tape recorded sessions are reported.

Induction courses can offer trainees many benefits. These include a feeling of being welcome, a sense of belonging, reduced anxiety and increased confidence about the work ahead. The benefits to services include increased morale and efficiency brought about the trainees' quick orientation to their clinical roles and the organisation of services. This article considers induction to a hospital unit, to a hospital, and to regional services.

This paper describes a supervision group for senior house officers which focused on the psychodynamics of their working relationships with patients. The SHOs worked in a variety of hospital specialties as well as general practice. The description includes details of how such a group was set up and some of the practical difficulties in maintaining the SHOs' attendance. Brief details are given of the types of cases the SHOs were most eager to discuss, and the nature of the leading anxieties connected with the cases. The SHOs found this type of supervision supportive and enlightening as they developed and improved their clinical skills.

A brief description of the place of psychodynamic psychotherapy in the treatment of offenders is followed by an account of a forensic psychotherapy course run under the auspices of the British Postgraduate Medical Federation. The first year of a second year course leading to the diploma in Forensic Psychotherapy of the University of London is also described.