In 1860 the Illustrated London News published an engraving of a male ward in Bethlem Hospital, in which two slightly wary looking whippets or small greyhounds are wandering among the patients, while one of them keeps a watchful eye on a smug cat seated beside the chair of a chess player. At intervals along the walls are birdcages and goldfish bowls, all with their appropriate occupants. Another engraving shows a female ward, where similar cages and bowls can be seen hanging between the windows, though the free-range livestock is absent. Each room is also furnished with a huge aviary reaching from floor to ceiling.

The role of relatives as carers of people with chronic mental illness has long been emphasised and was legitimised by Sir Roy Griffiths in his report to the Secretary of State in 1988. The White Paper (Caring for People), however, merely pays lip service to the role of the family. It does not suggest how such help might be provided. There is no reference to relatives, or even ‘informal carers’ (the most recent way of describing relatives), in its sections on provision of services by Social Services or the Health Service. While ‘informal’ is clearly used to indicate ‘unpaid’, it emphasises that relatives, even as carers, are not part of the formal caring process and can, therefore, be ignored as part of the team. If relatives are to be part of the service, as carers, then they need, as Griffiths and the White Paper point out, to receive support and resources to fulfil this role. But what support and services? And who is to provide them?

It could be said that one of the chief architectural legacies of the late 20th century, when it comes to be considered retrospectively, will be the wanton destruction and dispersal of buildings constructed in the previous century for the public benefit. Churches, schools and hospitals have been systematically sold off, and a good number of them, if not totally demolished, have lapsed into a pathetic state of limbo, particularly in this time of economic recession. Some of the worst cases of this known to the Victorian Society are hospitals of great architectural quality, constructed for the treatment of the mentally ill, then known as lunatic asylums.

When the 6th Prague International Conference was announced in September 1989, the organisers can have had little idea that within two months the communist regime in Czechoslovakia would collapse and the Berlin wall be breached. The conference was postponed until August 1991. That week the failed Soviet coup led to the disbandment of the USSR as such. It was an exciting time to visit Prague. It was a disconcerting time too, I was still not sure whether my contribution was meant to be a poster or a paper. Writing received no response, fax machines were unavailable, phoning at first resulted in repeated Sprechen Sie Deutsch? but eventually in an assurance that my accommodation had been booked So I arrived as Rusyne airport with a paper and a poster, having ascertained during the journey that delegates to two other unrelated conferences in Prague had had similar experiences!

One morning last week, I had said goodbye to my family, and as usual went to feed my chickens. They were excited to see me except for one, which was lying on its back with its feet up in the air, motionless and stiff. My medical training helped me diagnose death, and after I recovered from the initial shock, I had to consider the aetiology. Unfortunately, a few days earlier, I had found some tunnelling into the chicken shed and eggs had gone missing. I thought this was most likely to be rats. Can rats kill chickens? I was able to clarify the position later in the day, from a patient who was a poultry farmer, who informed me that rats do not kill chickens, but only baby chicks and that it was common for chickens at the age of nine months to suffer from sudden death.