Under the 1959 Mental Health Act of England and Wales, it was possible for courts to sentence offenders to hospital provided they had been found guilty of an offence which was punishable by a term of imprisonment. Higher courts could add restrictions to a hospital order if they so wished. This power has been retained in the 1983 Mental Health Act and this paper examines the nature and use of the restricted hospital order.

In September 1978 the Government published a review of the Mental Health Act (1959). This review was prompted to a large degree by an increasing awareness of the rights of the mentally ill and by an awareness among psychiatrists of the limits of their management procedures. The proposals of this review were largely incorporated into the Mental Health Act (1983). Among the proposals so incorporated was one that persons could not be detained in hospital against their will for assessment or treatment “by reason only of promiscuity or other immoral conduct, sexual deviancy or dependence on alcohol or drugs”.

During the past three years it has been my task and privilege to act as an assessor for The British Journal of Psychiatry. In this time I have assessed, and in some cases reassessed, over 30 papers. Having looked back on my comments on these papers a number of common criticisms emerge. I thought intending contributors to the Journal might find it helpful if I commented upon some of these. I hope I do so with a sense of humility, since it is always easy to criticise the work of others and appear to be patronising. However, I have the impression that if intending authors paid heed to some of my suggestions (which are certainly not original) they would save themselves a great deal of disappointment and save the assessors and the Editors of the Journal a degree of frustration and occasional irritation.

From the time of its foundation the College has been represented on Advisory Appointments Committees for consultant posts. One of the College nominated assessors' responsibilities is to supply confidential information on applicants, and those interviewed, to the Registrar by completing a form containing information on the number of applicants, numbers interviewed and their quality together with any deficiencies in qualifications and experience in those seen and those appointed. Prior to 1979 the assessors gave their opinion on qualifications and experience on all applicants but the form then in use did not allow for any quantitative analysis. Since the introduction of a new form in that year, such an analysis has been possible. A summary of assessors reports from 1974 to 1977 was published in the Bulletin.

The expression primary health care (PHC) gives the impression of an ensemble of control of communicable diseases, infant care, avoidance of insanitary personal habits and curbing environmental pollution. These indeed constitute the main elements of the scheme but are not exclusive to it. An integral but often ignored aspect is the community dimension of mental health whose importance is underscored by the fact that a significant majority of people in the third world live in rural areas with minimal or no access to formal psychiatric facilities. In this paper, I shall review the conceptual framework and practicality of primary health care with special reference to community mental health, highlight some notable limitations to policy execution and finally propose an organisational model structure for the community mental health services within the primary health care system.

To have been external examiner for the Masters Degree in Psychiatry (M Med) of the University of Nairobi for the last three years was an unusually stimulating opportunity, not only for a ‘busman's holiday’ (as my registrar called it) and a ‘good enough’ reason for a return to Africa, but it also enabled me to contribute again to training East African psychiatrists – a task which I first undertook in 1972 when a lecturer at Makerere University in Uganda. Because of the civil wars in Uganda, however, the Department of Psychiatry in neighbouring Kenya has now flourished and become one of the most substantial Departments in Central and Southern Africa. The Department, which includes one ‘full’ professor, two associate professors, four lecturers, two tutorial fellows, will soon have its own teaching in Kenyatta National Hospital as well as accommodation at the Mathari Mental Hospital, made famous by the pioneer observations of Carothers. In addition to its commitment to postgraduate training the Department provides three months teaching for other doctors taking an M Med in Medicine and Paediatrics and also teaches 150 medical students each year.

The College is debating how to train psychiatrists for community care (CC) that is spreading – ahead of hard evidence of its value for certain problems in the UK. Much future psychiatry will be practised in the community outside hospital within multidisciplinary teams not always led by a psychiatrist, and wherein the lead-rôle changes frequently within a single meeting depending on whose expertise and readiness to accept responsibility emerge.

The Richmond Fellowship has for almost 30 years been a leading mental health organisation delivering half way house care and rehabilitation to people needing to overcome the secondary social effects of mental breakdown. It has developed the half way house therapeutic community principally as a short term institution with a programme which stresses social relations and self management, and as such has been beneficial to many thousands of people who have quickly re-established themselves into their families and communities.

Work activities were systematically introduced by R. K. Freudenberg at Netherne Hospital, in the 1950s, as a component of a rehabilitation programme for severely disabled in-patients. At about the same time, Douglas Bennett utilised the psychological, vocational and economic benefits of work in preparing long-stay Netherne patients for resettlement in the community. The value of work as a principal rehabilitative medium in a wide spectrum of disability was periodically reported.

This paper has been prepared by the North East Thames Child and Adolescent Psychiatric Advisory Sub-Committee (NETCAP) in order to draw the attention of the Region to deficiencies in consultant child psychiatric services in the Region. It sets out below the population of each district and the current consultant manpower. These figures have been obtained from the district general managers and in some cases corrected by the local consultants.

Recent Government policy has encouraged initiatives aimed at preventing the spread of drug misuse and improving treatment for those who already suffer the effects of dependence. There are probably up to 100,000 opiate addicts in the UK and dependence on prescribed drugs such as benzodiazepines presents a problem of increasing medico-legal significance. All doctors have a responsibility to ensure that drug misusers are offered treatment and should be prepared to assist them with withdrawal from drugs if requested to do so. Many doctors still fight shy of becoming involved, often through fear of contravening the controlling legislation.