It is common knowledge that psychiatric patients sometimes need to have compulsory measures applied to them for the safety of themselves and of others.

Professor R. G. Priest and Dr K. A. Day have prepared a discussion document on the future of mental hospital sites on behalf of the Public Policy Committee (Psychiatric Bulletin, April 1990, 14, 245–248), and may be complimented for stating their views in such detail.

As well as the more spectacular 999 calls to urgent road traffic accidents and myocardial infarction victims, the ambulance service provides a background care which allows people with chronic and recurring disabilities to remain in their own homes.

Defaulting from out-patient surveillance constitutes a major problem among neuropsychiatric patients globally. In an extensive review of default studies (Baekeland & Lundwall, 1975), it was concluded that between 20–50% of psychiatric patients fail to return after their first visit and 31–56% attend not more than four times before defaulting.

There is growing interest in this country in developing training programmes suitable for overseas psychiatrists. The motive is partly one of self-interest. The implementation of current Government policy means that many departments will look to overseas visitors to fill their registrar positions in excess of their career registrar allocation.

The East-Anglian CTC Trainees' Day was held at Friern Hospital, London, on 14 December 1989. The programme comprised a morning session with two speakers and lunch sponsored by Duphar, followed by an open forum on CTC training issues and an address by the final speaker. Approximately 30 trainees attended, mostly SHOs and registrars. Professor A. Wakeling, chairman of the East-Anglian Division of the Royal College, was present and took the opportunity to meet trainees from the region.

This very large training scheme was formed at the suggestion of the then newly appointed Professor of Psychiatry, Ian Brockington, who saw that in the existing rotations the balance between specialty and general posts was very uneven. He also argued convincingly that it would attract more trainees of high calibre and improve the morale and enthusiasm for training of the consultants, particularly in those rotations which had difficulty recruiting junior doctors or had failed to achieve more than provisional approval by the Royal College on repeated accreditation visits. The new scheme was launched in 1984 following the establishment of a Steering Committee including representatives of the psychiatric divisions of the five Birmingham Health Authorities and the adjacent Sandwell and Solihull Health Authorities, of the University Department and of the various specialties such as child psychiatry. All the Authorities agreed to pay jointly for a clerical officer to service the scheme and Solihull undertook to provide accommodation and a Medical Personnel Officer with specific responsibility for the scheme. A senior universally respected Clinical Tutor, Eddy Sethna, was elected Organising Tutor and given full authority to manage the rotation, reporting twice yearly to the Steering Committee which would advise on any difficulties which he could not resolve directly with trainees, trainers or divisions and would agree additions or modifications to the scheme.

Much of the information generated in the practice of psychiatry is manipulated by microcomputer. Program packages allow text to be structured and viewed before it is printed, information to be filed so that it can be accessed from several parameters, and columns of figures to be manipulated and displayed graphically.

Drilling holes in someone's skull and destroying parts of the brain is the kind of scenario dreamt up by anti-psychiatrists. That it can happen in practice - and once happened on a fairly large scale - remains a matter of sensitivity for the public image of psychiatry, notwithstanding that there are still cogent reasons to retain leucotomy in its armamentarium. So any presentation of this subject on the mass media needs to be done with the greatest responsibility, and should convey an accurate message.

In the second of this occasional series, Mark Jones looks at Mozart and his 1788 masterpiece, Don Giovanni, and interviews Tom Sutcliffe, opera critic of The Guardian, about his views on this problematical work and its portrayal on the stage.

A large crowd throngs the out-patient hall and all 300 children cry in unison. The father of an eight year-old girl pushes her through the crowd until she reaches a partitioned cubicle where four doctors sit round a table. He puts her in front of the first doctor and tells him about the chest pain she has had for months. The doctor, struggling to hear above the din, takes a brief history and examines the girl standing up. The history is inconclusive and there are no signs; he cannot understand why her parents have bothered to make the 30 mile bus ride that morning; why didn't they accept the advice of the paediatricians they had consulted nearer their home? Usually he would have written a prescription for a tonic costing the father two days' wages, but this time he directs the girl and her father back through the crowd to where I sit, alone in my cubicle, separated from the gaze of the attenders by a saloon bar door.