In a lecture to the Royal College of Psychiatrists, published as an editorial in the British Journal of Psychiatry, Sir John Wood recommended a review of the structure and details of the Mental Health Review Tribunal (MHRT) system (Wood, 1995). The present article is a personal contribution to that review and describes aspects of the MHRT during 30 years of continual change.

The roles of doctors in relation to the MHRT have been reviewed in the Psychiatric Bulletin by Woolf (1991). Despite flurries of lively correspondence during 1994–95, there has been no discussion of the working conditions of medical members.

The high prevalence of post-traumatic and other psychiatric disorders in children and adults who have experienced violence and war-related traumas are well documented by research (Thabet & Vostanis, 1998, 1999). So far, there has been less systematic evaluation of treatment interventions or training programmes for staff working with traumatised individuals in war zones. Training initiatives have recently been described in countries such as Rwanda (Brandon, 1998). This paper describes the work of a community mental health programme in the Gaza strip, particularly through a visit by P. V. to work with the child mental health care staff.

In a recent review of the literature, Hayward & Bright (1997) offer four possible answers to the question of “What is the root cause of an unfavourable view of ‘mental illness’?” First, dangerousness: people fear the mentally ill because they believe them to be prone to violence. Second, attribution of responsibility: sufferers of mental/behavioural problems are seen as more responsible for their condition, implying a belief that the mentally ill ‘choose’ to behave as they do. Third, conditions perceived as being chronic, difficult to treat and having a poor prognosis are more stigmatised, and fourth, the cause for stigma lies in the disruption of normal social interactions based on social role.

In many psychiatric rotations, trainee psychiatrists usually move every six months between educational supervisors (consultant trainer). These moves may entail geographical relocation and nearly always involve an emotional relocation for the trainee. Trainees need to acclimatise quite rapidly to different methods of working, training style and expectations from each individual trainer.

Sir: I have had the opportunity, as the specialist registrar representative on a Child and Adolescent Psychiatric Special Advisory Sub-Committee team, to visit a different child and adolescent training scheme than my own. This was a very interesting experience both with regard to the process of the visit and seeing how another scheme functions. It also exposed me to new ideas about training. I strongly support the view expressed by Laurence Sheldon (1994) that approval visits should be open for any interested specialist registrar and recommend other trainees to consider offering themselves for approval visits.

Eighteen months ago I came to Geraldton, Western Australia from the United Kingdom to help develop a psychiatric service for Aboriginal people in the mid-west region of the state. This has been a fascinating and challenging experience both professionally and personally and I would like to outline the context of this work and to reflect on some of the issues that seem particularly relevant.

During March 1998 we had the privilege of visiting the mental health services in Kumasi, Ghana at the invitation of Dr Yaw Osei, Senior Lecturer at the Department of Behavioural Sciences, School of Medical Sciences, University of Science and Technology.

Bermuda has one psychiatric hospital, which is organised along a programme model; an acute programme, a rehabilitation programme, a child and adolescent programme, a substance misuse programme and a learning disability programme. Bermuda has good resources and the majority of staff are trained in British hospitals. There has been a shift away from the stigma of mental hospitals towards a more community-oriented mental health service.

I think I can honestly say that I am a seasoned complainer, although I am careful not to attempt to be Mary Whitehouse and I do not assiduously scan the media looking for trouble. My interest in the area of stigmatization started with an episode of the TV drama Boon, where they suddenly had a character become ‘mentally ill’ so that he could conveniently shoot the hero to achieve a cliff-hanging end-of-series episode. Subsequently I specialised in the portrayal of mental illness in dramatic productions, joined the Public Education Campaign divisional network and had some media training. I have been listed as an expert in the portrayal of mental illness for five years but have never been approached for my advice on this area. However, following this year's announcement of the new Royal College of Psychiatrists' campaign ‘Changing Minds: Every Family in the Land’, I obtained all the names and addresses in Deborah Hart and Jill Phillipson's article above and stood ready to ‘do my bit’ for truth and honesty.

Many typical antipsychotic drugs may be manufactured as alcohols, which react with carboxylic acids to form esters (organic salts). These compounds are highly oil-soluble, but are only sparingly soluble in aqueous fluids such as blood. Thus, an oily solution of an antipsychotic can be injected into a muscle, where it forms a reservoir or ‘depot’ of drug that is slowly dissolved in the surrounding blood. Once released into the blood, drug esters are rapidly hydrolysed by endogenous esterase enzymes to produce the parent antipsychotic. Stable serum concentrations of antipsychotics are usually engendered (although this is not always observed in practice (Tuninger & Levander, 1996)), and administration need only take place every few weeks or so. Adherence can be assured and relapse rates are reduced (Groves & Mandel, 1975: Davis et al, 1994).

When we call on the police, we can anticipate every officer will have received a basic level of training, which is given at the start of his/her career. This takes place at one of the National Police Training Centres within the UK. Over 10 weeks, new officers are taught self-defence, safety, communication and handcuffing skills. After this they transfer to a local force training centre, where the national training is put into the context of local policies and procedures, using local equipment. The officer works as a probationer for two years before final basic qualification is accepted.