I have recently taken up a post as Senior Registrar in Psychotherapy in Leicester where about 20% of the citizens are Asian or Afro-Caribbean. For the rest of this article I shall use the term ‘black’ as synonymous with Asian and Afro-Caribbean. While realising this may offend some readers, I use it in a political sense and know that many prefer it to the equally inaccurate use of the term ‘ethnic minority’. Before being promoted, I was on the general psychiatry registrar rotation in the same city and not surprisingly had a large number of black patients. Now I have none; there are very few referred to the Department, and I gather this is typical of psychotherapy units across the country. I want to consider why this is so, and what, if anything, should be done about it.

The benefaction for the award of an annual medal and prize to a member of the Royal Medico-Psychological Association was made by Mrs Elizabeth Holland, in memory of her brother, Samuel. She was herself a remarkable woman, who married a banker, had ten children, translated poetry from the German, began a social club for unemployed men, founded a cottage hospital, and was well-known for her wit, conversation and unflappability. However, she came from a remarkable family. Her older brother, William, was a noted Unitarian minister, philanthropist, and writer. Her sister-in-law, William's wife, was Mrs Elizabeth Gaskell, author of North and South, Wives and Daughters, and a celebrated, and for a season notorious, Life of Charlotte Brontë, as well as several other novels and short stories. Two of Elizabeth and William's children, Meta and Julia, were so well-loved in Manchester that flags flew at half-mast on their deaths.

Up to 37,000 chronic mentally ill and mentally handicapped patients have been discharged from long-stay hospitals over the past ten years and nobody knows for certain where most of them are. This is one of the findings of the 1986 Audit Commission into community care which prompted Sir Roy Griffiths (1988) to state in his report on community care that.

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.

In November 1987, I wrote to the ‘Planning Officer (Mental Health)’ of the 192 English Health Authorities requesting a copy of the section of their 1984 Strategic Plan dealing with mental health and any recent update. A checklist of information to be analysed was drawn up on the basis of an initial reading of the plans. This contained a substantial proportion of the elements for a comprehensive service listed by Hirsch (1988) and by MIND (1983). Replies were received from 137 (71%) of the health authorities. Of these, 127 (67%) sent planning documents, ten wrote saying that their plans were under review and therefore unavailable, or “meaningless”. Strategies were sent dated 1983 (2), 1984/5 (63), 1986 (11) and 1987/8 (45). Planning reports and Short Term Programmes were also sent which meant that four (3%) provided information updated to 1988, 74 (58%) to 1987, 16 (13%) to 1986, 17 (13%) to 1985, 15 (12%) to 1984, with one giving details relating to 1983 only.

Although psychiatric hospitals contain a population at risk of suicidal behaviour compared to the community at large, suicide in hospital in-patients and recently discharged patients is relatively rare. It has been suggested that hospital admission itself reduces the risk of suicide (Tenroche et al, 1984). Factors considered important are a calm ward routine carried out by staff confident in the immediate future, and the opportunities for social contract offered by the ward environment.

The concept of multidisciplinary care has arisen from the recognition that there are many areas in medicine and psychiatry which require professional skills and expertise in addition to those possessed by doctors and nurses. The attitude of psychiatrists towards this development has varied from enthusiasm to alarm. Whereas the latter may be understandable in the face of recent publications which portray the profession as being under threat, Bennett (1988) has addressed these changes in a positive manner, and it is surely more responsible to regard the emergence of related professions as a source of assistance rather than hazard.

In April 1987 the Bulletin of the Royal College of Psychiatrists published the results of a survey of the training of junior psychiatrists in behavioural psychotherapy in the South West Thames Region (Drummond & Bhat, 1987). This survey reported the experience of trainees based at 10 postgraduate teaching rotations in the Region. The survey was conducted shortly after the appointment of a new peripatetic senior lecturer. Prior to this appointment there had been no regular senior lecturer teaching in behavioural psychotherapy in the Region for at least one year. The paper demonstrated that the majority of trainees had received little or no previous teaching or supervision in behavioural psychotherapy. It also demonstrated that trainees welcomed the introduction of such teaching and that their knowledge of the subject improved significantly after three teaching sessions held at monthly intervals. However, after this short time only 17.1% of the trainees reported that they had started to use any of the techniques they had learned in clinical practice.

Ocean Sound, an independent Hampshire radio station, broadcasts pop music on a channel known as ‘Power FM’. The presenter/producer of Power FM occasionally asks a guest ‘expert’ to talk briefly about a particular subject and then listeners are invited to phone directly for a confidential talk during the following hour. At the end of the allotted hour the ‘expert’ comes on the air again with some concluding remarks and additional information.

Last year, I was very fortunate to be able to attend a workshop at Sheffield University on Rational Emotive Therapy – fortunate because Dr Albert Ellis of New York, who conducted it and who founded RET, is surely one of the most remarkable figures on the international scene in psychiatry. His presentation is frankly dramatic, but he insists that far from being undesirable, this quality may be essential in transmitting a therapeutic message to the patient.

Privatisation of psychiatric care is an increasing phenomenon in the USA. This is a relatively new trend and has followed on the heels of other trends like the deinstitutionalisation of the 1960s and 70s. Until recently the majority of in-patient population was in public hospitals, with some in psychiatric units of general hospitals. In the 1980s, the private hospital corporations seem to have discovered that there is money to be made in the business of psychiatric care and started building and marketing psychiatric hospitals on a wide scale.

Rarely in a lifetime do three people contribute to society in so many ways as the Burdens in Bristol. Here are some of their major achievements.

The Reverend Burden and his wifw Katharine opened ‘The Royal Victoria Home’, near Horfield Prison, for the care of inebriate women and girls in moral danger in 1895.

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.

Consultation is a term that can have many different meanings. In this paper, it is used in the sense that Caplan (1964) defines as mental health consultation, to describe the interaction between a consultee and consultant who meet to facilitate some area of mental health work in which the consultee is involved. By working with workers instead of directly with clients, the consultant aims to offer a service to a greater number of people than would otherwise be possible and to have a preventive role with earlier detection and management of mental health problems.

The 1984 Scottish Mental Health Act (and its counterpart in England and Wales) invoked unique restrictions in medical practice in this country. For the first time certain standard treatments could not be given to particular patients unless an independent second opinion doctor authorised that treatment. Fortunately, in respect of drug treatment and ECT the second opinion doctors are themselves practising clinicians. Second opinion doctors are asked to give their opinion about the suitability of a proposed treatment using the following guidelines: “the appointed doctor will have in mind his/her understanding of practice accepted as proper by a responsible body of medical men skilled in this particular art in Scotland at this time and should avoid any idiosyncratic view of treatment however firmly held”.

On the night of 16/17 November 1988, fire destroyed a male ward at Friern Barnet Hospital in North London. Two patients died in the conflagration and one was injured.

Mental Health Review Tribunals were introduced in the Mental Health Act (1959) to safeguard psychiatric patients against unjustified detention in hospital. The powers of tribunals form “an important part of the fabric of civil liberties” (Wood, 1974). However, in exercising their prime function of preventing unjust detention, tribunals in practice also have to take into account patients' clinical needs and the protection of the public. Further weight was added to this complex burden of decision making following a judgement by the European Court of Human Rights in 1981 which upheld the right of all detained patients to a periodic judicial review of their detention. As a result of this judgement the Mental Health Act (1983) extended tribunal powers to include the release of offender patients sentenced by Crown courts and given hospital orders with restrictions on discharge. Such individuals may have been convicted of grave criminal offences, and their discharge or transfer from hospital would otherwise require the consent of the Home Office.