During the last decade there have been a number of legislative changes establishing and extending the rights of patients to have access to their own medical and social service records. The Data Protection Act 1984, as modified by the Subject Access Modification Order 1987, gave patients access to computerised medical records with certain restrictions, in particular for information thought to be harmful to patients. The Access to Personal Files Act of 1987 granted access to Social Services Records. Again there were restrictions, e.g. to protect clients from serious harm or to protect confidential staff judgements. Finally, the Access to Health Records Act of 1990, which took effect on 1 November 1991 gives patients access to their own medical records and enables them to correct inaccuracies which they may find. Information likely to cause serious harm to the physical or mental health of the patient or of any other individual who could be identified can be withheld.

Although the work of general practitioners (GPs) with mental illness generally, particularly in relation to minor mental illness, has been extensively examined, there has been practically no work devoted to the role of GPs in assessment for compulsory admission, either under the 1959 or 1983 Acts. The notable exception is the work of Bean (1980), who is, in some respects, highly critical, accusing them of showing little interest in patients, referring at times inappropriately, committed to the rhetoric rather than reality of care and of knowing little or nothing of the law they were supposed to be using. Bean's work is, however, a study of the 1959 Act, and no research exists on the 1983 Act which now governs section assessments. This neglect of GPs is surprising, in view of the severe consequences of compulsory admissions (sections) and research on the use of the 1983 Act already available on other participating professionals (Sheppard, 1990; Rogers, 1989). GPs are likely to be professional instigators of section assessments as well as involved in the assessment itself.

This paper attempts to address the question, “What is higher training for?”. It then tries to explain some of the principles which have guided the work of the Joint Committee on Higher Psychiatric Training (JCHPT) up to now, and which are sometimes misunderstood by trainers and trainees, and finally, discusses some current problems. The views expressed should not be taken as reflecting the future policy of the JCHPT.

Service initiatives such as the decentralisation of adult mental health care by way of multidisciplinary patch teams have wide-ranging implications for professional practice. The successful development of community based services demands that staff adopt different roles from those appropriate to the hospital setting.

Following the 1983 Mental Health Act, Mental Health Review Tribunals (MHRT) now provide the opportunity for patients to have their detention reviewed and give a right of appeal against compulsory hospital detention or guardianship (Bluglass, 1983).

Without research psychiatry is brain dead! Perhaps the most significant discriminator between medical practice and the ‘alternative therapies’ is the responsibility, often honoured, of the medical profession to evaluate and hence vindicate its treatment methods. For the individual practitioner, research helps to maintain the highest standards of involvement in clinical care. In psychiatry many new methods of treatment and innovatory types of treatment service have been introduced over recent years. Their continued and extended use should not be justified by the zeal of their advocates but by demonstration of their efficacy.

The controversy concerning psychotropic drug use in children has waged over several decades. The recent trend in treatment has moved towards problem-orientated, eclectic and flexible approaches to disturbed children and their families, away from specific “pure” therapy models. Erstwhile over-use of medication in certain conditions, for example psycho-stimulants in hyperactive children in the USA (Werry et al (1980), has handicapped the development of paediatric psychopharmacology.

Most previously published opinion has indicated that the medical profession is predominantly opposed to the package of NHS reforms outlined in the Government's white paper Working for Patients and especially opposed to the administration of hospitals by self-governing trusts (Lister, 1990). Yet only Whitfield et al (1989) can claim to have independently and directly polled the opinions of a representative sample of a defined population of doctors on this subject, and their survey was published two years before NHS reform began to impinge on hospital practice.

This is the second of two articles on GP referrals for compulsory admission, and seeks to examine the process and outcome of assessment by (a) comparing GP with other section assessment referrals and (b) comparing GP referrals who were compulsorily admitted to hospital with those not compulsorily admitted or voluntarily admitted. In relation to the law the main relevant sections for this article are sections 2, 3 and 4. There are two basic grounds for admission: that the patient is suffering from a mental disorder and that admission is in the interests of his/her own health or safety or for the protection of others. Section 4 requires one and sections 2 and 3, two medical recommendations, as well as an application by an approved social worker (ASW) or nearest relative. Section 2, admission for assessment, involves admission for up to 28 days; section 4, emergency admission for assessment, involves admission for up to 72 hours; and section 3, admission for treatment, allows admission for up to six months, and is renewable.

Many patients with persistent mental illnesses enjoy a better life in a community setting than would be possible in a long stay mental hospital. Furthermore, the available evidence indicates that most such patients get better while living in the community. Unfortunately, community care has not served all patients well. Much of the difficulty can be attributed to lack of resources. However, there is also a tendency by planners to underestimate the severity of patients' disabilities. A realistic appraisal demands a detailed examination of the problems of patients whose needs have not been met by community care. One important issue is that of patients who fall through the net of community care and another is that of patients who have not but nonetheless have not survived in the community. This paper addresses the question of the needs of this latter group.

Community psychiatric nurses (CPNs) fulfil an important role in caring for people with mental disorders in the community. They provide a monitoring and information service for patients and relatives and form a link between general practitioners (GPs) and psychiatrists. Some CPNs provide advice to GPs about prescribing psychotropic drugs. We studied the extent of this activity in a geographically-defined district and the views of GPs, CPNs and psychiatrists towards it.

In the light of proposals to change the system of providing NHS health care, it is important for future district or regional procurers to have reliable data on which to base their treatment ‘contracts’, bearing in mind not only current but also the potential demand of a mature market.

The Mental Health Act (1983) came into being eight years ago but few studies into its use have been reported (West, 1987; Sackett, 1987). The Act provided for the setting up of the Mental Health Act Commission to safeguard the interests of detained patients and to monitor the use of the Act. The Commission visits ordinary psychiatric hospitals on an annual basis and writes a report of the visit. The Commission also submits a Biennial Report to Parliament. These reports address important issues but do not provide detailed information on the use of the various sections of the Act in differing hospitals.

Elderly patients constitute nearly two thirds of resident hospital patients (DHSS, 1988): 60,280 people were resident in mental illness beds at the end of 1986, and 34,340 were aged over 65 years; 21,500 had been resident for more than a year and 11,300 for more than five years. This represents a 15.7% fall in numbers of resident elderly patients over a decade, while numbers of younger resident patients fell by 40%. Mental hospitals are increasingly dominated by their population of elderly patients. Some patients have grown old in the hospitals, but more are admitted in late life and remain in care, usually because they are suffering from severe dementia.

Many admissions to general adult psychiatric beds occur as emergencies due to social crisis or relapse of psychiatric illness. Other admissions are planned to arrest or reverse deterioration. Length of stay varies depending on reason for admission and adequacy of support in the community. Rapid readmission or failed discharge, defined as readmission within three months, has been linked with multiple previous admissions and personality factors (Jones, 1991).

The purpose of this study was to establish whether any agreement existed about the side-effects of lithium carbonate between the consultant psychiatrists in a single health district responsible for care of patients maintained on lithium therapy.

Since the late 1960s the number of psychiatrists choosing to specialise in old age psychiatry has increased dramatically (Wattis, 1988) and in 1989 the Royal College of Psychiatrists recognised the specialty's status. Recent recommendations of the Royal Colleges of Physicians and Psychiatrists (Report of a Joint Working Party of the Royal Colleges, 1989) have considerable implications for the continued development of cooperation between psychogeriatricians and geriatricians and for senior registrar (SR) training in both specialties. This study attempts to describe the availability of and attitudes towards training in psychogeriatrics (PG) of geriatric SRs.

A good discharge summary is an important part of in-patient psychiatric care. It should provide a useful prècis of the admission in the hospital notes, and also provide the general practitioner with details needed for the immediate and longer term management of the patient after discharge.

This study considered the use of staff observation and patient's self-ratings of subjective psychopathology on admission to a psychiatric intensive care unit. The aim was to evaluate these measures as a means of predicting subsequent assaults and self-injury during the patients' stay on the ward. Few studies have shown a relationship between subjective experience and observable violent behaviour although some have found a correlation with ‘violence potential’. Eichelman & Hartwig (1990) have suggested the use of the SCL-90 hostility subscale, although doubts have been expressed about the ability of psychotic patients to complete such questionnaires reliably. The usefulness of both patients' self-ratings and staff observation would lie in their ability to help staff predict violence and self-injury and to take appropriate action.