In early 1992, I spent five weeks at the Costina Hospital in Romania – an exchange visit organised by the West Midlands Regional Health Authority at the request of a charity known as Faure Alderson Romanian Appeal, based in London. The team who set off with me in a lorry, minibus and a Land Rover, included a residential social worker, a medical student who helped me with the assessment of patients and four other volunteers from the charity to help in an orphanage. The journey across Europe was confronted with difficulties at Romanian customs but we eventually managed to meet the Director of the Hospital we were visiting, after a week on the road.

The 1970s horror film Asylum∗ is new out on the video store shelves. On the cover, above a severed head wrapped in brown paper, it warns, “you'll find more than cuckoos in this nest”. This anthology of popular perceptions of madness and mad-doctors

This Act, effective from 9 March 1992, contains amendments to the Mental Health (Scotland) Act 1984. It provides an extension to 28-day short term detention, requires sheriffs to hear applications for full detention within five days of their submission and authorises detention of patients until the outcome of such an application is known.

Much has been written about mental illness and driving, particularly the possibly increased risk of accidents. There is, however, little awareness of how this affects insurance premiums. It is well known that as a result of recent losses within the business, premiums were increased by 30% last year, and may be set to rise higher. This has made insuring a car a major part of the cost of running one. It appears that people with mental illnesses are being unfairly treated by motor insurers and therefore financially disadvantaged. I was first made aware of this problem by my involvement in a case.

I have been treating a 55-year-old man suffering from a 21 year history of agoraphobia. The treatment has been cognitive-behavioural, primarily based around a systematised graded exposure to different transport systems and increasing distances from home. An accident recently occurred which serves to remind us that no matter how controlled an exposure programme is intended, we cannot protect either our patients, or ourselves, from the occasional chance encounter with unmitigated disaster.