It is appreciated that the National Health Service already makes substantial contributions towards the training of doctors. Nevertheless, the view expressed in the Royal Commission Report (paragraph 195) that the N.H.S. should accept a broad responsibility for the cost of postgraduate medical training is endorsed. Moreover, a distinction between ‘academic’ and ‘vocational’ training is somewhat artificial as far as medical education is concerned: both are important, and it seems inevitable that much of the postgraduate training as psychiatrists will fall upon the universities, whose staff, on the whole, are more experienced in teaching. More teachers will be needed to implement the proposals of the Royal Commission, and their training will be largely the responsibility of the universities. At present, very few of the university departments of psychiatry are equipped for the increasing demands made for postgraduate education, nor do they receive any grant for this purpose. The future training of psychiatrists must be more intensive and better organized. While it is agreed that much of this training will be provided by the ‘non-teaching’ hospitals and by tutors at the periphery, the university departments will need to be actively involved in these teaching programmes. Moreover, there will have to be an increase in the courses organized by university departments for general practitioners, medical officers of health, school medical officers, etc. Such an expansion of university departments does not run counter to the principle of the N.H.S. financing the professional training of doctors. Finally, consideration should be given to establishing parity in the salaries of university clinical teachers and N.H.S. consultants, whose responsibilities are usually very similar.

A continuing problem in the care of patients suffering with depression is the assessment of how depressed the patient is, and how the level of depression changes over time. In clinical practice the patient is used as his own control, but the psychiatric assessment often has to be made in ways prone to the errors of subjective assessment. The psychiatrist is interested in how the depressed patient views himself and the world around him, that is, in terms of Kelly Personal Construct Theory, what constructs the patient uses to structure areas of his life and where on these constructs the patient sees himself. Personal Construct Theory and the Repertory Grid Techniques provide a useful framework for idiographic estimates of change.

The Committee discussed at length the administrative structure at present prevailing, with particular reference to current principles and practice in the mental health field. Undoubtedly varying standards of successful collaboration and integration exist, with, however, the greatest signs of stress and strain in communities where there is dissociation between the local health services and the distant psychiatric hospitals that serve them. Any attempt at integration of the present tripartite administration into a single authority for a single community of optimum size would be welcomed by the Association, provided satisfactory arrangements could be made that are better than the existing ones.

The Royal Medico-Psychological Association has given its general support to the unification implied in the Green Paper on the Administrative Structure of the Medical and Related Services in England and Wales. This document specifically states that ‘the effective development of comprehensive services for them (categories including the mentally disordered) requires that all aspects of their health care should be the responsibility of a single authority’. In our Memorandum on this subject we stated ‘we accept the need for a single authority in each area to coordinate the wide range of health services, to plan the use of related services, and to apportion resources between care in the community and hospital care’.

A questionnaire on postgraduate teaching and training facilities was prepared and circulated by the Education Committee late in 1965, and, after approval by Council, the report on this survey has been published (R.M.P.A., 1968). To find out what changes in teaching and training facilities had taken place in up to 21/2 years, a second questionnaire was circulated to all psychiatric hospitals in the United Kingdom approved by the Conjoint Board as providing training for the D.P.M. The second questionnaire was shorter and simpler than the first, some questions of doubtful value being eliminated and others re-phrased to make them less ambiguous.