Since central government allocated capital and revenue money for the regional secure units (RSU) programme, following the 1975 Butler Report, the planning and building programme has been gathering momentum. It was felt it would be useful to review the present complicated and varied picture and to look ahead to the future. This seems a particularly apt moment to look around the regions as the climate of opinion, both within the clinical professions and in the various NHS administrative levels, is changing. Reference will mostly be made to the provisions for Mental Illness rather than for Mental Impairment and Adolescents.

Following the taking of a psychiatric history and the examination of the mental state, it is standard practice to prepare a formulation (Institute of Psychiatry, 1973; Slater and Roth, 1977; Royal College of Psychiatrists, 1979; Garrick and Stotland, 1982). Indeed, the concept of formulation is central to the psychiatrist's approach.

I would like to bring to light an apparent oversight in the new statutory rules relating to consent to treatment by the mentally ill and mentally handicapped. This will have very serious consequences for the management of patients who are on short-term detention orders. The provisions relating to consent to treatment set out in Part IV of the Mental Health Act 1983 are the first attempt to cover by statutory controls the doctor's clinical freedom to prescribe treatment for his compulsorily detained patient. In addition, certain of the new provisions (which take effect from 30 September 1983) apply to the voluntary patients as well.

‘Our first concern must be to improve the psychotherapeutic skills of psychiatrists in general, as a means of providing a better service to our patients.’ Thus, Sydney Brandon concluded his personal view on psychotherapy in the Bulletin last year (July 1982, 6, 120). It was a similar concern that motivated us, two years ago, to set up a scheme which initially aimed to provide trainees in psychiatry with some form of regular teaching, experience and supervision in dynamic psychotherapy.