This paper focuses on issues relating to the place of psychotherapy within general psychiatry rather than describing details of psychotherapeutic methods and their range of application in psychiatric practice.

In 1975 the DHSS made psychotherapy one of the five psychiatric specialities. Since then, any comprehensive District mental health service has had to include a psychotherapy department.

Child sexual abuse has appeared as an epidemic of the 1980s. In our child psychiatry department we are acutely aware of the increased workload generated by referrals of complex and time-consuming cases. In this article we aim to look at the resource implications for a child psychiatry department which has teaching and regional commitments, as well as serving a district health authority.

The responsibility the health service owes to relatives who care for mentally ill patients is gradually being acknowledged. The Griffiths Report (1988) makes explicit both that families should care for their ill members and that the health service has a duty to provide some support. The new support for the family is more to enable them to be ‘better carers’ and to cope with the burdens of caring. One area of psychiatry where this support is a growth area is for relatives of people with schizophrenia. Research points to both the impact of some families on the career of the patient, including relapse rates, and the ways in which such negative impact can be reduced (Leff et al, 1989). This paper is concerned with the ethical issues involved in offering a service to relatives. The ethical dilemma of access to relatives is intimately related to the person at whom outcome is aimed.

Having trained in London and Manchester, I found psychiatry in the Yorkshire Dales a little different. Most senior registrar training is done within cities. Most consultant posts are old posts. Moving into a newly created consultant post with hardly any psychiatric service, miles from any city, was a new challenge with clear benefits professionally and personally. James Heriot, our famous local vet, gives the impression of being self-sufficient and isolated when providing his services. Though the countryside is the same, surely the opposite must be true for developing a mental health service.

The term ‘liaison psychiatry’ is becoming increasingly popular. Indeed, the Royal College of Psychiatrists has set up a special interest group, the Liaison Psychiatry Group, which has a growing membership. There appear to be developments in training and in service provision but it is difficult to assess their clinical impact. Ongoing research is required to quantify the actual level of service provided to general hospitals.

With the increasing emphasis on community care (Turner, 1986) the psychiatric day hospital has been seen as an alternative (Tantam, 1985) or as a complement (Tyrer, 1985) to in-patient care. Associated with this is the development of new styles of working with patients such as the ‘multidisciplinary team’ with those looking after individual patients being referred to as ‘key workers’ (Watts & Bennett, 1983). In our day hospital the keyworker has considerable responsibility for history-taking, organising a treatment programme and communicating with other professionals, including writing the discharge summary.

Lithium is widely used in psychiatry, mainly in the prophylaxis of manic-depressive illness. It is usually prescribed long term and because of its side effects, low therapeutic index and the possibility of toxicity, it is necessary to monitor serum lithium levels, thyroid function and renal status. Clinical guidelines are unclear; Vestergaard et al (1982) recommended that serum lithium and creatinine be checked every two to four months and thyroid function every six months. However, Crammer et al (1982) suggest that once stable levels are established, serum lithium need be checked only in response to clinical indications. The most recent edition of a widely read psychiatric text states that levels should be checked each six to eight weeks for as long as the patient continues on lithium (Loudon, 1988). Accepted standard clinical practice is thus unclear. It should be emphasised that these guidelines are not based on research evidence.

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.

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.

There has been a steady growth in the number of community psychiatric nurses (CPNs) working in this country over the last few years. Despite this there are still relatively few community child psychiatric nurses (CCPNs) and those that there are often work in relative isolation. It is difficult to find any articles concerning community child psychiatric nursing, either anecdotal accounts of individual practice or evaluations of a particular service.

The Somali Counselling Project was established in London's East End in December 1986 with the support of a grant from the City Parochial Foundation. It offers social support and psychosocial counselling to Somalis and other culturally related peoples from the Horn of Africa who are living in the United Kingdom. Its aims are: to advise on social, administrative and financial problems; to help clients make effective use of mainstream health services; to prevent and treat emotional disorder; and to provide administrative and emotional assistance to those with uncertain immigration status.

Last year I was fortunate enough to visit two GP friends running a district hospital in northern Malawi. As I had just taken Part 1 of the Membership Examination, they were intrigued to know my professional view of a condition called ‘the vimbusa’. In their experience, the vimbusa was a common complaint with a wide variety of presentations, none of which corresponded with disease entities they had learnt during their training. After a fascinating two weeks I was unable to categorise the vimbusa according to ICD-9, but the following essay summarises my attempts to understand this condition.

A leader in the British Medical Journal (BMJ) last year (Marks, 1988) suggested that the uptake of social security benefits among mentally ill people is low. However, this statement was based on the only data the writer could find – a study of 37 patients conducted in Islington based on the old social security system, prior to April 1988 (Linney & Boswell, 1987). Two weeks later, another BMJ leader (Marcovitch, 1988) bemoaned the fact that insufficient research had been conducted on the impact of changes in the social security system.

Opportunities for training in psychotherapy have become more extensive in Britain over the last decade or so, though the increase – as always – has been seen mainly in London and its satellites. The diversity of these training organisations, most of which are outside the mainstreams of NHS and university courses, does not make it easy for their value to be assessed in conventional terms, as well as raising problematic issues about the interface between the public and private sectors.

In August 1989 Meanwood Park Hospital, Leeds, the biggest hospital for mental handicap in the Yorkshire Health Region, reached the seventieth anniversary of its foundation. Like other hospitals for mental handicap. Meanwood Park is coming to the end of an era. The parkland of 134 acres, which has been the hospital's estate, and has existed for over 200 years, is to be sold in phases for housing schemes. Now is an opportune time to record the history of this hospital.

In a rash moment of bonhomie, having offered to one of the editors to write a personal view of psychiatry in the USA today, and with his encouragement to proceed, I find myself a long time later reflecting as to why the task seems to have been so daunting. Interpretations regarding my DSM-III-Axis II disorder apart, the numbers involved perhaps provide some of the reasons. There are 38,276 psychiatrists in this country, mostly paying dues ($300.00 per year) to the American Psychiatric Association, which has 76 district branches across the country, with between a few dozen and a few thousand members each; $428 billion spent on total personal health care in 1988, approximately two-thirds of which was covered by Federal Government programmes, of which $351 million went to the mental health sector; 150,000 patients treated for longer than one year in the long-term care psychiatric hospitals in this postdeinstitutionalisation era; and 6.5 million persons resident in nursing homes (at an estimated cost of $46 billion) of whom more than 50% are estimated to suffer from Alzheimer's disease. From such an array it is difficult to distill the essentials with much confidence as to their reliability or significance. What follows is therefore selective and impressionistic.

A one day conference on possession and religious psychosis drew clergymen, doctors and other health care workers from across England and Scotland. It was organised by Sunderland Health Authority and papers were presented by churchmen and by psychiatrists, under the chairmanship of John Cox, Professor of Psychiatry at Keele University.