Early in the 1980s I anticipated that sooner or later the Regional Adolescent Service based on the Young People's Unit in Macclesfield would ultimately have to face making a strong and if possible, an unanswerable case for survival.

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.

It is not uncommon to hear a psychiatrist claim to be able to judge from general practitioners' letters which new referrals will attend and which will fail to turn up. However operational research has failed to define clear characteristics of patients who do not keep first appointments (Hillis and Alexander, 1990; Skuse, 1975; Zegleman, 1988). Also the standard of referral letters has been criticised in the past and shown more recently to omit key items of information (Pullen & Yellowlees, 1985). The aim of this study is to test the ability of psychiatrists of varying experience to predict non-attenders.

It is acknowledged that assessing ‘consumer satisfaction’ is an important part of medical audit (The Royal College of Psychiatrists, 1991). For the mentally handicapped, it can be argued that ‘carer satisfaction’ is particularly relevant. This is particularly so at a time when the ‘community’ is being advocated as the preferred setting for the long-term care of the mentally handicapped, the families and neighbours of the handicapped being the main providers of this ‘community care’ (Griffiths, 1988).

The need for severely disabled long-stay general psychiatric in-patients to be resettled within their own districts is likely to arise increasingly as area mental hospitals close. The White Paper, Caring for People, acknowledges that some of these patients will continue to require hospital care. Transfer between hospitals might be considered a major life event for these patients, some of whom will have spent many years in the area mental hospital. Conflicting results have been found in studies of mortality rate following relocation (Morriss et al, 1988). Pryce's (1977) study with long-stay chronic schizophrenic patients and other more recent studies with new long-stay patients yielded data suggesting optimal environmental factors in keeping with Wing & Brown's (1970) observations.

Community psychiatry represents a major revision of psychiatric service provision, and although there is currently no consistent body of knowledge upon which training for community psychiatry can be based, in the near future most psychiatrists will be working to a greater extent in the community.

Advertisers use powerful images to sell everything from cars to coffee, from banks to baked beans. That this should also apply to pharmaceuticals then is unsurprising. Whatever view we as clinicians might take of drugs, for their manufacturers they are a product like any other, and doctors are the natural targets for their promotion. In 1982 the pharmaceutical industry spent £150,000,000 on drug promotion in the UK (Medawar, 1984). We have attempted to take an objective view of drug advertisements by examining the images used in all the advertisements that have appeared in the British Journal of Psychiatry over the last 30 years.

UKSCP was inaugurated in January 1989 as a sequel to the “Rugby” Psychotherapy Conference, itself a sequel to the Sieghart Committee. In 1990 UKSCP resolved to establish psychotherapy as a separate profession and to seek to establish itself as the competent authority in relation to EC regulations, present and impending, which regulate the freedom of movement of professional people in the EC. The key to being a competent authority lies mainly in holding a register for the profession.

Higher professional training is designed to produce consultants and in general this aim is achieved by combining the increasing practice of consultant-like activities (clinical, teaching, administration) with the opportunity to consolidate basic skills and knowledge and to undertake research. This combination of the practical and the intellectual is regulated by clinically and academically responsible professional bodies. While the same principles apply in psychotherapy, there are a number of special features.

The multidisciplinary team and its functioning have been much debated. Such teams have been encouraged as a basis for good clinical practice. However, exactly how these teams should function has gone through various phases. With the advent of family therapy, some teams have experienced a process of crisis and the dismantling of more traditional ways of working. This has brought about a lot of disillusionment within teams and also a challenge to medical authority in the team. Unfortunately, it seems that family therapy as a treatment approach has been confused with the organisation of a multidisciplinary team. Considerable stress has been produced in the process as each professional has vied for a position and role in the team.

In many parts of the country, child psychiatrists currently provide services on their own. This ‘unidisciplinary’ model of practice is out of step with College recommendations for multidisciplinary working in child and adolescent psychiatry (Royal College of Psychiatrists, 1990). The question arises whether one model is in fact superior to the other. In this article we look briefly at the history of the multidisciplinary team, describe our own experience of providing a unidisciplinary service and suggest a working model for the future.

In 1987 the Charing Cross General Psychiatric Training Scheme incorporated an exchange with the National University Hospital, Singapore (NUH) sponsored by Glaxo Pharmaceuticals. Four selected UK trainees have now spent nine months at NUH as part of their general rotation. A description of psychiatric training based at NUH is outlined here.

The EFPP is a British initiative concerned with public sector psychoanalytic psychotherapy that seems to have touched upon a recognised need in our European neighbours and colleagues. Its origins are inextricably linked with the development of the Association for Psychoanalytic Psychotherapy in the British Health Service (the APP).

On a recent study trip I was able to examine approaches to health care, in particular, mental health services in what was West Germany. I visited a range of facilities and met a wide range of professional workers.