Although relatively neglected in Britain, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders has been widely adopted in both Western and non-Western countries (Spitzer, Williams & Skrodol, 1983). The descriptive and multiaxial approach used in DSM-III (1980) and in its revised edition DSM-III-R (1987), together with the introduction of specific criteria for allocating each diagnosis, would seem particularly useful when comparing psychopathologies across societies. In addition to Axes I, II and III (Clinical Syndromes, Developmental and Personality Disorders, Physical Disorders and Conditions), the Manual has two more obviously ‘social’ axes – (IV) Severity of Psychosocial Stressors and (V) Global Assessment of Functioning.

Although the definition of a specialist as an individual knowing “more and more” about “less and less” could be construed as a somewhat cynical critique of certain aspects of contemporary psychiatry, the Universal English Dictionary defines a specialist as a person engaged in a “special line of study or special branch of a profession”; a definition more relevant to this article which attempts to resolve the paradox of the “generalist as specialist”, and to outline the way in which general psychiatry is a special branch of a profession.

Dr McGrath was born in Liverpool in 1922. He was Medical Director of St John of God Hospital from January 1955 until December 1991 and Consultant Psychiatrist, St Laurence's (Richmond) Hospital (Beaumont Hospital from 1987), Dublin from 1956 until 1988. He was a Foundation Fellow of the Royal College of Psychiatrists and was a member of Council from 1974 to 1979, a member of the Court of Electors from 1979 to 1982 and Chairman of the Irish Division from 1974 to 1977. He was a member of Council and Censor of the Royal College of Physicians of Ireland from 1980 to 1982 and Chairman of the Section of Psychiatry of the Royal Academy of Medicine in Ireland from 1973 to 1975. He was President of the Medico-Legal Society of Ireland from 1966 to 1968 and has served on the Fitness to Practice Committee of the Medical Council of Ireland since 1989 and the Mental Health & Neurology Committee of the Medical Research Council of Ireland from 1969 to 1991.

The way in which residential and other forms of continuing care have developed in the United Kingdom has been reviewed (Lewis & Wattis, 1988). It has been a story of unclear policy and confusion, especially in respect of people with dementia. At present there is a lack of clarity about who is responsible for providing continuing care for demented people. Traditionally, their care was shared between social services Part III (including EMI – for the ‘elderly mentally infirm’) homes and NHS psychogeriatric and geriatric beds.

Professor Lynch was born in Dublin in 1922. From 1953 to 1961 he was Staff Psychiatrist, St Patrick's Hospital, Dublin, and Consultant Psychiatrist to Meath Hospital, Dublin. He was Resident Medical superintendent at St Otteran's Hospital, Waterford from 1961 to 1968. From 1968 to 1990 he was Professor of Psychiatry, Royal College of Surgeons in Ireland. He has been Chairman and Clinical Director of the Eastern Health Board, Chairman of the Irish Psychiatric Training Committee and Chairman of the Irish Division of the Royal College of Psychiatrists. He was a member of Council of the Royal College of Psychiatrists from 1980 to 1984, Junior Vice-President of the Royal College of Psychiatrists from 1981 to 1982 and Senior Vice-President from 1982 to 1983. He served on the College's Court of Electors from 1983 to 1988.

“There they stand, isolated, majestic, imperious, brooded over by the gigantic water tower … the asylums which our forefathers built with such immense solidity to express the notions of their day. Do not for a moment underestimate their powers of resistance to our assault” (Enoch Powell, 1961).

This short review outlines the clinical profile of the selective serotonin re-uptake inhibitors (SSRIs). There has been much recent publicity and promotion of this group of drugs and this review attempts to give a balanced account of their current place in the treatment of depression. Although a large number of preclinical and clinical trials have been carried out many questions and problems remain – it is important to proceed carefully and carry out (and replicate) controlled independent clinical trials. The views of general psychiatrists and GPs about these drugs in normal clinical practice will be the acid test – this will be particularly important in view of their cost.

The College has become increasingly concerned about the failure to achieve what has for many years been a reasonable policy for the chronic mentally ill. This paper will outline the significant effect that the blight in provision of services for this group of patients has had on mental health services as a whole, the extent of the shortfall and the effect on the patients themselves.

Old age psychiatrists' main concern with regard to incapacity is with patients with dementia. Dementia is predominantly a disorder of old age, probably affecting over half a million people in the UK, and it inevitably affects decision-making capacity. The 1983 Mental Health Act does not appear to have been framed with particular consideration for this group and it is vital that any new laws pay special attention to people with dementia.

Smoking accounts for 15–20% of all British deaths (Royal College of Physicians, 1983). Smoking-related diseases incur considerable cost to the NHS and smokers' materials cause 39% of accidental hospital fires (Batten, 1988).

Greater care in the community will lead to the geographic dispersal of psychiatric services and the role of communications technology will become increasingly important. McLaren et al (1991) described the potential role for new communications technology, such as interactive television, in the provision of psychiatric services but before resorting to new communications technology it will be important to ensure that full use is being made of existing technology such as the telephone. The telephone is widely used in the UK health service but poorly understood, in contrast to the USA where it has been recognised as an important medium for care delivery (Hallam, 1989). This pilot study was designed to gather information on the current role of the telephone in an acute psychiatric service and to aid the planning of the use of more advanced communications technology such as interactive television.

The quality of care which patients receive within the NHS is dependent upon the communication between general practitioners (GPs) and specialists and the letter is the most widely used instrument in this process (Freeling & Kessel, 1984). There are only a few studies which have evaluated the efficiency of communication between the GP and the hospital specialist. For example, de Alarcon et al (1960) showed that 96% of specialists' reports to GPs were found to offer a definite contribution to the understanding of the case, whereas 4% were “vague and useless”.

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.

During the last decade there have been a number of legislative changes establishing and extending the rights of patients to have access to their own medical and social service records. The Data Protection Act 1984, as modified by the Subject Access Modification Order 1987, gave patients access to computerised medical records with certain restrictions, in particular for information thought to be harmful to patients. The Access to Personal Files Act of 1987 granted access to Social Services Records. Again there were restrictions, e.g. to protect clients from serious harm or to protect confidential staff judgements. Finally, the Access to Health Records Act of 1990, which took effect on 1 November 1991 gives patients access to their own medical records and enables them to correct inaccuracies which they may find. Information likely to cause serious harm to the physical or mental health of the patient or of any other individual who could be identified can be withheld.