Much has been written about mental illness and driving, particularly the possibly increased risk of accidents. There is, however, little awareness of how this affects insurance premiums. It is well known that as a result of recent losses within the business, premiums were increased by 30% last year, and may be set to rise higher. This has made insuring a car a major part of the cost of running one. It appears that people with mental illnesses are being unfairly treated by motor insurers and therefore financially disadvantaged. I was first made aware of this problem by my involvement in a case.

We followed up 33 cases over three months where psychiatrists recommended the compulsory detention in hospital of mentally ill men and women but social workers disagreed. Seventeen of the cases were detained a mean of 25 days after the index date of assessment by social workers, but the group as a whole spent fewer days in hospital than a “control” set of patients whose detention had been agreed (P = 0.02). The terms of reference of the Mental Health Act Commission should be extended to cover such cases.

We investigated the detection and awareness of child sexual abuse by examining case notes. Child sexual abuse was recorded in 4.7% of cases. There was no evidence that enquiry about child sexual abuse or detection of the problem had increased in recent years, and recording of the details of abuse was rare. Victims received more psychological help and less medication than others. We conclude that awareness of the issue has not increased. Previous findings about child sexual abuse are rarely used in evaluation, and diagnosis and drug treatment may be overlooked in some victims.

After 25 years of promoting football in psychiatric hospitals, the authors highlight the potential benefits of sport and physical activity in treating people diagnosed with psychosis. A number of clinical cases are used to illustrate the benefits to individual people as well as to the collective and the institution.

Self-injury is a major clinical problem on the women's wards at Ashworth Hospital. Ashworth Hospital is one of three special hospitals within England and Wales that provides assessment, treatment and rehabilitation for those legally detained patients under the Mental Health Act (1983) who suffer from a mental disorder and require conditions of special security because of their dangerousness. There is extensive literature on the psychological aspects of serf-injury. However, since patients with self-injury present with damage to the body, it is surprising that there is little information on the physical health care and associated resource costs of this behaviour.

We review a case history of a young child who was admitted to an in-patient mental health unit due to extremely challenging behaviour and review the legal issues that had to be considered in ensuring that there was appropriate legal authority for the child's admission and treatment. In this particular case, the patient was detained for assessment under section 2 of the Mental Health Act 1983. This case demonstrates that all clinicians working in this area require a good understanding of the law in relation to treatment of children with mental disorder, which is extremely complex.

With the emphasis on ‘care in the community’ there have been moves to provide psychiatric care away from the large psychiatric hospitals, which have resulted in the development of community mental health teams and the expansion of primary care and health centres to cater for people with psychiatric needs. The opinions of patients attending a hospital-based depot neuroleptic clinic are reported. A 17-item questionnaire was designed addressing the functioning of the clinic, including aspects of the medical and nursing care offered and the overall service provided. The majority of patients were in favour of attending this facility and expressed their wish for the service to continue.

The College has recently published an occasional paper in response to the Francis inquiry into the care at Mid Staffordshire NHS Foundation Trust. We consider that it overlooks one key question implicit in the inquiry's recommendations: ‘Is the business model of care fit for purpose?’ We question whether the business model in its present form is appropriate for the delivery of healthcare. We suggest there is a need for greater conceptual clarity with regard to the nature of compassionate care and the meaning of person-centred medicine. We recommend that a broader moral and ethical framework is considered not only for psychiatry, but for all healthcare provision which would transcend specialty and Royal College boundaries.

The College since its inception has striven to ensure the highest standards of psychiatric training and education. We are aware, however, that these training recommendations are not as widely known as we would like. The objective of the Collegiate Trainees' Committee Trainees' Charter is to disseminate as widely as possible a brief document on training that draws together strands from other documents including the Statement on Approval of Training Schemes for General Professional Training for the MRCPsych. This Charter has the fun support of the Court of Electors. The intention is to raise awareness about training problems and encourage trainees to be more proactive in ensuring that their training needs are met. Only by providing the best possible level of postgraduate training can we ensure the standard of patient service we would wish and the public increasingly expect.

A survey of the views of consultant psychiatrists concerning possible difficulties for the practising clinician in the early aftermath of the Mental Health Act 1983 is presented. The number of consultant psychiatrists written to was 118 and the breakdown of responses was as follows: 37 of 79 general psychiatrists replied; 4 of 8 psychogeriatricians replied; 2 of 9 consultant adolescent psychiatrists replied; 2 of 4 forensic psychiatrists replied; and 5 of 18 consultants in mental handicap replied. The letter asked eight questions concerning specific aspects of the Act and invited any comment.