The issue of sexuality and the mentally ill provokes an uneasy reaction in many people. The lay person possesses inaccurate notions, for instance, about the level of sex drive or the expression thereof. Public interest and anxiety was recently fuelled by the case of Jeanette, the mentally handicapped woman for whom sterilisation was requested. Less understandable is the reaction of the more informed carers of the mentally ill. Being in such a position of responsibility raises a challenge, though the usual attitudes are of either ambivalence or denial. It was not then without some reservations that we organised a group for young people with psychotic conditions, with the aim of tackling sexual issues in relationships.

Buddhism started in India in the 6th century BC. It is not a faith, but a way of life that includes maintaining virtuous and moral conduct (Sila), improving the concentration of the mind (Samadhi) and developing insight or wisdom (Panna).

This report describes one of the largest published surveys of users' views of services, with 287 users returning a 34-item questionnaire and 80 people interviewed about their views and satisfaction with services provided by two psychiatric day hospitals. The combination of questionnaire and interview methodologies provided data such as an overall satisfaction score (which was relatively high) and satisfaction scores with specific aspects of the service, as well as highlighting specific problems and providing recommendations on how to make improvements.

The Urgent Assessment Service (UAS) was set up to provide community based urgent psychiatric assessment to a range of referrers. The work of the service was assessed over a six month period. Results show that it was popular with a broad range of medical and non-medical professionals. Patients generally presented with depression or psychotic illnesses and those referred from non-medical sources were more likely to be suffering from schizophrenia and assessed as being at least as unwell as those referred by GPs and hospital based doctors. Rates or referral to hospital services were low with the vast majority of patients being referred back to their general practitioner after initial assessment and treatment.

In 2004 I was asked by the College first to respond to the Inquiry's questions and later to attend a ‘stakeholders' meeting’. This was not so much in my capacity as Treasurer but as an officer with an interest in the issue of risk and professional difficulties for psychiatrists. A review of the public reports from the General Medical Council (GMC) of their determinations in the Professional Conduct Committee had made it evident that sexual misconduct was probably the single greatest cause of a finding of serious professional misconduct against a psychiatrist. In addition, I had contributed to an earlier debate on sexual safety for women in psychiatric hospitals (Subotsky, 1991, 1993).

Psychiatric care is delivered by a wide range of workers (psychiatrists, hospital nurses, community psychiatric nurses, occupational therapists, psychologists, social workers, counsellors and general practitioners) who work as teams with some patients and as individuals with others. Health authority resources for psychiatric care are widely distributed among facilities both hospital-based (wards, day hospitals, out-patient departments, social work departments, occupational therapy departments) and community-based (community psychiatric nursing departments, community mental health centres and facilities funded jointly with social services and voluntary agencies).

This is a personal view on the implications for mental health services of the Executive Letter of the National Health Service Management Executive (NHSME), published in July 1992 (EL (92) 48): ‘Guidance on the extension of the Hospital and Community Health Services elements of the GP Fundholding Scheme from 1st April, 1993’.

Unrecognised and untreated depression is common, particularly in the elderly. This paper describes an attempt to offer screening for depression to 4,500 people over the age of 60. Only two people attended and both were depressed. This may have related to the arrangements for screening, to the symptoms of depression, to inadequate publicity or to characteristics of the elderly population. Others contemplating screening for depression in elderly populations are advised to adopt a different methodology.

Fate, it seems, conjures up all sorts of ways for us to be in a certain place at a certain time. In 1982 as a trainee psychiatrist in the UK, I found myself co-facilitating a group at the Castlewood Day Hospital, then part of the Bexley psychiatric rotation scheme, in the south-east of London. Group psychotherapy was part of our training. Held thrice a week the groups were open-ended and patients ranged from those with interpersonal relationship and personality problems to those with anxiety and substance misuse problems. At the time the experience was somewhat baffling. Not only was I from a different country and culture, my exposure to psychiatry was limited to about 12 months. More often than not I felt lost as I tried to come to terms with ‘group dynamics', ‘reality testing’, ‘transference’, ‘multiple transference’, ‘group cohesion’, ‘group pressure’, etc.