Rarely in a lifetime do three people contribute to society in so many ways as the Burdens in Bristol. Here are some of their major achievements.

The Reverend Burden and his wifw Katharine opened ‘The Royal Victoria Home’, near Horfield Prison, for the care of inebriate women and girls in moral danger in 1895.

In order to investigate bias in history taking among psychiatric trainees, a retrospective study of case-notes was undertaken in an emergency psychiatric clinic in a teaching district. Two hundred and twenty-seven consecutive new patient assessments were assessed for quality of alcohol, substance use and forensic histories. Trainees were more likely to take alcohol, substance use and forensic histories from men, and more likely to take substance use histories from younger patients. It is concluded that trainees make sexist and ageist assumptions when they assess patients. There is a need for the education of doctors in this area.

Over the past 20 years, with the closure of psychiatric hospitals, there has been a greater emphasis on treatment of the seriously mentally ill in the community. Recently, there have been untoward incidents involving psychiatric patients leading to increasing public concern over this policy. Steps to reduce this concern have included the care programme approach, the supervision register and the community supervision order. Each requires some form of risk assessment to be carried out prior to their implementation, although there is little guidance on what areas should be covered.

A survey of the medical management of 75 mentally handicapped in-patients with epilepsy was carried out between June and December 1991. The study focused on the number and type of anti-epileptic drugs used, the frequency of monitoring of serum anti-epileptic drug levels and the nature and frequency of other blood tests carried out. Quality standards were then agreed and the survey repeated a year later. The results show that the agreed standards were generally achieved, although a large number of patients continued to receive more than one type of anti-epileptic drug.

Over the last four decades there has been a substantial reduction in the number of psychiatric hospital beds. Alternative residential facilities in the community have been developed. These include staffed hostels, group homes and supportive lodgings providing bed and breakfast. While hostels and group homes are often integrated with psychiatric services and run by experienced staff, this may not be the case with the small privately run homes. Anstee (1978, 1985) described two supportive lodging schemes and suggested that such facilities were particularly helpful for people with schizophrenia. However, there has been little further research in this area even though supportive lodgings may constitute a significant proportion of long-stay residential facilities. We know little about the landladies, their background, training, experience and particularly the rewards and frustrations of their work. The extent of psychiatric morbidity and the overall burden of care for these landladies is also unknown.

The aim of the present study was to gather information about the carers, the residents and the level of care provided in these facilities.

The emphasis of psychiatric care is being moved from the large mental hospitals towards community-orientated care and there seems also to be a need for a shift in the training of psychiatrists to include greater emphasis on the special issues involved in this approach to service provision.

One of the chief problems mentioned by the relatives of people suffering from schizophrenia is the difficulty in obtaining factual and practical advice. Many have struggled on for years, using trial-and-error methods, without knowing whether their lack of success was due to the immutable course of events, to ignorance, or to a deficiency in themselves of the ability to care. Some have made tentative enquiries but have been given a more or less polite brush-off. Although most relatives, like most sufferers, do eventually become aware of the diagnosis, it is rare for them to be given this information as part of a long-term plan of management which they are invited to share with professional staff and patient, and even more unusual for them to be told early in the course of the disorder.

In 1981, the Labour Minister for Health in a coalition government, Mrs Eileen Desmond, set up a study group ‘to examine the main components, both institutional and community, of the psychiatric services; to assess the existing services, to clarify their objectives and to draw up planning guidelines for future development of the service with due regard to cost implications; to carry out such studies and to take part in such consultations as are necessary to assist this examination’. The result appeared in December 1984 in the form of a report The Psychiatric Services: Planning for the Future. The text of the response of the Irish Division of the College, reproduced in full here, was sent to the current Minister for Health, Mr Barry Desmond, (also a Labour Minister in a coalition government) in October 1985. Meanwhile, in February 1986, Mr Desmond caused widespread alarm in political circles by the sudden announcement of the closure of two of the 22 psychiatric hospitals in the Republic without prior provision of alternative community services. British readers will detect a close parallel between this Irish report and the series of DHSS reports exemplified by Better Services for the Mentally Ill (HMSO, 1975). Perhaps the only significant difference between these two reports is that sectorisation (a mental health team headed by a psychiatrist and assigned to a ‘sector’ of 25,000 to 30,000 persons) is advocated rather more firmly in Planning for the Future. It is also worth remembering that the Republic of Ireland, in its population size and urban-rural distribution is comparable to the whole of Yorkshire. Half the population lives in Dublin. Elsewhere, psychiatric services must cope with widely scattered rural populations, with a minority only of working adults. There is a large private sector in Irish medicine and 20% of psychiatric admissions are to one or other of five private psychiatric hospitals. Despite these social differences from the UK, several comparative studies have shown a remarkable similarity in declared attitudes and practice amongst Irish compared with British psychiatrists. Finally, the method of remuneration of Irish family doctors differs from the UK: Irish GP's are paid, not on a capitation basis, but on a ‘fee-per-item-of-service’ basis with a majority of the population availing of this service free: patients tend to move from doctor to doctor and many use private health insurance to opt for private care. Psychiatric referral rates from general practice are low as in Britain.