Large psychiatric hospitals are notoriously resistant to change. Their size and organisational complexity inevitably hinder their capacity to keep pace with trends. The serious consequences of a system that has ceased to adapt have been documented many times. Stereotyped routines and practices combine with rigid and bureaucratic management structures to produce the phenomenon of staff ‘burn out’, the “I've seen it all before and it doesn't work” syndrome.

It is unarguable that R. D. Laing was the best-known and, certainly outside mainstream psychiatry, the most influential psychiatrist of his time. His ideas have continued to exercise an astonishing appeal to writers, film directors, sociologists and philosophers. He epitomised for many the so-called anti-psychiatry movement and its portrayal of psychiatrists as agents of social control, psychiatric institutions as centres of degradation and psychiatric treatment as a process of invalidation. His rolling Glaswegian rhetoric summoned forth once again the compelling romantic concept of the psychotically ill as bearers of a potent insight into the fallibility, the malevolence and the violence at the heart of the human condition. He was, as his old teacher, and fellow-psychiatrist and Scot, Morris Carstairs, observed in a review in the Times Literary Supplement in 1976, “a guru of our time”. Now that he is no longer with us, how will time remember him?

The first meeting of the Violence Management Special Interest Group on 25 February 1992 drew a mixed group of delegates from three of the 15 Scottish Health Boards, three Regional Social Work Departments and several Education Departments, as well as the Scottish Prison Service. The majority of those who attended were actively engaged in designing training programmes for public sector staff.

In 1991, Derek Humphry published Final Exit – The Practicalities of Self-Deliverance and Assisted Suicide for the Dying. The book was written for mature adults who were suffering from terminal illnesses and required guidance in committing suicide, but it has encouraged suggestive and susceptible people to attempt suicide (Lavin et al, 1992). There appears to be a thin line between assisted suicide and culpable suicide. ‘Culpable suicide’ is used here to describe contributory negligence attributed to persons who unknowingly assist another person's suicide.

The Chinese community in the UK has existed since the latter half of the 1800s and traditionally has been perceived as insular and self sufficient (Lynn, 1982). In the 1960s and ‘70s, there was a large influx of Chinese into the UK to work in catering businesses. Many of the children of this generation were born in this country; with this group now in their early adulthood, there is more integration into the indigenous population. However, there is still an impression that Chinese psychiatric patients are under-represented in the services, but as yet, there has been little psychiatric research carried out among the Chinese in the UK. This study examined briefly the level of contact with, and difficulties encountered in, managing Chinese patients by psychiatrists in Merseyside.

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.

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.

SafetyNet is a computerised, networked patient care system currently under development in the South Camden sector of Bloomsbury Health Authority. The project is primarily targeted at the clinical monitoring of people suffering from schizophrenia and the system incorporates measures which can provide a basis for quality assurance of care and a clinically driven approach to audit. SafetyNet is being designed to help keep track of individual sufferers, chart their needs as they change over time, prompt the services to action and knit together the responses needed from different agencies. It is a modular system which can be adapted to the needs of people with different kinds of mental illness and to different community populations.