The study examines the knowledge and views among district social workers of a local child psychiatric service and determines whether their views influence decisions to refer to the service. The results are compared with similar studies of general practitioners (GPs) and paediatricians and discussed with reference to recent national reviews of child psychiatry in the UK.

Long stay patients who continue to require 24-hour nursing care can be divided into two main groups: those who need to remain in hospital and those who could receive their care outside hospital. The Hostel Ward, with a multidisciplinary team providing input to individualised rehabilitation programmes, has been conceived as a possible solution to providing care for the second group. Some of its clinical, social and economic benefits have been reported (e.g. Hyde et al, 1987) and there now seems to be increasing agreement about its potential value within the range of rehabilitation services needed by a health district for people with chronic psychiatric illnesses (Abrams, 1988). However, it is still a relatively new concept and as the experience of this type of service may vary from one district to another, further reports of its utility and limitations are still needed (Garety et al, 1988).

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.

Forensic mental health services are low-volume, high-cost services. Payment by results (PbR) is the UK s latest attempt to improve efficiency and controls pending behaviours within the secure services. This article discusses the utility of the PbR mechanic in forensic mental health. It explores PbR implementation in non-forensic mental health settings, similar funding processes internationally, and early PbR implementation work in the UK's secure services. Finally, the article discusses the challenges faced when implementing PbR in forensic mental health services and puts forward possible next steps in determining the utility of PbR in forensic mental health.

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.

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.

The decision of the Law Lords in May 1989 that allowed the sterilisation of a woman with serious mental handicap (F. v. W. Berkshire H.A., 1989) is arguably the single most important legal development in relation to psychiatry in the last 30 years. It has far-reaching implications beyond the field of mental handicap and will affect the practice of all psychiatrists. The Law Lords used the appeal to consider “the startling fact that there is no English Authority on the question whether as a matter of common law (and if so in what circumstances) medical treatment can lawfully be given to a person who is disabled by mental incapacity from consenting to it” (Lord Goff). Quite clearly this encompasses a large part of psychiatric practice and promised to clarify much of the controversy surrounding consent and the incompetent patient. The decision that they reached has now been incorporated into the Code of Practice of the Mental Health Act 1983 which was approved by Parliament in December 1989. The effects of this are of huge importance, and it has extensive consequences for all psychiatrists and their patients by simplifying the legal aspects of treatment. The most surprising aspect of this whole issue, therefore, is the silence that has surrounded both the original decision by the Law Lords and the subsequent publication of the Code of Practice. The only reference to these in The British Journal of Psychiatry, or its sister journal, Psychiatric Bulletin, has been a brief letter outlining some implications of the Lords' decision (Lovett, 1989). This is doubly surprising as the Royal College of Psychiatrists has shown considerable interest in this debate, not least by publishing a book about it! (Hirsch & Harris, 1988). The purpose of this paper is to provide a background to the Code of Practice and to clarify certain issues surrounding the Common Law.

Bohmer's concepts of custom and standard care are briefly discussed with specific reference to their implications for the role of doctors in mental health services. It is argued that these concepts help to clarify the unique contribution of doctors within multidisciplinary teams and help define the limits of standardisation in mental health services.

Doctors who are embarking upon general professional training in psychiatry as Senior House Officers (SHOs) are now faced with making a choice between two types of training schemes. The first type offers training on a membership course aimed primarily at teaching the skills required to pass Part 1 and Part 2 of the MRCPsych. The second type offers training on a university course leading to the award of a Masters degree in psychiatry.