The declared aim of the World Health Organization, based on the Alma Ata declaration (1978), is to promote health care for all by the year 2000. It is recognised that this can be achieved only by the channelling of efforts into the development of primary health care, with medical care greatly augmented by the utilisation of non-medical carers, traditional healers and public health measures. As in more developed countries, where psychiatry struggles to maintain its share of national health resources against the ever increasing demand of technical advances in physical health care, so the mental health services of the less developed countries constantly are in danger of losing out to physical health in the battle against illness and natural disasters. To redress this balance and to meet the needs for mental health by the year 2000, the less developed world needs more psychiatrists (who are currently estimated to relate to the population at a rate of approximately only one per million) and these psychiatrists need to be appropriately trained to meet the challenges. How can the more developed nations help in this training of trainees from the less developed world? Can a partnership be formed between nations that ensures that trainees in psychiatry, in whichever country, are equipped as well as possible for the needs of their home country?

A postal survey was conducted among doctors practising psychiatry in the Mersey Region to ascertain attitudes, beliefs and practice with regard to psychotherapy, achieving a response rate of over 60%. There was a surprising absence of very strong feelings for or against psychotherapy which was not seen as a powerful treatment modality. There was little knowledge of the facilities provided by the regional service, and no general support for their expansion. The role of training in psychotherapy and its significance in light of guidelines for general trainees ore discussed. A need is recognised for greater awareness and contact between psychiatrists and the psychotherapy service.

Day care has been called one of psychiatry's gifts to medicine. The British psychiatric day hospital movement began in the post war years and its philosophy continues to flourish with the decline of institutional care.

Psychiatric patients have had the right to see their notes from 1 November 1991. The ‘Access to Health Records Act (1990)’ makes provision for certain parts of the record to be exempt, including information which may cause serious mental or physical harm to the patient or anyone else. In addition, patients should not have access to information given by third party informants unless appropriate consent has been obtained. The legislation only applies to records made after 1 November 1991. It does not cover informal arrangements where written application for access is not made.

In setting out a health strategy for England the White Paper, The Health of the Nation includes mental illness as one of its five key areas for action. Within mental health three targets are set out.

The move towards community care essentially aims at the provision of a comprehensive psychiatric service in each District with facilities for the chronically disabled based outside the hospital for the greater part. Parallel with this move runs the aim to close all large mental hospitals. The present debate centres around the extent to which we can move towards a system of comprehensive District psychiatric services alone at this stage in time and the question of whether it is desirable to abandon totally the large psychiatric hospital style of care. The brief of this paper is to summarize the reasons for concern about a wholesale move towards District-based services from the large mental hospital from the psychiatrists' view-point. Unfortunately, much of the debate is based on speculation because of the experimental nature of this move and the fact that objective research is lacking on any changes already made in this country.

The clinical observation that some psychotic patients were attempting to register their ideas as patents prompted a survey of published patents. The hypothesis was that, given supposed links between creativity and mental illness, the Patent Office might be a repository of psychotic ideas. Searches were made on specific topics suggested by our patients' applications. A survey was undertaken of unusual patents in the collection as a whole, and of authors with unusual track records. Bizarre and eccentric patents were identified, but patents of the sort that our patients attempted to register were absent. Possible explanations for this result are discussed.

In November 1980, two men, Mackenny and Pinfold, were convicted at the Old Bailey on several counts of murder which were of a particularly callous and brutal nature. They were sentenced to life imprisonment. In the preceding December (1979) another man, Childs, had pleaded guilty to all the murders with which Mackenny and Pinfold had been charged, and which he alleged had been carried out with them together. He turned Queen's evidence, and it was his testimony that was crucial and central to the Prosecution's case against Mackenny and Pinfold.

Although there are some well recognised physical disorders such as intracranial lesions that can present with mental illness, many psychiatric conditions do not appear to be associated with underlying somatic complaints. However, a number of recent studies have shown that there are often high rates of concurrent medical conditions among acute psychiatric in-patients that were previously undiagnosed or unsuspected. The author illustrates this point by presenting two case studies in which a significant medical condition was only identified after physical examination on a psychiatric unit.

Every once in a while there is a mini renaissance in an area of medicine. The flowering of research that has taken place world-wide in the field of psycho-oncology in the last decade is one such example. This deepening interest in all the different psychological aspects of cancer, with the prevention of psychiatric morbidity and the development of a healthy adaptation being the main outcome aims, has led to hundreds of publications in recent years, along with the launching of two high-quality journals, the Journal of Psychosocial Oncology and the Journal of Psycho-Oncology. There have been numerous robust research findings proving the efficacy of psychosocial interventions in cancer patients on a range of outcome measures (Stein et al, 1993; Fawzy et al, 1995). The search for conclusive evidence of the positive effects of psychological therapy on disease progression and hence survival rates has also developed, becoming a holy grail for researchers in mind/body medicine, and has been brought tantalisingly within reach by a number of well-controlled trials (Spiegel et al, 1989; Richardson et al, 1990; Fawzy et al, 1993; Ratcliffe et al, 1995).

A Regional Gender Identity Clinic was established in Yorkshire ten years ago. It is an entirely NHS-based service and is well used by the psychiatrists in the region. The Director of the clinic is a psychiatrist and there is a cohesive group consisting of a plastic surgeon, gynaecologist (who supervises medication) and a speech therapist. The clinic has won the recognition of the Leeds Community & Mental Health Services Teaching NHS Trust which supports its continuation. An audit of outcome of the first 12 male to female reassignment procedures was conducted by a independent assessor. The result gave the team clear indication that the work should continue. A plea is made for the establishment of more regional services.

Moving to a different country for work can be an interesting experience but can be demanding for healthcare professionals as the systems across countries are vastly different. At the same time, such an opportunity can enable professionals to broaden their skills and experiences. The National Health Service (NHS) provided such an opportunity by recruiting consultants from overseas under the International Fellowship Scheme. In this paper three psychiatrists (M.S., S.G. and G.S.) who moved to the UK under this scheme describe their initial experiences.