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.

Active voluntary euthanasia may be defined as the deliberate taking of a patient's life, or the facilitation of his or her suicide, with the informed consent and at the express request of the patient. It may therefore be distinguished from passive euthanasia, when no positive step is taken to hasten death but when potentially life-saving measures are intentionally withheld, and also from non-voluntary euthanasia, when the patient is unable to participate in the decision, or is incapable of providing an adequately informed consent.

Mental health services in general are at present receiving a bad press. Recent complaints focus on two main areas: the widespread prescription of tranquillising drugs, and the social consequences of the policy of community care. There is now serious concern, both among the public and in the profession, about the over-prescription of tranquillisers. The legal implications are serious. An article in the Journal of the Medical Defence Union was recently quoted in the Bulletin: “Dr Ashton's article is a timely reminder that the prescription of benzodiazepines is now a high profile activity for the psychiatrist that has been scrutinised much more closely than many of our other functions. It is well to be aware that one of the potential onlookers is a lawyer” (Tyrer, 1988).

Despite a good deal of argument to the contrary (Maughs, 1941; Hunter and Macalpine, 1963; Walk, 1954; Walk and Walker, 1961; Craft, 1965; Whitlock, 1967) it is still commonly believed that Prichard's ‘moral insanity’ (1835) was the forerunner of our present-day concept of psychopathic (sociopathic) personality; the most recent example of this appearing in the paper by Davies and Feldman (1981), who write: ‘In 1801 Pinel described a condition termed by him manie sans délire, the notable feature of which was that the sufferer showed bouts of extreme violence but with no signs of psychosis … Prichard confirmed Pinel's observation and coined the term “moral insanity” which led to “a marked perversion of the natural impulses”.’ A number of modern textbooks (Sim, 1974; Friedman et al, 1975; Slater and Roth, 1977; Trethowan, 1979) also appear to regard moral insanity as the precursor of psychopathic disorder, although Trethowan correctly noted how the word ‘moral’ denoted ‘affective’ and was not being used in the usual ethical sense. He went on, however, to write that Prichard described cases showing antisocial or even criminal behaviour.

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.

The pharmacological treatment of depression and the time elapsed since last seen by a doctor were investigated among 507 adults who subsequently killed themselves. The proportion of people consulting a general practitioner or psychiatrist prior to suicide was lower than reported by the British government in the Health of the Nation document. General practitioners prescribed relatively low doses of antidepressants. Nineteen out of the 115 people receiving antidepressants used the drugs to kill themselves. Our findings emphasise the importance of prescribing adequate doses of antidepressants and underline the need for safer prescribing.

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.

The staff and associated specialist grade in psychiatry represents a large proportion of the non-consultant career grade workforce in some areas of the UK, with no direct equivalent worldwide. The advent of separate funding for continuing professional development (CPD) in England offers an opportunity to commission bespoke educational resources for a group of doctors who deliver front-line clinical care. This article details the background to the UK staff and associated specialist grade workforce and describes a model of CPD delivery that has attempted to meet training needs, with a view to improving patient care. Also at the heart of this model is the acquisition of consultant-level competencies through personal and professional development.

The practice of modern high quality psychiatry would be well served by the abandonment of the expression ‘community psychiatry’ and a moratorium on its further use for at least a decade.

Direct access residents in an inner London homeless women's hostel were interviewed and asked to provide information on medical, personal and social history. For each a DSM–III–R diagnosis, General Health Questionnaire, CAGE and Global Assessment Scale score was assigned, and their views on future housing were sought. The effect of severe mental illness (SMI) and age on dependent variables was examined. A third of the sample (n=14) suffered from SMI, and a further quarter from other mental illness (n=10). A quarter had a DSM–III–R substance misuse disorder. The prevalence of SMI was similar across age groups. Younger women had a different pattern of service needs, with greater levels of psychological distress, substance misuse and residential instability, than older residents.

Recent attention has been focused on divergent practices in the implementation of Section 136, problems in its practice encountered by the police, and possible means of improving the service and reducing unnecessary detention. In these studies, doubts have been raised about the justness of the section, both in principle and in practice, and about the efficiency and efficacy of its implementation. In the context of the closure of the large psychiatric institutions it seems probable that these issues will become increasingly acute. The purpose of our brief study was therefore to investigate the trends of admissions to Friern Hospital, not only of patients under Section 136, but of all patients accompanied by the police.

The question is often asked: “Does family therapy work?” This is an important but useless question. It is important because an enormous amount of time, energy and money is put into the clinical practice of family therapy. It is practised in every continent; there are many training courses and qualifications in very many countries, and there are over 40 journals devoted to families and family therapy. Yet there is a healthy and justified scepticism. So yes, we ought to ask whether it works.