Older people comprise an increasingly significant proportion of the population of the UK and other developed countries. Most remain fit and able to make continuing contributions to their families and society, but they are at risks of periods of ill health and other stresses. Dementia, especially Alzheimer's disease, is one of the major health problems of our times and particularly affects older people. Mental ill health, physical ill health and social difficulties are often intertwined, calling for close working between health and social services to provide appropriate help for patients and their carers.

The Court of Appeal in its judgement of this case ruled that special care needs to be taken in cases where the defendant suffers from “a significant degree of mental handicap” (This term is used with a specific legal meaning – see below) if the only evidence against him is his confession.

The limited previous research on usage of section 136 of the Mental Health Act 1983 (MHA) has either confined itself to description of socio-demographic and clinical data (Dunn ft Fahy, 1990) or considered procedural issues solely in urban areas (Rogers ft Faulkner, 1987). This is despite the repeated concern of the Mental Health Act Commission (1991), which has noted more widespread difficulties in the use of section 136, highlighting individual failures by local services to adhere to the Code of Practice MHA (Department of Health and Welsh Office, 1990). This study attempts a region-wide survey of section 136 agreements and the corresponding frequency of use of the procedures. This is in line with the Reed Committee recommendations (Department of Health/Home Office, 1992), which prioritised early diversion from custody as an area of research, and emphasised the desirability of multi-agency section 136 agreements.

Deception is commonplace and a discipline such as psychiatry, so often reliant upon subjective accounts, may be susceptible to its effects (especially in the fields of military, liaison, medico-legal and forensic practice). However, psychiatric trainees receive little formal teaching on the subject of medical deceit. Here, I review some recent books on deception, emphasising those works that cast tangential light upon everyday psychiatric practice. Useful sources of reference include those concerning the philosophy of deceit, the recent rise of political lying and the clinical problem of feigned illness. A clinically helpful distinction emerges: that between truth (accuracy) and truthfulness (sincerity).

Hamilton is New Zealand's fourth largest city. Situated on the banks of the Waikato river in the central North Island, it was my home during a year's experience as a psychiatric registrar in the Waikato Hospital. This paper describes aspects of a medical and psychiatric practice, including training in New Zealand, and offers general advice to trainees planning or considering overseas placements.

It is acknowledged that assessing ‘consumer satisfaction’ is an important part of medical audit (The Royal College of Psychiatrists, 1991). For the mentally handicapped, it can be argued that ‘carer satisfaction’ is particularly relevant. This is particularly so at a time when the ‘community’ is being advocated as the preferred setting for the long-term care of the mentally handicapped, the families and neighbours of the handicapped being the main providers of this ‘community care’ (Griffiths, 1988).

The role of relatives as carers of people with chronic mental illness has long been emphasised and was legitimised by Sir Roy Griffiths in his report to the Secretary of State in 1988. The White Paper (Caring for People), however, merely pays lip service to the role of the family. It does not suggest how such help might be provided. There is no reference to relatives, or even ‘informal carers’ (the most recent way of describing relatives), in its sections on provision of services by Social Services or the Health Service. While ‘informal’ is clearly used to indicate ‘unpaid’, it emphasises that relatives, even as carers, are not part of the formal caring process and can, therefore, be ignored as part of the team. If relatives are to be part of the service, as carers, then they need, as Griffiths and the White Paper point out, to receive support and resources to fulfil this role. But what support and services? And who is to provide them?

The General Medical Council have agreed that part of a letter which they wrote to a member of the College containing their current policy on confidentiality can be published in the Psychiatric Bulletin. This letter was written in response to a specific enquiry.

The desire to provide care and services for people with mental health problems in a community context, rather than in large institutions, is a long-established feature of Government policy. In the more local context of the Portsmouth and South East Hampshire District Health Authority, a strategy of decentralising both the organisation and the delivery of services for adults with mental health problems began to be implemented early in 1986. Five multi-disciplinary area community mental health teams would work with and alongside other service-providers in their localities to provide a range of support, including residential, day and other community and domiciliary services.

A case-note survey was carried out on the first 50 referrals to a treatment service for adolescent sex offenders. The average rate of referral was 10.5 per year and all referrals were male. of those who attended, 66% showed evidence of psychiatric morbidity, while only a minority had a past history of child sexual abuse. The majority had offended against victims known to them. Treatment was labour-intensive with a mean of 19 sessions being provided per patient. of those taken on for treatment, 2.6% re-offended, while of those not offered treatment, 25% did so.

More than any other area of medicine, psychiatry is influenced greatly by the cultural setting in which it is practised. Iran and the UK have similar-sized populations, but are very different in many other respects. The opportunity arose to compare psychiatric practice in these two countries when one of us (N.H.) spent 3 months visiting mental health services at a UK centre.