There is now an extensive literature describing the value of work for people with a psychiatric disability (Shepherd, 1989; Bennett, 1970; Wing & Brown, 1970; Pilling, 1988). Apart from financial gain the benefits of work can include social contacts and support; social status and identity; ‘normal’ non-patient roles; a means of structuring and occupying one's time; a sense of personal achievement and mastery and a criterion of recovery from illness (Shepherd, 1984). However, for many people with a long-term psychiatric disability the range of opportunity for work is often very limited, usually consisting of subcontract packing or assembly work. The provision of this repetitive and simple work satisfies a basic occupational need. However to a large extent it neglects the fulfilment of broader psychological and social needs. People with a vulnerability to experience periods of major mental disorder usually have more than just an occupational need; they also need to be in an environment which can provide the conditions that will actively assist in the promotion of a state of positive mental health.

It is now widely recognised that families represent a hidden and largely unacknowledged resource to the NHS in the day to day management of long-term disabilities, particularly severe mental problems like schizophrenia. It is most likely that 50–60% of first admission schizophrenic patients will return to some type of family environment and a significant number will remain with the family for a considerable time. The current trend towards community management of mental illness, hampered by the lack of community provision, almost inevitably means discharge to families and is likely to continue and increase further.

Vienna, a city with a population of 1.5 million, as well as being the capital of Austria is also one of its nine provinces. Care for the mentally ill in Vienna, as elsewhere, was for decades either misguided or poor. The large mental hospitals in the city were seriously overcrowded and understaffed. In the extramural sector, there was an enormous deficit in out-patient and complementary facilities.

With the rapid expansion in the number and variety of psychotherapy courses in this country, it is perhaps timely to review some of the issues influencing these courses. One purpose of this paper is intended to draw attention to the fact that not only are there interesting conflicts in establishing such courses but also establishments whose power relationships affect the educational effectiveness of these complex teaching ventures. These issues will be discussed with reference to the trainees, trainers, patients, and host organisations.

Previous studies have looked of repeated admissions and failed discharges but none have followed up a group of patients requiring multiple admissions over several years. We found that of the 42 patients admitted three or more times to acute wards in 1990, half were having a bad year and did not require this level of inpatient care in succeeding years; one-quarter continued to use acute services heavily but none required three or more admissions in every year of follow-up; one-quarter did badly and required prolonged in-patient care or died.

The high-security hospitals are undergoing a retraction process. In conjunction with this, regional services are being developed for those patients who require longer-term treatment at medium-security units.

Group psychotherapy for adults reporting childhood sexual abuse is a well recognised form of treatment but little attention has been given to the possible adverse effects. This paper reports on three patients seen within a NHS trust department of psychotherapy who had taken part in an incest ‘survivor group’. They described individual satisfaction with their improvement but appeared, when viewed externally, to have deteriorated.

It is not uncommon to hear a psychiatrist claim to be able to judge from general practitioners' letters which new referrals will attend and which will fail to turn up. However operational research has failed to define clear characteristics of patients who do not keep first appointments (Hillis and Alexander, 1990; Skuse, 1975; Zegleman, 1988). Also the standard of referral letters has been criticised in the past and shown more recently to omit key items of information (Pullen & Yellowlees, 1985). The aim of this study is to test the ability of psychiatrists of varying experience to predict non-attenders.

We performed a survey to examine the behavioural–cognitive psychotherapy teaching and experience of trainee psychiatrists in the South Thames (West) Region. Sixty-four per cent of the whole sample who responded to the survey, including 90% of the registrars who responded, had treated at least one patient using behavioural cognitive methods. Few trainees reported no experience of behavioural cognitive psychotherapy with almost all attending some form of teaching. Trainees generally reported that they valued this experience.

A leader in the British Medical Journal (BMJ) last year (Marks, 1988) suggested that the uptake of social security benefits among mentally ill people is low. However, this statement was based on the only data the writer could find – a study of 37 patients conducted in Islington based on the old social security system, prior to April 1988 (Linney & Boswell, 1987). Two weeks later, another BMJ leader (Marcovitch, 1988) bemoaned the fact that insufficient research had been conducted on the impact of changes in the social security system.

The clinical examination is the cornerstone of the MRCPsych Parts I and II. Trainees frequently prepare for the clinical by practising in a mock examination setting. One person's experience in examining candidates in mock clinical examinations is reported and an approach to the clinical examination is described. Some of the common pitfalls are highlighted.