Residential child psychiatry units inevitably offer a form of temporary parenting to their patients. This paper explores various effects of this ‘parenting’ task on the treatment process itself and on a unit's relationship with parents. The potent therapeutic opportunities as well as potential unwanted effects deriving from this role are described. An awareness of the processes involved along with appropriate case management can maximise the benefits and minimise the unwanted effects of this factor within in-patient treatment.

Although psychiatric hospitals contain a population at risk of suicidal behaviour compared to the community at large, suicide in hospital in-patients and recently discharged patients is relatively rare. It has been suggested that hospital admission itself reduces the risk of suicide (Tenroche et al, 1984). Factors considered important are a calm ward routine carried out by staff confident in the immediate future, and the opportunities for social contract offered by the ward environment.

Following the recommendations of the Butler Report (Home Office, 1975), there has been a slow growth in the number of Regional Secure Units (RSUs) (Snowden, 1985), which aim to assess and treat mentally disordered offenders in England and Wales in conditions of “medium security”. One particular recommendation of the Butler Report was that:

“The main emphasis in forensic psychiatric services … should be on community care and out-patient work.” (paragraph 20.14)

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.

The objects and purposes of the constitution of the Royal College of Psychiatrists in 1971 included to “advance the science and practice of psychiatry” and “to promote study and research” (Supplemental Charter and Bye-Laws, 1989).

A leading article in the British Medical Journal (Miller, 1992) comprehensively criticised the Joint Planning Advisory Committee (JPAC) for failing to implement the changes in manning levels needed for Achieving a Balance. This leader came as no surprise to psychiatric trainees, and nor did it offer much comfort. The ‘bottleneck’ between registrar and senior registrar has become a ‘log-jam’ and although prospects for trainee psychiatrists are not as bleak as for the unfortunate would-be thoracic physicians cited in the leader, they are bad enough. For example, when a single SR post in adult psychiatry was recently advertised for the NW Thames region, there were over 60 enquiries, 45 of which transformed into definite applications, even though the post offered was in a less than popular sub-speciality. Local selection committee members for NW Thames in other psychiatric specialities have also been surprised by the number of applicants. JPAC may not be entirely to blame: the economic recession may be a disincentive for consultants wishing to retire early, thus slowing-up career progression throughout the profession.

This study investigated the links between aspects of cultural life and response to ethnic monitoring questions, and compared parental and adolescents' responses. Questionnaires were given to consecutive attenders at a child and adolescent psychiatry department situated in central London. Forty-seven parents participated, and 24 adolescents (aged 12–16 years) also completed questionnaires. Parents came from many parts of the world and their offspring were mostly born in the UK, but had varied cultural life with respect to language, peer group and diet. Just over half of the offspring were regarded as ‘White British’ by parents but the second largest group was that marked ‘other’, who all had mixed identity. There were differences in how parents described adolescents, especially in relation to peer culture. Since ethnic categories have limitations the data should be used carefully, and for many aspects of health planning and delivery other cultural variables would be useful. Consideration should be given to the need for specifying whether adolescents or their parents should respond to ethnic monitoring questions.

The Internet opens up brand new possibilities for medicine. Nowhere before has it been possible to confer with colleagues from all over the world to swap ideas on an hour-to-hour basis on all manner of subjects.

As usual, I bought my wife Vogue magazine for Christmas. It always serves well as, in North America parlance, a ‘stocking stuffer’. This year it had further value as it highlighted the brain. A well-known psychiatrist, Nancy Andreasen, set out to inform America about modern psychiatry (Andreasen, 1990). The article is entitled ‘Brave New Brain’ with the subtitle being ‘Modern Psychiatry has Left the Couch for the Laboratory’. She takes the reader through neuro-imaging, molecular genetics and psycho-pharmacology. It is an elegant synopsis and worthy of someone who had a doctorate in English before she took up medicine. Importantly, however, she prefaced her serious material with a mock-comic story about a conversation she had had with someone at a New York hospital recently. She was phoning about the retrieval of a brain for research and the ingenuous person at the hospital just could not put the idea of psychiatry and brains together. Another sad tale of psychiatric breast-beating? Those of us who trained in psychiatry in Britain a generation ago might give a wry smile. After all, biological psychiatry was all that we ever knew. When I entered the Maudsley in 1964, part of the orientation for registrars consisted of going to the laboratories. A mouse was popped into a jar containing liquid nitrogen, it went rock hard and the group was advised that freezing the neurotransmitters in that way was the royal road to solving problems.

Roundway Hospital provides all rehabilitation and continuing care (rehab) beds for the Swindon Health District (Swindon), population 245,000; the Wiltshire sector of the Bath Health District (Wilts) population 200,000; and the Bath City sector of the Bath Health District (Bath), population 85,000.

Mental disorders may seriously impair insight and therefore cause some patients to refuse potentially life-saving treatment which they would otherwise accept. Opinion on the ethics of current legislation regarding compulsory admission and treatment varies with open debates leading to heated and emotive exchanges. During the reading of the 1982 Mental Health Amendment Bill intense lobbying of MPs took place (Bluglass, 1984). Some argued against compulsory detention because of its infringement on personal liberty while others argued that it was necessary for the adequate treatment of mental disorders which impair insight. They pointed out one's right to receive appropriate treatment whether or not insight is impaired.

Despite the increased availability of psychotherapy within the NHS, inequalities remain (Holmes & Lindley, 1989). Traditionally, psychotherapy services have been provided from teaching centres in cities and patients have had to travel for treatment. This may account in part for the middle-class predominance in psychotherapy patients and Holmes (1991) has identified the need for psychotherapists to reach out and cater for the disadvantaged in large housing estates and rural areas. While services are changing to meet such needs (Pedder, 1989) there are powerful economic restrictions on service expansion. The potential for communications technology such as interactive television to aid the delivery of general psychiatric services has been reviewed by McLaren et al (1992) and similar arguments apply to the delivery of psychotherapy.

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.