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.

This article explores some basic questions about management and reveals that psychiatrists may already have a head start in management. The aim is not to make good psychiatrists into managers, but to enable good psychiatrists to provide good mental health care.

Music therapy is a non-analytic therapy concerned with the creative process in which an attempt is made to reach the emotions of the patient without recourse to verbal means. It should in theory be suitable for chronic psychotic patients and all whose verbal ability is minimal. The ability to appreciate music may persist despite psychotic disintegration and provides one way, maybe the only way, into a patient's inner life. Music is one aspect of the aesthetic or creative experience that neurotic patients often lack and for this group music may provide a broader view of emotional life than their own more narrow previous experience.

Like many countries in Asia, Singapore has its own system of postgraduate training and specialist accreditation in psychiatry. Psychiatry trainees are strongly encouraged, but not required, to receive supervision in psychotherapy with patients during the 6-year period of basic and advanced training since the inception of the Masters of Medicine in Psychiatry (MRCPsych equivalent) in 1985.

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.

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 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).

Changing methods of recording psychiatric histories by a community mental health team for the elderly was associated with a dramatic improvement in the quality of recording of clinical Information and of communication with general practitioners. Comparison is made with published studies of case note audit with feedback. It is suggested that restructuring the way we work may be more effective than simple review of case notes with feedback.

The quality of lithium monitoring in a health district serving a population of 450 000 was studied over a period of a year. The following instances of poor monitoring were found: too frequent monitoring in stabilised patients, and failure to take action when lithium values fell below 0.3 mmol/l or rose above 1.0 mmol/l. Ways of improving the standard of monitoring are considered.

With the current balance of manpower, being appointed to a senior registrar post is seen as more of a hurdle in the NHS career path of junior psychiatrists than the MCRPsych examination. Numerically, it is the most significant bottleneck in the system, with substantially more suitable applicants than available posts. One effect that this has had is to encourage a climate where rumours and myths circulate about what is necessary to become an SR. As well as being stressful and demoralising, this can give candidates the wrong ideas of what is realistically required.

Earlier this year a senior Department of Health official asked me if I had seen an article in the Health Services Journal about child psychiatry (Light & Bailey, 1993). Shortly afterwards a consultant colleague asked me about the same article, having been told about it by her manager, and one of my own managers mentioned it to me and asked for my thoughts. Now the Psychiatric Bulletin wants 500 words on this same article. If nothing else, Professor Light and Dr Bailey have stimulated debate.

Access to a senior registrar post is growing more difficult because of increasing competition. The College Court of Electors and Joint Committee for High Psychiatric Training have agreed only two criteria for appointment as SR in Psychiatry (possession of MRCPsych and at least three years of general professional training), but, despite heavy workloads, busy timetables, and the need to prepare for the membership examination, clinical skills and dedication to patients will not ensure career progress if they are not accompanied by other aspects of training, sometimes with insufficient facilities and supervision. Indeed, Lewis (1991), after reviewing a group of applications for SR posts, found that the only variable which predicted likelihood of being shortlisted was having published: “Trainers generally believe that evidence of completed research and publications say more about a trainee than a good reference ever can”.

In 1992, Pippard reported a comprehensive audit of electroconvulsive treatment, (ECT), in two NHS regions. He found deficiencies in most aspects of ECT administration (Pippard, 1992), particularly the training and supervision of the administering doctor, usually an SHO or registrar. Regrettably, the competence of a trainee to administer ECT appeared to have improved but little in the 11 years since the same author first reported on the subject (Pippard & Ellam, 1981). In particular, it failed to meet the guidelines issued by the Royal College of Psychiatrists in 1989. This was reflected in inadequate administration of ECT as assessed by direct observation and by determining the provision made for teaching and supervision of ECT by senior staff. Pippard concluded that the overall standard of training was inadequate and that “The responsibility for this mediocrity rests squarely on the consultants as a whole and not just on those whose nomination to be in charge appears to absolve the rest…”.

Last year I was unfortunate enough to suffer a major depressive episode which required in-patient care and extensive physical treatment. I have now progressed far enough from the experience to be able to look at it more objectively, and to think about the implications it will have for my own practice of psychiatry in the future. I hope that what I have observed, reflected upon and learnt will make me a better psychiatrist, more in touch with the needs and fears of my patients, and that my view of ward dynamics “from the other side” will give me more insight into why things happen as they do. The thoughts that follow are offered not as a critique of my care, which was excellent and for which I am very grateful, but merely as a view of the practice of psychiatry from an alternative standpoint. Hopefully they may encapsulate some of the difficulties faced by the depressed in-patient, although of course they cannot presume to speak for those suffering from other forms of psychiatric illness.

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.

Prescriptions for psychotropic drugs for in-patients in the Dundee Psychiatric Service were studied for three five-month periods in 1991, 1992 and 1993 using computer data and drug sheets. Information about Journal advertising and advice to doctors was obtained for the same period. A possible effect of Journal advertising was detected in the first year but there was no further Increase in the second year in the total of prescriptions. Information is presented of a similar survey in 1975 and 1976. A high proportion of prescriptions was for formulary drugs and doctors rated the British National Formulary as the strongest influence on their prescribing.

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.