In 1974 we published a pilot study on the use of consultant time in child psychiatry, based on detailed timesheets kept by a group of child psychiatrists in and near London (1). The group, which is still meeting, decided to see what changes, if any, have occurred over the last seven years in the way we allocate our time. The primary purpose of the group, now, as then, is ‘the provision of a forum where members can exchange views and compare experiences relating to the problems encountered while engaging in and often being professionally responsible for administering a child psychiatric service.’ A nucleus of about six consultants took part in both studies.

Luiz Dratcu makes a case for a new specialty of acute inpatient psychiatry; Frank Holloway argues otherwise. In neither instance are the arguments at all surprising, and in both they are eloquently expressed. The case for a new specialty is based upon recognition of a continuing need for acute psychiatric in-patient services, and recognition that these services require particular skills and facilities which are likely to be most efficiently and effectively provided when interests and activities are focused upon them. The case against does not deny the need for attention to widely acknowledged shortcomings of many acute psychiatric in-patient services, but it does ask the questions ‘what should constitute a specialty?’ and ‘what benefit would flow from having a specialty and for whom?’

A previous article in the Bulletin describes the ‘BTC’ (Been to Canada) scheme sponsored by the Nova Scotia Department of Health to bring psychiatric trainees to Canada in order to undertake a year's clinical work in addition to ongoing medical education under the auspices of the Department of Psychiatry at Dalhousie University. Over the years the scheme has attracted a number of graduates, some of whom have been prompted to stay on and develop rewarding careers. The original article by Munro and colleagues (1987) describes the programme from the sponsor's perspective and might well be complemented by this account from a BTC graduate who has now returned to the National Health Service.

Of all the decisions taken by psychiatrists with or on behalf of their patients, few are as potentially far-reaching as the decision to repatriate a mentally ill person to his or her country of origin. Although many psychiatrists have anecdotal experience of individual cases, published research on repatriation is surprisingly sparse. Burke (1973) reported 66 persons repatriated from Britain to Jamaica over a four year period, and Asuni (1968) found 82 returning via Aro Hospital, Nigeria, over a similar period. Although it is difficult to extrapolate an estimate of the number leaving the UK each year, these figures suggest that the practice is not uncommon and that significant, possibly increasing, numbers of people are affected.

In their editorial, Michael et al focus on what they see as shortcomings in one important area of clinical assessment of psychiatrists in training and they suggest that methods of workplace-based assessment have failed. However, current thinking in assessment of doctors is to consider assessment systems as a whole and we contend that both forms of assessment – clinical examinations and workplace-based assessments – are needed because they fulfil different needs. This is not to argue that more should not be done to ensure that all who are involved in the assessment of doctors are better prepared for the task or that the current portfolio of assessment methods is complete.

In 1979, I wrote a personal paper on psychiatry viewed from retirement (Jones, 1979). Six years later Wounded Healers included a chapter by me (Phoenix, 1985). In the first I was coy about the nature of my ‘personal crisis’; in the second, I could pseudonymously be frank. Now, at 76, my further account appears above my own name.

The 1991 annual meeting of the American Psychiatric Association (APA)∗ one of the world's most influential psychiatric organisations with a membership of over 35,000, and an annual budget of $24 million, was attended by over 12,000 persons from all over the world. (The cost of the meeting itself was about $2.5 million). Over 230 workshops and symposia were presented together with lectures from distinguished researchers, video presentations, debates and 600 posters. With up to 25 concurrent sessions, it was impossible for any one individual to attend more than a fraction of the programme. The theme, chosen by outgoing president, Dr Elissa Benedek, Professor of Child Psychiatry at Michigan, was ‘Our Children - Our Future’.

For more than a decade psychiatrists have paid lip service to the idea that peer group medical audit might be valuable, but few have initiated regular audit meetings. This could be due partly to fear of criticism from colleagues and partly to a feeling that we can well do without additional, possibly time wasting, meetings. We in the Department of Psychiatry of the Royal South Hants Hospital have held monthly audit meetings for the last three years. We would like to report our experience of these, as we have found them to be supportive rather than threatening—despite our initial apprehension—and we believe that they have resulted in improvements in our service.

Earlier research reported that female undergraduates performed significantly better than their male counterparts in medical school examinations. Such findings were partly explained by biases in admission policies with women (who formed only 25% of the student body) being higher achievers than men prior to entry to medical school. While some recent studies provide evidence of higher achievement levels by women (Norcini et al, 1985), it is increasingly recognised that these differences do not apply to all specialities within medicine (unpublished observation, Ferrier & Scott, 1987).

Serenity Integrated Mentoring (SIM) involved the police and mental health crisis services working in a single team, developing case management plans that allowed a seamless move from offers of therapeutic engagement (by the mental health team) to use of coercive measures (by the police) with those who persisted with frequent crisis presentations. Withdrawn after widespread criticism, the scheme raises important questions – about the practice of mental health professionals who are involved in decisions about using criminal sanctions for people presenting in crisis, about the ethical and legal status of the sharing of confidential clinical information with the police, and about the processes that professional bodies use in promoting, monitoring and responding to controversial service developments.