Exchange visits with Soviet colleagues are being encouraged. I recently had the opportunity of spending two weeks visiting services for drug misusers in the Soviet Union with two colleagues, a visit sponsored by the British Council as a UK/USSR collaborative project. We spent most of our time in Leningrad and the surrounding region, and a short time in Moscow. Since then a party of Russian specialists has visited the Wessex Region to see drug and alcohol services.

In a landmark decision, the Supreme Court of the UK ruled that the state has a special operational duty to protect the right to life in informal psychiatric in-patients (‘Rabone case'), in sharp distinction to general medical or surgical patients. We will argue that the significance of this case is general, not just local, and that it exposes four important unresolved problems in mental health law: the place of decision-making capacity; the meaning of ‘informal’ admission; parity between mental and physical health; and the accuracy of risk assessment.

In spite of all the publicity in recent years about child abuse, very little mention has been made of another group of people who are also very vulnerable to abuse, namely adults with a mental handicap. Although chronologically adults, and therefore not susceptible to the laws designed to protect children, they may be functioning intellectually and emotionally at a much lower level. Because they are often dependent on other people for many aspects of their care, this makes them vulnerable to physical and sexual abuse and neglect. Difficulties with speech and communication may render them unable to inform anyone of their plight or ask for help, therefore many problems remain hidden. Personal involvement in one such case made me aware of this problem and the current lack of legal protection for this group of people. I therefore undertook a national survey in order to gain more information on the prevalence of abuse, factors associated with it, and possible legal solutions.

Recommended changes in services for adults with mild learning disabilities are likely to have training implications. A case vignette study examined the effect of coexistent mental illness and learning disability on trainees' clinical assessment and management. Mental illness was more likely to be diagnosed in those with a mild learning disability than in a control group who had no learning disability. Despite this, the learning disability group was less likely to receive treatment. Service and training issues are discussed.

This course was organised so that future general practitioners might learn those aspects of psychiatry which are relevant to their future work. It has been recognised that six months working in a mental hospital is only helpful to the future GP in terms of assessment and treatment of severe psychiatric illness of which the general practitioner sees relatively little. The vast majority of psychiatric illness seen by a general practitioner in his day-to-day work is not represented at all in an in-patient psychiatric unit.

Many trainees, like myself, are so daunted by the prospect of working with patients within a psychodynamic framework that their anxieties can overcome them, and their experience of psychotherapy suffers. As a result they can end up deeply sceptical of this style of treatment. Later in their career, when they are more confident of their general skills, they may wish to return to psychotherapy to try to understand at a deeper level the interaction between individuals, in particular between doctors and patients. Often though, there is too little time to develop these skills at this stage.

YouTube is a video-sharing website that is increasingly used to share and disseminate health-related information, particularly among younger people. There are reports that social media sites, such as YouTube, are being used to communicate an anti-psychiatry message but this has never been confirmed in any published analysis of YouTube clip content. This descriptive study revealed that the representation of ‘psychiatry’ during summer 2012 was predominantly negative. A subsequent smaller re-analysis suggests that the negative portrayal of ‘psychiatry’ on YouTube is a stable phenomenon. The significance of this and how it could be addressed are discussed.

Child abuse could be defined from predominantly legal, clinical and research perspectives, and attempts at an integrative enunciation are fraught with over-inclusiveness. Meadow (1989) proposed that a child is considered to be abused if he or she is treated by an adult in a way that is unacceptable in a given culture at a given time. This definition usefully incorporates the essential issues including secularity and diversity of socio-cultural norms which often create controversy in case detection and are particularly relevant to the debate.

The establishment of mental health teams which take responsibility for small geographical catchment areas has been a fundamental element in the planning of community services in most Western European countries over the last decade. This idea is challenged in the companion paper in this issue of Psychiatric Bulletin which refers to catchment areas as a “relic of the past”. The case is put for catchment areas in terms of their planning, service delivery and quality advantages for the development of comprehensive inter-agency mental health services. In brief, it is argued that community mental health services are still in many areas poorly developed (Audit Commission, 1994; Faulkner et al, 1994), and that catchment areas are necessary but not sufficient for their fuller realisation.

Following consultation in 1994, changes were proposed to mental health legislation. In Scotland these included the limitation of Leave of Absence (LOA) to 12 months and the introduction of Community Care Orders (CCOs). All consultants in general psychiatry in Scotland were surveyed regarding their views on LOA and CCOs. The results of our survey showed that the majority of consultants use LOA and extended LOA, giving lack of insight and threat of stopping medication as the main reasons. Consultants reject both CCOs and the limitations on LOA. Those who have been consultants for more than 16 years are significantly more likely to agree with restriction of LOA than others.

Some names appear to stick to syndromes or diseases like a proverbial glue, regardless of their total inappropriateness. Gross self-neglect in old age characterised by domestic squalor, social withdrawal, apathy, tendency to hoard rubbish (syllogomania) and a lack of shame was originally reported by Macmillan & Shaw in 1966 and subsequently ‘christened’ by Clark et al as Diogenes∗ syndrome in 1975. Post (1982) preferred the term ‘senile recluse’ and argued that this is not a syndrome but merely an end stage of personality disorder. It was usually extremely difficult to help these patients, as one's care and goodwill often met with hostility and blunt refusal to cooperate (Cybulska & Rucinski, 1986). More recent studies, however, have shown a strong association of this condition with frontal lobe dysfunction (Orrell & Sahakian, 1991), thus giving a psychiatrist of old age a somewhat firmer basis for action.

There is a growing pressure on universities to review their curriculum for undergraduate medical students in the light of the new General Medical Council (GMC) Education Committee recommendations (1993). One major recommendation was for universities to develop a ‘core curriculum’ for every medical discipline. In psychiatry, the curriculum for undergraduate medical students has always varied between universities. We propose a broad design of a core curriculum that consists of eight modules covering what is considered vital to the subject and relevant to the student's future medical practice. The curriculum is designed to be taught in pre-clinical as well as clinical years in an attempt to achieve full integration and aspires to succeed in eliminating this traditional divide.