We live in an era in which debates on the need for mental health reform are over-focused on single issues (like how to ‘get people who live in the community to keep taking their medication’) or, even worse, single cases (how to prevent another tragedy like the killing by Jason Mitchell). This prevents rational policy-making. Unusual cases make bad law. Narrow proposals for risk reduction ignore many of the most pertinent risks: that service users will be victims of attack, but have no access to justice because they are not seen as ‘credible witnesses’; or that they will be detained for fear of violence when in fact they would not have been violent (Sayce, 1995). The recent statement on prime time British TV by Dr Deahl that he would rather detain nine people unnecessarily than discharge one who went on to harm a member of the public, shows how ‘single issue’ risk analysis can lead straight to breaches of natural justice (‘Panorama’, 13 October 1997, British Broadcasting Corporation).

Launched with little more than a whimper during the Labour Party Conference the much vaunted National Service Framework for Mental Health (NSF–MH) outlines the Government's ‘ambitious agenda’ for mental health services (Department of Health, 1999a). The official driving force has been the desire to deliver a quality service throughout the whole NHS via clinical governance and underpinned by professional self-regulation. Developed following widespread consultation and with the advice of the External Reference Group (although some of this advice was clearly disregarded), the NSF–MH provides a series of seven core standards with examples of good practice. Although developed with general psychiatry and severe mental illness in mind, the NSF is not quite the ‘National Schizophrenia Framework’ that some envisaged, since it also acknowledges the needs of young people and the influence of developmental factors on adult mental health. The NSF–MH sets standards in five areas: mental health promotion, primary care and access to services, services for the severely mentally ill, caring about carers and preventing suicide. It is only the second to be published (the other being for coronary care) which is hopefully a reflection of the ‘priority’ once more being given to mental health. However, the near-simultaneous appointment of a cancer ‘tsar’ suggests that ‘priority’ is a readily used and easily diluted term.

Racial discrimination and prejudice are endemic in all societies. Strangers, people of different appearance or habits, evoke strong and mixed feelings. Their poverty may be seen as “a burden on society”, their ability as “a conspiracy to take us over”, and their unfamiliarity as “diluting our island heritage”. Immigrant groups may hold equally distorted views about their indigenous hosts.

On the opening page of Daniel Hack Tuke's 1892 Dictionary of Psychological Medicine, is a statement which reads:

Clozapine is an atypical antipsychotic drug with relatively weak D2 and D1 blocking properties and strong 5HT and cholinergic blockade. Its potency as an antipsychotic drug is surprising considering the ratio of receptor blockade and it represents a true advance in treatment of schizophrenia. The efficacy of clozapine calls for revision of the seemingly over simplistic dopamine theory of schizophrenia. Now clozapine is available in the UK to consultant psychiatrists who register with the Clozaril Patient Monitoring Service (CPMS).

A need for improved communication between the social sciences and psychiatry is being expressed from many quarters. Interest in social and cultural issues is not, of course, new to psychiatry, but collaboration between the two approaches has not always been easy. Recently one social science in particular has become popular with psychiatry. This is social anthropology, and many psychiatrists consider that the inclusion of anthropological data and methods, particularly in cross-cultural research, can be useful and informative to psychiatry. What then is the relationship between anthropology and psychiatry and what are the problems which professionals face in attempting interdisciplinary research?

The relatives of people with schizophrenia are a group who have much to offer professional carers and other relatives. They have a huge store of knowledge, often gained painfully by trial and error, about the problems involved in caring for sufferers from schizophrenia.

A recent Royal College of Psychiatrists' statement concluded that current evidence on abortion and mental health is inconclusive. This contribution examines the background to the Royal College of Psychiatrists' statement and the issues it raises. It is concluded that the best route to resolving such issues is through further and better research.

Over the past three decades there has been a shift in emphasis from hospital based to community care of psychiatric patients. Central to this change has been the development of the community psychiatric nursing services and an increase in its numbers. Until recently community psychiatric nurses (CPNs) were almost entirely hospital based, working as members of a multidisciplinary team and providing follow-up for psychiatric patients.

Most long-stay patients discharged from psychiatric hospitals under community care policy are being accommodated in suburban communities. The communities' attitudes have a major bearing on the success of this policy. A census of perceptions of psychiatric services was conducted in two areas prior to the opening of long-stay supported houses for the mentally ill. Many respondents (37%) had a negative perception of psychiatric treatment in hospital. Most (82%) had heard of community care policy but few (29%) knew about the imminent opening of supported houses for the long-term mentally HI in their own street. Most respondents (66%) were against the closure of psychiatric hospitals and many saw It as a cost cutting exorcise. The majority agreed with the idea of long-stay patients being discharged into smaller units in the community although a substantial minority (20%) thought it would have a bad effect on the local community. An overwhelming majority of respondents (91%) thought it was important for local residents to be given information about new mental health facilities in their neighbourhood. Respondents were worried that patients would not get adequate support and that they might be dangerous. If community care policy is to succeed, attention needs to be paid to the community's opinions and desire for information about local services.

In the light of proposals to change the system of providing NHS health care, it is important for future district or regional procurers to have reliable data on which to base their treatment ‘contracts’, bearing in mind not only current but also the potential demand of a mature market.

ECT has been valued for over 50 years as an effective treatment for mental illness and especially for depressive illness, and its value has been confirmed by many double-blind comparisons of real and simulated ECT.

A postal survey of old age psychiatrists was carried out to examine the pattern of services currently available for elderly people with chronic functional mental disorder, and to identify innovative models of care for this group. The opinion of respondents was sought regarding problems with service provision and additional resources that would be desirable. The majority of respondents felt that the needs of individual patients should determine whether they should be cared for by old age, general or rehabilitation services. Seventy-three per cent of respondents felt that more specialist residential care outside hospital was needed to improve the care of this group.