In 1981, the Labour Minister for Health in a coalition government, Mrs Eileen Desmond, set up a study group ‘to examine the main components, both institutional and community, of the psychiatric services; to assess the existing services, to clarify their objectives and to draw up planning guidelines for future development of the service with due regard to cost implications; to carry out such studies and to take part in such consultations as are necessary to assist this examination’. The result appeared in December 1984 in the form of a report The Psychiatric Services: Planning for the Future. The text of the response of the Irish Division of the College, reproduced in full here, was sent to the current Minister for Health, Mr Barry Desmond, (also a Labour Minister in a coalition government) in October 1985. Meanwhile, in February 1986, Mr Desmond caused widespread alarm in political circles by the sudden announcement of the closure of two of the 22 psychiatric hospitals in the Republic without prior provision of alternative community services. British readers will detect a close parallel between this Irish report and the series of DHSS reports exemplified by Better Services for the Mentally Ill (HMSO, 1975). Perhaps the only significant difference between these two reports is that sectorisation (a mental health team headed by a psychiatrist and assigned to a ‘sector’ of 25,000 to 30,000 persons) is advocated rather more firmly in Planning for the Future. It is also worth remembering that the Republic of Ireland, in its population size and urban-rural distribution is comparable to the whole of Yorkshire. Half the population lives in Dublin. Elsewhere, psychiatric services must cope with widely scattered rural populations, with a minority only of working adults. There is a large private sector in Irish medicine and 20% of psychiatric admissions are to one or other of five private psychiatric hospitals. Despite these social differences from the UK, several comparative studies have shown a remarkable similarity in declared attitudes and practice amongst Irish compared with British psychiatrists. Finally, the method of remuneration of Irish family doctors differs from the UK: Irish GP's are paid, not on a capitation basis, but on a ‘fee-per-item-of-service’ basis with a majority of the population availing of this service free: patients tend to move from doctor to doctor and many use private health insurance to opt for private care. Psychiatric referral rates from general practice are low as in Britain.

In 1793 Pinel started the move towards modern psychiatry by removing the chains from patients at the Bicetre Psychiatric Asylum. In 1986 the Mental Health Commission through their draft Code of Practice (COP) are metaphorically attempting to place those chains upon the professionals whose job it is to treat psychiatric disorder. Psychiatry will not benefit by having either the patients or the carers chained. I feel that if the COP in its current form is accepted, then it is likely in the long-term to lead to a deterioration of services for the mentally ill and we should ensure through the Royal College that we are not forced into accepting proposals from people who are in a worse position than ourselves to determine what is best for our patients.

On my retirement in the summer of 1984, Professor Gelder, in a generous valedictory speech, drew attention to the entry under my name in Who's Who. ‘You will notice’, he said, ‘that he has described himself as ‘Writer and Psychiatrist’, not ‘Psychiatrist and Writer’ The inference which Michael Gelder intended that his audience should draw is in fact justified. I have not whole-heartedly devoted myself to the practice of psychiatry to the exclusion of other pursuits; certainly not since I was 40, when my first book was published. I have contributed nothing to psychiatric research. If my psychiatric writings contain anything of value, it is because I have interleaved them with the fruits of reading from other disciplines.

The climate in 1969, in which the HAS was created, was one of increasing anxiety and embarrassment about the quality of long term care being offered to elderly, mentally ill and mentally handicapped patients in England and Wales. The need for a body to advise the Secretary of State, independently of the Department of Health and Social Security, was recognised and, with the wise guidance of Dr Alex Baker, the concept of multidisciplinary review by professional colleagues was established. Both these important principles have been maintained and stoutly defended by subsequent Directors, including myself.