In case any of you read On Call or Hospital Doctor (I forget which it was before they amalgamated) and believe what you read, I should point out that I did not say what I was recently reported to have said to the House of Commons Select Committee, namely that the secrecy of Distinction Awards should be maintained. It was in fact Mr David Bolt, the Chairman of the Central Committee of Hospital Medical Services (CCHMS) of the BMA, who said this, and I do not agree with him. On the whole, I think more good than harm would come from information being available; but I don't think anyone should ever use his award as part of the subscript to his signature along with his degrees (as a member of our College once did—and probably others equally unwisely).

Health Advisory Service visits to services for the mentally ill in recent months keep throwing up a persistent theme: the apparent failure of the medical staff to provide the impetus that is necessary to develop and manage an effective comprehensive psychiatric service based upon the needs of patients rather than on professional or sectional interests.

Since the publication of the Trethowan Report (1977) psychologists have been encouraged to expand their role outside the more orthodox psychiatric setting. As a small and steadily developing professional group, they have attempted to gain visibility by seeking alliances with medical specialties other than psychiatry, which had provided them with a kind of sheltered environment since the inception of the National Health Service. General practitioners have probably most often been solicited in these attempts to obtain a wider recognition. The favourable response of many general practitioners created the necessary climate to stimulate clinical psychologists to carry out systematic evaluations of their contribution to primary care (McPherson and Feldman, 1977; Johnston, 1978; Ives, 1979; Koch, 1979; Earll and Kincey, 1980).

The great leap forward from trainee to consultant ends with one well-grounded foot. Clinical training to current standards provides the novitiate with a firm base as far as taking clinical responsibility. Responsibilty for maintaining or developing service and the profession is another matter, and in this respect too many newly-appointed consultants find themselves with their other foot in a quagmire, at risk of being bogged down in administration. One foot that has received solid grounding is not enough to hit the ground running. Actually, the stumble goes unnoticed as often as not. Dead-end committee posts are hived off on to the new appointee and no-one remarks on his silence at table or the failure to grasp the politics of administration. Some, of course, take to the mud with squeals of glee, throwing their weight around without moving from the spot. Some colleagues get spattered. Some sink. No progress ensues. There may then evolve a distaste for administration, a spurning of bureaucracy, truancy from the Division (can there be worse?) and rotting relationships with hospital administrators. Does it matter? Surely people find out soon enough how the system works; if you can run a group you can chair a committee; individuals make better decisions than committees and nobody listens in any case.

The practice of child psychiatry depends upon clinical skills; the first requirement, then, of a training programme is that at the end of a given period the trainee should be really expert and rightly confident in his practical skills as a diagnostician and therapist. A total of four years, combining registrar and senior registrar experience, might be an appropriate period and would allow a full training, whereas at present some new consultants have spent only two and a half years in the specialty as senior registrars.

One hundred years ago, in July 1881, President Garfield met his death by assassination. The trial of the murderer, Guiteau, and the controversy about his mental state, were extensively commented on in the Journal of Mental Science between July 1882 and January 1883. First there is a lengthy editorial (an ‘Occasional Note of the Quarter’) in which the Editor gives his own opinion as to Guiteau's sanity and responsibility, and in later pages there is a full report of the Judge's summing up in the case. The October issue contains a detailed account of the post-mortem carried out on the body of the murderer after his execution; and lastly, in January 1883 the Editor replies to letters and criticisms he has received. The following is a condensed version of the first editorial.

The first step towards the establishment of an independent body to supervise standards of care for psychiatric patients was taken with the appointment in 1774 of Commissioners in Lunacy with the responsibility of licensing and inspecting private madhouses in London. It consisted of five physicians elected annually by the Royal College of Physicians. They were replaced in 1828 by a body of Metropolitan Commissions, consisting of fifteen members appointed by the Home Secretary, of whom only five were physicians and most of the rest were Members of Parliament. Their powers included (with respect to London) the supervision of 'subscription hospitals for the insane’ in addition to private madhouses (but with the exception of Bethlem). For a short period from 1842 their jurisdiction widened further to include provincial hospitals as well as those in the Metropolis.

The Royal College of Psychiatrists recommends the formation of a Mental Health Commission or Commissions. These will be independent bodies to look after the welfare of individual mentally disordered persons. They may be the appropriate bodies to deal with matters of individual patient care which are not the responsibility of other bodies, such as the Health Advisory Service, which deals with hospitals and some community services, Mental Health Review Tribunal's which are concerned with detained patients only, the National Development Team which deals with the mentally handicapped and the Court of Protection which is concerned with the administration of patients' affairs and property.