It is clear that, at least in recent years, American psychiatry has been on the move. The past decade has seen dramatic shifts in emphasis away from the complicated, empirically derived and little validated theories of the Post-Freudians. A new, aggressive medical specialty is challenging analytical departments in medical schools and postgraduate teaching hospitals. This is most apparent on the Eastern seaboard, in States which have traditionally been more orientated to European views.

In 1975, seven years after registration, I had two small children and a part-time post as Staff Medical Officer with an Area Health Authority in London. For various personal and medical reasons I had decided to have a family early in my marriage. I felt it right that their upbringing should be largely done by me, and the alternative, if I worked full time, would be to hand over their care to someone else. I knew, however, that I should not be satisfied with a purely domestic role and part-time work in occupational health provided a compromise at the time. But I was uneasily aware of the lack of a definite goal and of my own doubts about continuing long term in this type of work.

The Irish Division, through its Executive Committee, is pursuing a policy of pressing for early consultation with the Department of Health on Irish national issues bearing directly on the welfare of the mentally ill. Part of this policy is to publish from time to time selected position papers of significance which have been submitted to the Department. The following paper advocates the monitoring of psychiatric services in the Republic of Ireland by peer review with tentative suggestions as to how this might be achieved. In a slightly different form this paper was submitted to the Department of Health in March 1983 without, to date, formal response.

Occupational therapy is rarely featured in psychiatric journals and little discussion takes place between our two professions. Now, however, we have a chance to consider a paper, issued by the Education Board of the College of Occupational Therapy, stating their case for a professional degree.

On the whole, when psychiatrists get together in meetings or conferences, they have a fairly good idea of what they are talking about. Discussion flows in a more or less coherent way. Even if the topic involved is problematic—say, the diagnostic criteria for schizophrenia—there is a general sense of agreement about what is meant by the words ‘diagnosis' and 'schizophrenia’; even if the meanings are fuzzy at the edges. In areas of psychiatry made complex by the number of variables involved, statistical methods help to clarify the information gleaned, so that in the assessment of, for example, social factors in mental disorder, some clarity of conclusion prevails.

The police are now the only laymen in Britain who can pass judgement on a person's mental state and compulsorily admit them to places of safety.1 Various papers have looked at how the police use this power, and one paper in particular2 has shown that police are as efficient at recognizing persons in need of psychiatric care among those called to their attention as are medical practitioners who are not approved psychiatrists.

The following letter and statement were published on 28 February 1984 and were widely circulated to influential bodies.