At present about 4% of doctors opt for a career in psychiatry. Between 1974 and 1977 almost a quarter of the consultant posts in general psychiatry remained unfilled; in 1981 there were no less than 220 unfilled consultant vacancies. This shortage is regarded by many as representing a deficiency in quality as much as quantity of applicants. If the consultant grades are expanded in the future to the levels suggested by the Short Report these problems are likely to increase rather than decrease, unless recruitment into the speciality is enhanced.

The debate regarding the scientific status of psychoanalysis is considered by many psychiatrists to be a sterile one; this leads to a polarisation of views in which those in favour of psychoanalysis, feeling themselves to be losing, retreat to the position of stating that meaning is more important than scientific status, while those against argue that because psychoanalysis is unscientific it is meaningless and thus should not remain part of our psychiatric practice; the debate being reformulated as psychoanalysis: sense or nonsense? The consequence of giving up this debate is that it allows us also to give up the struggle to define science adequately to ourselves, and to question the relationship between psychiatry and science. Our understanding of science reflects directly on the quality of our research; this is particularly relevant to research in the practical application of psychoanalysis. Before we consider our understanding of science, however, we should consider our epistemological theories, or how we know things.

It is often felt that group meetings with long term chronically psychotic patients have little therapeutic value and become weekly ‘complaints’ sessions. In this paper I would like to indicate that group work with such a population can be both a therapeutic and valuable training experience. I shall describe a group which I took over a six month period in one of the wards at the State Hospital, Carstairs Junction, Lanark.

A general practitioner needs to be kept well-informed when a patient with a psychiatric disorder is admitted to hospital. This can be difficult because a number of professional workers, not all of whom are hospital based, become involved in management, and confusion over clinical responsibility may develop. In these circumstances communication usually depends upon the hospital discharge summary which should contain information that is relevant to the GP's requirements.

In their major piece of research, ‘Fifteen Thousand Hours. Secondary Schools and their Effects on Children’, Rutter and his colleagues showed how, with the right ethos, secondary schools could be a powerful force, promoting good outcomes over a range of measures, including attendance, exam results, behaviour in school and delinquency outside it.

Although behaviour therapy, primarily in the form of gradual and prolonged exposure to phobic situations, is now well established as the treatment of choice in most cases of agoraphobia not all suitable patients receive this treatment. This is partly because behaviour therapy is time-consuming and, although there have been great gains made in recent years with the establishment of training for nurses in behaviour therapy, in many peripheral hospitals few nurses have the necessary training. There are increasing demands made upon the time of the community psychiatric nurse and it seems likely that the proportion spent in behaviour therapy will be squeezed to a level that will deprive some patients of its benefits.

The National Health Service at the present time depends on overseas doctors to maintain a reasonable standard of patient care; the presence of large numbers of such doctors in British hospitals, however, is not a recent phenomenon.