In 1974 we published a pilot study on the use of consultant time in child psychiatry, based on detailed timesheets kept by a group of child psychiatrists in and near London (1). The group, which is still meeting, decided to see what changes, if any, have occurred over the last seven years in the way we allocate our time. The primary purpose of the group, now, as then, is ‘the provision of a forum where members can exchange views and compare experiences relating to the problems encountered while engaging in and often being professionally responsible for administering a child psychiatric service.’ A nucleus of about six consultants took part in both studies.

Libraries vary greatly: there is a common theme of books and information, but at the edges, one finds all sorts of variations. Examining the range of facilities provided by other College and Institutional Libraries may give us ideas for possible developments in our own College. Such rough statistics as number of staff, number of books held, number of journals taken give basic information. Using this approach, let us look at some of the larger London libraries.

The 1959 Mental Health Act has provided the legal framework for psychiatric practice in the UK for the past two decades. The Mental Health (Amendment) Bill (DHSS, 1981) currently before Parliament proposes to update the Act by improving the safeguards for detained patients, clarifying the position of staff looking after them, and by the removal of uncertainties in the law. The Bill incorporates changes relating to the compulsory care of Mentally Disordered patients in the community whereby a person may be accepted into Guardianship on the grounds that he or she is suffering from a Mental Disorder. Once accepted into Guardianship, the person or body named as Guardian has the power to exercise control over the person as if he or they were the father of the patient, and the patient was under 14 years of age.

Interest in the application of hypnosis to clinical psychiatry has increased recently in this country. In the 1950s it had been recommended (Subcommittee of the Psychological Medicine Group, 1955) that experience of the techniques of hypnosis should be available to all medical undergraduates and to postgraduate trainees in certain specialties, including psychiatry. Such a training would lead to an awareness of the practical use and limitations of hypnosis, and would also allow an informed and rational decision to be made about its employment in the practice of medicine. Despite this recommendation, a review twenty years later (Scott, 1978) showed that teaching of hypnosis was a rare feature of medical training.

The progress of psychiatry in India during the last 35 years is indeed impressive. At the time of Independence in 1947, there were just a handful of Indian psychiatrists looking after some 20 odd mental hospitals scattered throughout the country. Colonel M. Taylor (1946), who reviewed the status of mental health services for the Bhore Committee on Health Survey Development in India, ruefully noted the gross inadequacy of mental health services. A major recommendation of the Committee (1946) was to start local training facilities for doctors and other health professionals in the field of mental health. The first landmark was the opening of the All India Institute of Mental Health at Bangalore in 1954. The role of Dr Mayer-Gross, who was closely associated with the development of this Institute in its early years, will be long remembered by many Indian psychiatrists.

We get in a muddle about responsibility and in our communications. Doctors are not the only ones who can discharge patients from hospital—patients can do that themselves (Teeling-Smith, 1979) and the myths about medical responsibility (as if patients are not responsible for themselves) exacerbate feelings of inequality. We are responsible for ourselves and our work; not for our patients or colleagues, much as we may care for them.

My invited attendance at a College working party on community psychiatry has prompted this communication.

Faced with recruitment difficulties, financial stringency, changing public needs and important advances in clinical and academic psychiatry, the time is ripe for a re-evaluation of the education and training of psychiatrists and factors influencing recruitment to psychiatry. The Conference, held in Cambridge in March, providing a forum for the discussion of such issues involving the Royal College of Psychiatrists, the AUTP and APIT, was an imaginative concept which deserved widespread support within the specialty. However, the breadth of the conception meant that for some organizers and participants it was a conference on training, and for others it was mainly concerned with recruitment.

Rehabilitation is a subject of topical interest in psychiatry and the Royal College of Psychiatrists has laid down guidelines of practice in its publication Psychiatric Rehabilitation in the 1980s. More detailed advice is given in Wing and Morris's (1981) practical manual for people involved in this work. Morgan and Cheadle (1981) make the point that consultants appointed to posts with a special interest in and responsibility for rehabilitation often have no special knowledge of or experience in the field and have to learn as they go along. This was the case with me when I took up my post in March 1978. Having learnt something from colleagues, from my reading and from my own experience, I thought that I needed to look elsewhere and see at first hand what experts in the sphere were doing. I was granted six weeks' study leave in the Spring of 1981 and arranged to spend five weeks at the Maudsley Hospital and a week at Southampton. I also visited Montrose for the Scottish Division's meeting on rehabilitation.

I suspect that caring not only for patients but also for staff is the lot of most senior registrars. Patients need understanding and ‘formulating’, while staff need support and supervision. A less obvious role for the senior registrar is that of caring for the organization of which staff and patients form a part. True, this is often done by the consultant. But frequently the unique position of the senior registrar, closely in touch with the day-to-day life of the ward and yet sufficiently detached, makes him the ideal person for this role.

In 1973, Morris Carstairs, writing in the Journal (123, 271–77) on the psychiatric problems of developing countries, made references to Baghdad: the newly completed teaching hospital had very few nurses, and might have been a misguidedly expensive project for a developing country; there were no psychiatric beds in the teaching hospital; the out-patient clinic was primitive; and the students learnt psychiatry only by visits to the unsatisfactory mental hospital.

The whole object of using a library is to obtain wanted material and information. Libraries are in a constant state of evolution, and local facilities have improved, in some cases dramatically, but on the whole the situation is still far from adequate.

In the Second World War there was a Royal Naval Unit for the assessment and rehabilitation of personality disorders in a remote part of the Cheviot Hills. The site is now submerged in the Kielder Reservoir.

I am a strong advocate of the provision of training in psychotherapy to all psychiatrists. In my view this should comprise the enhancement of interviewing skills, development of counselling skills, understanding of and experience in the use of a variety of psychotherapeutic techniques. Among these I would include supportive psychotherapy, short-term psychotherapy, crisis intervention and grief counselling. The trainee should acquire some theoretical understanding of and experience in the use of behavioural methods of treatment, of social skills training and of group processes.