Policy and practice in the cart of people with a mental Illness has been changing radically for many years. This article draws attention to the Important role doctors can play in Influencing the development of central policies and to the need for leadership, including leadership by doctors, in developing a mental health service for the next century.

The coils of operating a psychiatric intensive care unit (PICU) were recorded for a six-month period. There were 110 admissions and 99 discharges. Mean length of stay was 12.3 days. Total costs were £346,516 over the study period, £283.56 per patient-day. Fixed costs comprised 93% of the total, inducing nursing staff ($169,447), overheads ($77,017), medical staff ($48,819), hotel costs (£24,160) and miscellaneous (£1,750). Variable costs included special nursing, (£19,405), treatment of major self-harm (£3,024), drugs (£1,707) and staff time to manage aggressive incidents (£1,188). Reduction of the incidence of aggression could result in valuable cost savings.

Results of a retrospective survey of the reasons for referral and admission to a specialist neuropsychiatric hospital are presented in an effort to address the uncertainties which exist regarding the nature of the conditions treated by this subspecialty. The results indicate that a wide range of both neurological and psychiatric conditions are treated, but the paper suggests that boundaries between these two specialities are largely conceptual and that the differentiating principle in the practice of neuropsychiatry is mainly philosophical.

We undertook a study on the staff group of an in-patient unit for deaf patients which is run on therapeutic community principles. The study addressed attendance patterns and attitudes of staff to the group, using a Questionnaire with open and closed Questions. About half of the staff found the group useful and attended with some regularity, while a minority expressed negative opinions and did not attend. There were conflicting views about the boundaries of the group and is purpose. The implications for setting up and running a staff group are discussed.

In this paper the ethical concept of competence is explored in the context of a very challenging child psychiatry case. Both mental disorder and immaturity may impair a child's competence. However, It is emphasised that competence Is not a generic quality but one that should be applied to specific decisions, even when working with children.

Forty of 46 consecutive admissions to a psychiatric inpatient unit were encouraged to read their admission notes and discuss them with the Junior doctor. The offer was withheld for two patients with organic impairment. Twenty-eight patients (including 12 on compulsory admissions) accepted the offer. The 12 who refused were characterised by overall lower educational attainment. Diagnosis raised only a few problems, prognosis and maintenance treatment being the focus of most discussions. There was no evidence of a deterioration in the quality of notes or therapeutic relationships as a consequence of access. Only in one case was the exercise judged ‘harmful’, but ‘useful or essential’ in 22. Possible benefits for both patients and doctor are explored.

The Job descriptions for five consecutively advertised consultant posts in psychiatry of old age were surveyed for the content and clarity of the information provided and for the adequacy of the resources described. Only one post provided a job description which came close to meeting our audit criteria. Employers may optimise the number and quality of applicants for consultant posts in psychiatry of old age by providing Job descriptions which contain both clearly written and comprehensively detailed information.

We have previously reported on the formation of a large regional registrar scheme covering 11 health districts in the South Thames region (Herzberg & Watson, 1991) and highlighted educational principles which we considered important for registrar training. The purpose of the present paper is to review those principles in the light of experience to date in running senior house officer (SHO) and registrar training schemes.

In the year of the College's 150th anniversary, the President invited essays with the title The Therapeutic Effects on Psychiatric Patients of a Pleasant and Congenial Environment’. Writers were asked to consider “current literature”.

Magical thinking co-exists with rational, logical thought. It may be eclipsed by reason, but not extinguished. Magical thinking is an ever-present component of the mind's activity.

The preliminary report on homicides committed by mentally ill people was published on Wednesday, 17 August 1994. The decision to present some of our findings ahead of the more comprehensive report to be published in 1995 was made by the Steering Committee after it became clear that some information coming from our collection of data might usefully be made more widely known. The media reaction which had followed individual cases over the previous months made it important to provide some perspective into the frequency of homicides by psychiatric patients, to indicate that the respondents to our questionnaire often saw these tragic episodes as unexpected and unconnected with shortage of services and to point to the finding that several of the cases showed that the individual patient had somehow removed himself or herself from supervision or from regular medication in the weeks or months before the homicide.

The purpose of aftercare is to enable patients to return to their home or accommodation other than a hospital or nursing home, and to minimse the need for future in-patient care. Under section 117 of the Mental Health Act 1983, local health and social services authorities have a legal duty to provide aftercare for certain categories of patients when they leave hospital (Department of Health and Welsh Office, 1993).

This paper describes mental health services in the Lower North Shore (LNS) catchment area of Sydney, Australia, and is based on a visit made in early 1994. The local population of 170,000 is predominantly Caucasian, but there are also groups from other ethnic backgrounds. The mental health service has about 800 registered clients, with 60 new clients each month, the majority of whom have a serious mental illness. Since the service has won several awards, it may be instructive to review its structure and function.

Having viewed the Glastonbury Festival for many years as local residents, it seemed time for us to venture inside and see how 100,000 people can converge onto a dairy farm in rural Somerset for three days of music and assorted entertainments. We were interested in reactions to such intensely communal living and also the organisational aspects of psychiatric services in this extreme version of community care.

Unlike NHS practice, Army psychiatry is an occupational psychiatric service. This is a description of my three visits to Bosnia-Hertzegovina (BHG) as the visiting Army psychiatrist during 1993.

The General Medical Council have agreed that part of a letter which they wrote to a member of the College containing their current policy on confidentiality can be published in the Psychiatric Bulletin. This letter was written in response to a specific enquiry.