Our objective was to establish a mechanism for monitoring indicators of the state of health of inner London's mental illness services. Data were collected for a census week around 15 June 1994. Local data collection was coordinated by consultant pyschiatrists working in inner London services. Twelve services participated with a combined catchment population of 2.6 m. They included ten London services which were among the 17 most socially deprived areas of England. Main indicators were admission bed occupancy levels (including an estimate of the total requirement), proportion of patients detained under the Mental Health Act, number of assaults committed by inpatients, number of emergency assessments and CPN caseloads. The mean true bed occupancy (which reflects the number of patients who were receiving, or required, in-patient care on census day) was 130%. To meet all need for acute psychiatric care, including for patients who should have been admitted and those discharged prematurely because beds were full, a further 426 beds would have been required. Fifty per cent of patients were legally detained. Physical assaults were virtually a daily occurrence on the admission units. Average community pyschiatric nurse caseloads were 37, suggesting that the majority were not working intensively with limited caseloads of patients with severe mental illness. These indicators, although imperfect, will allow for some measurement of the impact of local and central initiatives on the poor state of London's mental illness services.

Community mental health teams are handicapped by long-standing ambiguities about responsibility and accountability. Professional responsibilities need to be separated from practitioner's responsibilities as employees, and clear lines of accountability established accordingly. This requires stronger delegated operational management responsibility at team level. Greater attention should be paid to defining shared, core responsibilities among team practitioners employed by health and social services. These are here defined as ‘care coordinating’ responsibilities and provide a means of reconciling the care programme approach and care management into coherent practice.

Severn NHS Trust has recently commissioned a psychiatric intensive care unit (PICU) which became operational on 18 July 1994. Although the number of PICUs is increasing and their services are greatly valued, they are often fraught with problems. A model for the development of PICU services is described. It includes admission criteria, overall clinical organisation of the PICU, discharge criteria and a discussion. The model described is based on the hypothesis that the primary role of the PICU is to deal with clinical nursing problems rather than medical problems. The discussion points out some of the instrumental components necessary for the successful development of PICU services.

A postal questionnaire assessing key professionals' and managers' views about local services achieved an overall 72% response rate. The results demonstrated concerns about the range, quantity and quality of mental health and social care provision for adults with learning disabilities and mental health needs in all 15 districts. Only eight (14%) respondents provided specific local service utilisation data, and confusions about care co-ordination responsibilities were evident. Improving future service provision should involve utilising needs assessments and quality assurance data to better inform multi-agency commissioning and purchasing strategies.

Previous studies have demonstrated high rates of non-attendance among new referrals to psychiatric out-patient clinics. Consistent factors which distinguish non-attenders have not been shown. Forgetting an appointment contributes towards non-attendance and offers potential for its reduction. The effect of sending patients an appointment reminder three working days prior to the appointment date was examined. The rate of attendance of those sent a reminder improved significantly.

There have been a number of recent changes in mental health care legislation in Australia some of which mirror the changes that have occurred in the UK. These are reviewed within the context of the differing health care system in Australia and with particular reference to the State of New South Wales.

The clinical examination is the cornerstone of the MRCPsych Parts I and II. Trainees frequently prepare for the clinical by practising in a mock examination setting. One person's experience in examining candidates in mock clinical examinations is reported and an approach to the clinical examination is described. Some of the common pitfalls are highlighted.

A one year training post at senior registrar level in psychotherapy in a developing community mental health team is described, not only for its relevance to training at all levels but also as an example of how general psychiatry and psychotherapy can work together to promote good psychiatric practice in a community team.

This is the first in a short series of articles on portraits of children from the point of view of a child psychiatrist.

Tom Trevelyan, describes his impression of a debate for which he was considered too reasonable.

Over the past four years I have visited a number of special care wards (also known as locked/intensive care/secure wards) and interviewed many staff and patients, both as a Mental Health Act Commissioner and as a second opinion appointed doctor. It has been suggested to me that my observations may be of some interest. The points are not exhaustive nor are they research based. Before continuing I must also declare that I have no special knowledge or expertise in the care or treatment of patients in this setting.

In the Amazon rainforest there grow two plants: the mariri (Banisteriopsi caapi) and the chacrona (Psychotria viridis), which have been used by native Indians for hundreds of years to make an infusion. The infusion, known as ‘hoasca tea’, is no ordinary herbal brew but one with psychoactive properties. The leaves of these plants contain dimethyltryptamine (DMT), which has hallucinogenic effects, and beta-carbolines, which are monoamine oxidase inhibitors that prevent the degradation of DMT in the gastrointestinal tract. The preparation and consumption of these substances are legal in Brazil; although the Federal Council for Narcotics (CONFEN) states that they can only be used during recognised rituals.

As an expatriate psychiatrist, working in a new culture has exposed me to the difficulties in practising my profession, and in particular, its limitations. In search of understanding common psychosocial distress in the communities we serve, I have sought to work with traditional healers in the high-density suburbs of Harare city.

Diagnosis and treatment of mental health problems in individuals suffering from deafness or severe hearing impairment poses particular challenges. This is recognised for adults by the provision of specialised services based in London, Birmingham and Manchester but for children and adolescents there is only a specialised out-patient service based at Springfield Hospital in London which has itself only been in existence two years. This day conference of invited hearing and non-hearing professionals held in Birmingham in October 1994 considered how appropriate services might further develop.

Gentle Teaching (McGee et al, 1987) has been described as a technique for working with people who have learning disabilities and severe behavioural disorders. I attended a two-day workshop from 25–27 May 1994 run by the Royal College of Nursing, Bexley MENCAP and Values Incorporated.

The Royal Hotel overlooking College Green in Bristol accommodated members attending the Spring Quarterly Meeting of the Royal Medico-Psychological Association (RMPA) in May 1957 and the Annual Conference of the Specialist Section of General Psychiatry of the Royal College of Psychiatrists in May 1994. I was privileged to be there both times.

A one-day symposium was held at the Royal College of Psychiatrists on 4 October 1994 by the Transcultural Special Interest Group (TSIG) entitled The Practice of Psychiatry in a Multi-Cultural Context’. Speakers included Yvonne Christie of the Regional Race Programme for the NHS Mental Health Task Force, Drs Suman Fernando, Sashidharan, Ndegwa, Nasirullah, and Mahadeshwar.