From 1 January 1990 medical and dental practitioners employed by health authorities were no longer required under the terms of their contracts to subscribe to a medical defence organisation. The health department, however, advised practitioners (DHSS circular) to “maintain their defence body membership in order to ensure they are covered for any work which does not fall within the scope of the indemnity scheme”. The expediency with which the scheme was introduced enabled little discussion on the consequences of such change and surprised medical practitioners and defence organisations alike. This major change in medical indemnity since 1954 will have long-term implications for practitioners, medical defence organisations, local health authorities and most importantly, the quality and quantity of health care which can be delivered. A meeting held on 9 April 1990 at Charter Nightingale Hospital was convened to discuss the implications of the NHS indemnity scheme between senior registrars in psychiatry and representatives from the Medical Defence Union, Medical Protection Society, British Medical Association and the local health authority.

It is the intention of the Mental Handicap Services of the Chichester Health Authority to implement a discrete electronic alert system for some of the patients who are incapable of consent. An activator, similar to the bar code in a library book, or tag in a clothing store will be kept in a pocket of the patient's clothing. When a patient who carries the activator walks through a magnetic field at the door of the unit, it will trigger a bleep held by the nurse in charge to inform him/her that this particular patient is leaving.

Before 1977 there was little work done with eating disorders in the psychiatric unit at Burnley General Hospital. The hospital dietetic department was aimed mainly at special diets for medical, surgical, and paediatric patients and services for the obese. Many patients with anorexia nervosa were treated on paediatric or medical wards, until in the early ‘80s, following the establishment of a clinical psychology department, a principal-grade psychologist was appointed.

“One fine day, after he had joined a fighter squadron, it would dawn on the young pilot exactly how the losers in the great fraternal competition were now being left behind.” (Tom Wolfe)

This article describes the response of some RAF and RN mental health personnel and civilian mental health teams to the challenge of dealing with the psychological needs of wounded Servicemen. The preparation for war casualties could be seen as a useful exercise for future conflicts.

This paper draws upon over 30 years experience of Tribunals as RMO, medical member and independent psychiatrist.

High attrition rates in psychiatric out-patient departments are well documented in the literature (Baekeland & Lundwall, 1975; Gillis & Egert, 1973). Non-attenders' attitudes and beliefs about their illness and treatment may provide valuable insight into reasons for not attending. This consumer orientated approach could enable clinicians not only to improve clinic attendance but to assess their treatment efficacy.

The North West Thames Regional Health Authority rationalised its in-patient service in 1989 to fund an eight-bedded five day unit for children under 13 years of age at Collingham Gardens. Riverside Health Authority's District Child Psychiatric Day Unit was also relocated to provide ten places primarily for pre-adolescent children. The unit is staffed by a multidisciplinary team of child workers, nurses, occupational therapists, psychologists, psychiatrists, teachers, and a psychotherapist, social worker and speech therapist.

The community psychiatry service in Bassetlaw District has been developing since 1984 and provision includes hospital hostels, supervised flatlets, nursing and rest homes, group homes, cluster flats and warden assisted accommodation. Close liaison with an enthusiastic Local Authority Housing Department has also led to the development of a new initiative, an unstaffed flat for use in crisis intervention and rehabilitation. Placements in the flat are described over the first 12 months of its existence.

For more than 20 years, in parallel with moves towards community care, psychiatric teams have been trying to develop closer links with general practice. Many styles of working with GPs have been developed, five of which are described by Mitchell (1989). The literature contains numerous reports of most of these, particularly the shifted out-patient model (see for example Tyrer, Seivewright & Wollerton, 1984). In this paper we describe a liaison project which is closest to Mitchell's (1989) ‘joint team consultation’ and report the results of a simple survey of GP satisfaction with this scheme.

In Southampton we have been carrying out audit that conforms to the Government's definition in the White Paper Working for Patients (1989) for over a decade. During the last six years the results of the audit have been presented in regular meetings, while the specific projects on procedures used for diagnosis and treatment, the use of resources and outcome that we have undertaken date back much longer than this.

The Southsea Mental Health Team serves a geographically-defined catchment area of 80,000 adults under the age of 65. The area lies on the south coast of England, merging on its northern boundary with the naval city of Portsmouth. There is a variety of housing types including council housing estates, private housing and a significant number of large houses in multi-occupancy use as flats, bedsits or bed and breakfast accommodation.

Long stay patients who continue to require 24-hour nursing care can be divided into two main groups: those who need to remain in hospital and those who could receive their care outside hospital. The Hostel Ward, with a multidisciplinary team providing input to individualised rehabilitation programmes, has been conceived as a possible solution to providing care for the second group. Some of its clinical, social and economic benefits have been reported (e.g. Hyde et al, 1987) and there now seems to be increasing agreement about its potential value within the range of rehabilitation services needed by a health district for people with chronic psychiatric illnesses (Abrams, 1988). However, it is still a relatively new concept and as the experience of this type of service may vary from one district to another, further reports of its utility and limitations are still needed (Garety et al, 1988).

The UK, in common with all other countries party to the Vienna Convention on Diplomatic Relations, affords foreign diplomats a special status in law. Under the Diplomatic Privileges Act (1964) (DPA), accredited diplomats are accorded inviolability and cannot be detained compulsorily under any Act of Parliament, including the Mental Health Act 1983 (MHA).

The management of mentally handicapped offenders has long been problematic. Three misconceptions of the relationship between mental handicap and criminality have been widely held since the turn of the century, despite there being no conclusive evidence in their support (Jackson, 1983). These are: that mentally handicapped people are more likely than others to commit antisocial acts in general; that they have a particular predisposition to commit serious crime, especially sexual crime (Robertson, 1981); and that they are unlikely to be deterred by normal sanctions. Misunderstanding breeds misapprehension. Sadly, in the past, many mentally handicapped people were admitted to hospital after committing only trivial offences. Moreover, one Special Hospital study (Parker, 1974) found that most “severely subnormal and subnormal” detained patients actually had IQs above the category to which they had been assigned.

Clinicians, in particular consultants, are and always have been operational managers (Kennedy, 1989). Senior registrars also exercise considerable day to day management responsibility, often without any formal training (Hindle, 1990). Attitudes to management training have changed rapidly over the last five years from the “support” offered by the College Working Party (1985) to an “intrinsic part of psychiatric training” (CTC Working Party Report, 1990). Constantly increasing expectations of the clinicians' management role have led to an increasing recognition of the need for clinicians to develop specific management skills and have resulted in rapid expansion of training available. A further survey examining the extent training needs are currently being met is therefore justified.

Evidence bearing on the issue of what happens to patients from long-stay psychiatric wards in Britain is scarce. The results of a particularly well-planned resettlement programme may not be representative of the outcome from general policies of discharge from all psychiatric hospitals. The present study was undertaken in Sheffield to find the whereabouts of patients from long-stay wards after eight years, a longer period than usually studied previously. The expectation was that difficulties in tracing patients could be overcome with sufficient time and effort.

The old age psychiatrist's role has been evocatively described as “physician to the soul of the elderly”. A more practical definition is psychiatrist to patients over the age of 65 with both functional and organic illnesses.

The word serendipity has its origins in a fairy-tale about ‘The Three Princes of Serendip’, the latter being the former name for Ceylon. The heroes of this fairy-tale were always making discoveries, by accident and sagacity, of things they were not in search of. The earliest use of this term was by Horace Walpole, the essayist, who coined it in a letter of 1754. Later, he wrote a little fairy comedy on this theme, which was produced successfully at the Haymarket Theatre, London. The term means, therefore, the gift of being able to make delightful discoveries by pure accident and this is why it is used sometimes as the name for an antique shop or a second-hand clothes store. It is likely that most people could give examples of serendipitous incidents in their lives and the purpose of invoking the concept of serendipity in relation to sub-specialty selection by trainees is concerned with the possibility that chance can be a major determinant of outcome in this process. This issue is related to wider concern that the optimum methods for the well-informed recruitment of trainees into the sub-specialties and special interest areas in psychiatry have not yet been organised satisfactorily.

Supported lodgings are an important means of achieving the successful rehabilitation and resettlement of the chronically mentally ill into the community (Anstee, 1978, 1985). In a survey of 15 psychiatric hospitals in England and Wales, it was estimated that 9.3% of the long-stay patients (i.e. in-patients from one to five years) under 65 years of age were ideally suited to less supervised accommodation outside the hospital. In Gloucestershire the Supported Lodging Scheme is provided by the Psychiatric Social Services Department. It was started to enable ‘new’ and ‘old’ long-stay patients at Coney Hill and Horton Road hospitals to be settled in the community. Now any psychiatric or mentally handicapped patient can also enter the scheme if appropriate.