Those working with families in the field of child abuse often find themselves becoming intimately involved with Family Law. Although the involvement may produce confusion and frustration in professionals untrained in the law, it may also help facilitate appropriate and effective treatment of severely disordered families. I believe not only that legal framework can help those working in the mental health field, but also that a psychotherapeutic understanding of individuals, families and groups can aid lawyers steer families more effectively and humanely through the legal process. By the term psychotherapy I mean a body of theoretical and clinical knowledge concerned with looking at people's conflicts, feelings, anxieties and reasons for actions, which includes an understanding of the unconscious processes of the mind. A psychotherapeutic approach cannot provide a substantial basis for legal theory, for the latter is heavily weighted towards the notion of the ‘reasonable’ man, whose unconscious ideas and emotions are significant only if they lead to an intention to act illegally and the carrying out of the illegal act. However, the day-to-day practice of law may perhaps be enriched by a more rigorous attempt to understand human emotions, particularly in the often emotionally painful areas of Family Law. Moreover, I suspect that there are a number of shortcomings in the current complex, sometimes muddled, way that families have to deal with the law, which the proposed new legislation (DHSS, 1987) may not address. A psychotherapeutic understanding of some of the reasons for this muddle as well as of the general issues in this field may have benefits for lawyers, mental health workers and clients.

In 1975 the DHSS made psychotherapy one of the five psychiatric specialities. Since then, any comprehensive District mental health service has had to include a psychotherapy department.

Mental health professionals seem to have a curiously ambivalent attitude towards work. On the one hand, it is generally accepted that the experience of unemployment is often associated with severe social and psychological distress. On the other, we seem reluctant to strive to provide work for those patients who have the greatest social and psychiatric disabilities and for whom work, in all its forms, may have the greatest benefit. I don't wish to speculate on the psychological roots of this ambivalence, although I suspect that it stems, at least in part, from the way in which we all feel about our own jobs. However, there are other reasons why the concept of work has always sat uneasily within the context of psychiatric services.

Under the 1959 Mental Health Act of England and Wales, it was possible for courts to sentence offenders to hospital provided they had been found guilty of an offence which was punishable by a term of imprisonment. Higher courts could add restrictions to a hospital order if they so wished. This power has been retained in the 1983 Mental Health Act and this paper examines the nature and use of the restricted hospital order.

The history of this East German plane flight to Moscow is interesting enough to record. In 1983 the All Union Association of Soviet Psychiatrists and Neurologists left the World Psychiatric Association, when it became clear that a resolution condemning the abuse of psychiatry in the USSR was about to be adopted.

The 1983 Mental Health Act was introduced to increase the safeguards of the civil liberties of patients. One of the new provisions is that it is now the statutory responsibility of hospital managers to inform detained patients of their rights; this is done by giving them a leaflet explaining the appeal procedures. Doubt has been expressed (Dunlop, 1979) about whether this is an efficient means of conveying information to acutely ill patients.

Child sexual abuse has appeared as an epidemic of the 1980s. In our child psychiatry department we are acutely aware of the increased workload generated by referrals of complex and time-consuming cases. In this article we aim to look at the resource implications for a child psychiatry department which has teaching and regional commitments, as well as serving a district health authority.

I suspect I have a certain modest reputation in psychiatric circles as a “cautious researcher”. What follows is neither cautious nor research; it is an intensely personal account. I have no doubt that many of my colleagues, medical and non-medical, saw things in a very different way.

In September 1978 the Government published a review of the Mental Health Act (1959). This review was prompted to a large degree by an increasing awareness of the rights of the mentally ill and by an awareness among psychiatrists of the limits of their management procedures. The proposals of this review were largely incorporated into the Mental Health Act (1983). Among the proposals so incorporated was one that persons could not be detained in hospital against their will for assessment or treatment “by reason only of promiscuity or other immoral conduct, sexual deviancy or dependence on alcohol or drugs”.

Group therapy in an out-patient setting has been well established for over 40 years. Today, most acute wards offer some in-patient group therapy experience. Duration of in-patient stay (Yalom, 1983), the type of group therapy offered (Cox, 1976; Kanas, 1980) and patient psychopathology, can all alter efficacy of in-patient group therapy. However, in-patient units do appear to benefit from group therapy programmes, although some approaches are more effective than others and psychotic patients may suffer from the traditional group therapy approach (Cox, 1983).

The Government White Paper, Working for Patients (1989), although presented as a discussion document, should be seen as a position paper. It is clear that the government intends to implement the major proposals, and will be able through its control of general management, enhanced by a stream-lined management structure (Working for Patients para 2.3–2.11), to put pressure on health authorities to take action accordingly.

One of the first principles on which a good service for adolescents will be based, according to the Health Advisory Service Report Bridges Over Troubled Waters (1986), is “The age group concerned from 12–19 years requires separate consideration and provision”. Up to the publication of this report, many adolescent psychiatrists dealt only with those up to the age of 16 (Bruggen & O'Brien, 1987) or up to school leaving age. Such a recommendation means a considerable change of practice, and this study was designed to assess the nature of that change.

The London-Berlin (GDR) Committee was established in June 1986, with the aim of encouraging cultural exchanges between Britain and the German Democratic Republic. This Committee organised a study tour of East Berlin for British health care workers in October 1988. This was the first exchange of this kind since the Second World War and the subsequent foundation of the modern Republic of East Germany.

The Royal College of Psychiatrists (1986) recommends that psychotherapy be part of training in general psychiatry. The College suggests weekly specialist supervision with two individual patients for at least one year.

Working for Patients and the subsequent Working Papers mention psychiatric services explicitly only twice. The proposals have been formulated for patients requiring tests and treatment for elective surgical conditions. They are the conditions which are believed to be predictable and therefore the most receptive to contractual specification and pricing. The health care contract is to be central to the new NHS. It is the device by which the Department of Health hopes to produce a fundamental change in attitude by both doctors and managers. Kenneth Clarke seems much more concerned with this attitudinal shift than with the detail of what the NHS might resemble a decade from now. This omission of overt consideration of psychiatric services does not allow us to ignore the White Paper. I intend to focus on the potential implications of the proposed themes for psychiatric services, particularly in the context of what they might indicate about the Government response to Community Care: Agenda for Action.

With the rapid expansion in the number and variety of psychotherapy courses in this country, it is perhaps timely to review some of the issues influencing these courses. One purpose of this paper is intended to draw attention to the fact that not only are there interesting conflicts in establishing such courses but also establishments whose power relationships affect the educational effectiveness of these complex teaching ventures. These issues will be discussed with reference to the trainees, trainers, patients, and host organisations.

Many psychiatrists are deeply disturbed by the changing and challenging circumstances in which they are responsible for patient care. This became evident at a conference on the role of the consultant in the clinical team, held by the Health Services Manpower Review at the Royal Society of Medicine on 14 July 1988 and attended by an entirely medical audience. The need for the consultant to act as leader of the clinical team was emphasised without identifying the nature and extent of this task, resulting in the failure to develop any strategy to tackle the many problems identified.

Psychiatric patients often break society's rules and find themselves before the courts. Sometimes an offence is the first sign of mental illness. The coincidence of mental disorder and an offence complicates both assessment and management, but particularly the latter.

Consultation-liaison psychiatry had its inception in North America, the term making its first appearance in the 1930s to describe the department at Colorado General Hospital in Denver. As Mayou (1987) points out, when comparing British and American liaison services, the role, boundaries, and organisation of this subspecialty are very different in the two countries. Money and resources do not exist in Britain within the National Health Service to provide the extent of involvement liaison psychiatry now enjoys with the general wards of many American hospitals. Thomas (1985) refers to basic differences between the countries. He points out that few British district general hospitals have consultation psychiatric units now in place and that the theoretical background of psychiatrists in the two countries are different. In addition, he suggests that there may well be differences in the referral patterns and expectations with regard to psychiatric consultation requirements of general hospital doctors in the two health care systems.