During the past three years it has been my task and privilege to act as an assessor for The British Journal of Psychiatry. In this time I have assessed, and in some cases reassessed, over 30 papers. Having looked back on my comments on these papers a number of common criticisms emerge. I thought intending contributors to the Journal might find it helpful if I commented upon some of these. I hope I do so with a sense of humility, since it is always easy to criticise the work of others and appear to be patronising. However, I have the impression that if intending authors paid heed to some of my suggestions (which are certainly not original) they would save themselves a great deal of disappointment and save the assessors and the Editors of the Journal a degree of frustration and occasional irritation.

The responsibility the health service owes to relatives who care for mentally ill patients is gradually being acknowledged. The Griffiths Report (1988) makes explicit both that families should care for their ill members and that the health service has a duty to provide some support. The new support for the family is more to enable them to be ‘better carers’ and to cope with the burdens of caring. One area of psychiatry where this support is a growth area is for relatives of people with schizophrenia. Research points to both the impact of some families on the career of the patient, including relapse rates, and the ways in which such negative impact can be reduced (Leff et al, 1989). This paper is concerned with the ethical issues involved in offering a service to relatives. The ethical dilemma of access to relatives is intimately related to the person at whom outcome is aimed.

The dichotomy caused by the National Health Service Act, Section 28, which split the responsibility for the mentally disordered between the Minister of Health and local authorities has remained with us. Along with a separate GP service this dichotomy has caused inconsistencies, confusion and overlap in day care facilities. Although psychiatric day care has now become accepted as an essential element in the comprehensive psychiatric care of the mentally ill, its development has been unplanned and there is a great regional variation (Vaughan, 1983).

The natural grouping of training rotations in psychiatry into those based on a central University Teaching Hospital and those in a peripheral location invites comparison between the two groups. Training perspectives in two neighbouring schemes, one in each category, have been explored recently (McWilliam & Morris, 1988). It was noticed that, although styles differ, resulting clinical competence is comparable. An important part of clinical training is out-of-hours experience. For approval of a rotational scheme, experience of on-call duties and emergencies is necessary (Royal College of Psychiatrists, 1987). We were interested in comparing on-call duties in two different types of scheme, one in Sheffield, the other in Chichester.

Over the last ten years it has been shown that it is possible to treat the majority of patients with acute psychiatric illness in their own homes. Home treatment has been shown to produce a superior outcome to hospital care on measures of symptomatology, subsequent independent living and employment status (Hoult, 1986) self-esteem (Stein & Test, 1980) and may decrease the need for re-admission. Additionally, home treatment decreases the burden felt by the relatives (Pai & Kapur, 1982) and may enable them to cope better with the patient after the acute episode.

Huntington's disease is associated with a considerable psychiatric morbidity and mortality. These risks are not confined to the sufferer. The relations of victims, both biological and legal, are also at high risk for significant psychosocial dysfunction (O'Shea & Falvey, 1988). Despite recent advances in genetic research, there is still no cure for this chronic choreodementia syndrome. Medical management is confined to palliation of symptoms. The doctor and the patient's family, in the face of this unpleasant disease, are wont to exercise a variety of psychological defences which may hinder the delivery and receipt of adequate support (Martindale, 1987).

The Department of Health and Social Security has designated eight services as ‘National Demonstration Services in Psychiatric Rehabilitation’. The aim of this was to identify services which would exemplify good practice in psychiatric rehabilitation and long-term care. In preparing his report Sir Roy Griffiths met with representatives from these services. It was felt appropriate that the National Demonstration Services should comment on the recommendations in so far as they are likely to affect those with long-term psychiatric problems.

What follows is concerned with the role of the consultant. To avoid stereotyping of gender or race, this consultant will henceforward be referred to as she and should be considered as of minority ethnic origin.

As I walked into the waiting room, I remember being struck by his appearance. Although he was almost exactly my age, I saw an old, tired-looking, white-haired man, his face deeply lined and drawn. I wondered what I had to offer this survivor of torture. Would I be able to help him recover from such a dreadful trauma? How could anyone come to terms with an experience which seemed to threaten some of the most basic human needs?

Currently, resources for acute mental illness services are allocated on the basis of the age, sex and marital status profiles of the catchment population. However, it has been argued (Hirsch, 1988) that mental illness budgets and bed provision should also be weighted according to the socio-demographic characteristics of the local population.

Having trained in London and Manchester, I found psychiatry in the Yorkshire Dales a little different. Most senior registrar training is done within cities. Most consultant posts are old posts. Moving into a newly created consultant post with hardly any psychiatric service, miles from any city, was a new challenge with clear benefits professionally and personally. James Heriot, our famous local vet, gives the impression of being self-sufficient and isolated when providing his services. Though the countryside is the same, surely the opposite must be true for developing a mental health service.

It was with some surprise that I learnt I should be settling but a stone's throw away from Baron von Münchhausen's birthplace in today's West Germany. The house at Bodenwerder on the Weser where he was born now serves as the town hall; the Münchhausen family had obviously been influential in the area for when I began to work in the psychiatric hospital at Moringen, I found that the original building had been erected by them in 1738.

The depot clinic has long been part of the traditional British psychiatric service. With moves towards care in the community many of the traditional, particularly hospital based, methods of service delivery are becoming unfashionable. The depot clinic has been criticised (Beveridge, 1987) for being out of date, not geared to the needs of the patient, inaccessible and unable to provide personalised care, especially regarding the family factors recognised to be important in the management of chronic psychosis, and is portrayed as a facility designed for the convenience of the staff not the patient. This has led to suggestions for alternative methods of administering treatment to these patients, e.g. at home, from GP, health centre based.

The issue of the relationship between physical illness and psychological disorder has a long and chequered history. It is therefore difficult to derive practice implications. However, there are associations between methods of patient care and long-term psychological and physical functioning which have provided some guiding principles (Nichols, 1984). This paper describes how these principles have been applied in a regional burns unit.

In each of three mental handicap hospitals I have observed an institutional disorder. From consideration of these I have suggested a classification. I have analysed the aetiology and pathogenesis of some of these disorders and discuss the treatment and prognosis.

In a survey of district plans for Mental Health services (Kingdon, 1988) befriending schemes, where volunteers are recruited to visit isolated and lonely users of psychiatric services, were planned or in existence in 14 of the 127 districts who responded. However, lists of the components of a comprehensive community service (MIND, 1983) and Hirsch (1988) surprisingly do not include references to such schemes, although Griffiths (1988) alludes to them in his recent report. There are moreover no reports in the psychiatric literature of such enterprises. The scheme established by MIND in Bassetlaw (population (103,000) is therefore described.

From the time of its foundation the College has been represented on Advisory Appointments Committees for consultant posts. One of the College nominated assessors' responsibilities is to supply confidential information on applicants, and those interviewed, to the Registrar by completing a form containing information on the number of applicants, numbers interviewed and their quality together with any deficiencies in qualifications and experience in those seen and those appointed. Prior to 1979 the assessors gave their opinion on qualifications and experience on all applicants but the form then in use did not allow for any quantitative analysis. Since the introduction of a new form in that year, such an analysis has been possible. A summary of assessors reports from 1974 to 1977 was published in the Bulletin.

Our aim in this paper is to examine the current practice of psychiatry in relation to race or ethnicity in England. The problems that European psychiatry has in relation to black people in a white and predominantly racist society and the responses to these from within the professional sphere are only one aspect of our current topic. We merely mention these to contextualise the problems black people experience as a result of institutional psychiatry. Our main aim in this paper is to articulate the oppression black people experience in relation to conventional psychiatry and to seek ways of confronting and changing this, very much as part of the larger, black struggle in the UK. We believe that the alternative that we propose, based on black experience of psychiatry, is equally valid in other contexts where questions of disadvantage and discrimination are the overriding themes. Although the theoretical basis of our work is grounded on issues such as inequality and structural oppression and the need to confront and change them, a detailed analysis of these topics is beyond the scope of this paper. Instead, we examine the practice of professional psychiatry in relation to black people in the UK and argue that the model that is imposed on us is antithetical to the interests of black minority groups. We also look at practical ways in which our community is beginning to organise in challenging such professional orthodoxy.

A cynic might regard the plethora of reports on community care as a study in how to create the impression of activity while doing nothing. Demands or suggestions for action are easily deflected by holding up the spectre of a forthcoming inquiry – for example the Griffiths' report on community care. Only six months after its launch, one could be excused for thinking that Sir Roy's report never happened. But it would be short-sighted to view Griffiths as a non-event. It embodies a workable framework for implementing community care, emphasises the importance of individual choice and demonstrates the foolishness of relying on those above to wave magic wands and produce instant national solutions. Community care is about localising services and must evolve locally.

I had acquainted myself with the psychiatric services in New Zealand some years ago during my student elective. I wanted to return to experience further a system which was both similar and different to the NHS. The New Zealand hospital system was funded in a similar way to the NHS. One organisational difference was the managerial layer, which was still filled by medical superintendents. Another difference was the extensive no-fault accident compensation scheme through which settlements were made without resort to lawsuits. Thus doctors paid low medical defence fees and were rarely sued, but the Government had regularly to meet a large bill. The psychiatric services were in the process of moving from hospital-based to community-based, in line with prevailing clinical and public attitudes. This was fuelled by some headline-making scandals over patient care in the asylums. One cause for general alarm was the poor health of ethnic minorities, especially the indigenous Maori. This issue resonated with racial and political overtones.