Traditionally, general practitioners and psychiatrists relate to one another through a system of cross referrals, from primary care to secondary care and back again, the referral being initiated by the GP through a request for a domiciliary visit or more usually for an out-patient assessment of the clinical problem. However, in the mid-1960s, individual psychiatrists began to report a new way of working, which consisted of the psychiatrist going by invitation into GPs' surgeries or health centres to work directly with the general practitioners and with other members of the primary health care team. A survey undertaken by Strathdee & Williams of the General Practice Research Unit of the Institute of Psychiatry, showed that by 1984 in England and Wales, one psychiatric consultant in five, sometimes with, sometimes without, junior staff, spent some time in a general practice setting. At the College meeting in Cambridge (April 1988), Pullen reported that in Scotland a similar survey showed that as many as 40 to 50% of psychiatric consultants spent some time in primary care settings.

As a relative newcomer to the medical undergraduate curriculum, child psychiatry is still looking for ways in which to best convey its message to students. There is fairly general agreement that this should combine opportunities to assess children or at least to observe the psychiatric assessment of problems and to impart basic information on child development and psychopathology.

It is now widely recognised that families represent a hidden and largely unacknowledged resource to the NHS in the day to day management of long-term disabilities, particularly severe mental problems like schizophrenia. It is most likely that 50–60% of first admission schizophrenic patients will return to some type of family environment and a significant number will remain with the family for a considerable time. The current trend towards community management of mental illness, hampered by the lack of community provision, almost inevitably means discharge to families and is likely to continue and increase further.

Over recent years a number of non-hospital based services have been developed that can be subsumed under the title of Community Mental Health Centres (CMHCs). Conferences held by the King's Fund (McAusland, 1985) and the National Unit for psychiatric Research and Development (Sayce, 1987) have highlighted the importance of CMHC-like services in health authorities' plans to develop community based psychiatric services. There is no single view of CMHCs in the United Kingdom and, while many such centres already exist, they are diverse in nature and their activities have been sparsely documented.

SafetyNet is a computerised, networked patient care system currently under development in the South Camden sector of Bloomsbury Health Authority. The project is primarily targeted at the clinical monitoring of people suffering from schizophrenia and the system incorporates measures which can provide a basis for quality assurance of care and a clinically driven approach to audit. SafetyNet is being designed to help keep track of individual sufferers, chart their needs as they change over time, prompt the services to action and knit together the responses needed from different agencies. It is a modular system which can be adapted to the needs of people with different kinds of mental illness and to different community populations.

The David Lewis Centre for Epilepsy has approximately 300 adult residents. All have epilepsy, which is often only partly alleviated by available treatments; many have mental handicap or psychiatric illness, adding to their total disability. The Centre's explicit aim of understanding and caring for people with epilepsy implies concern not just for clinical measures such as seizure frequency, but for our residents' quality of life.

Since their introduction in the 1960s, benzodiazepine drugs have been widely prescribed for anxiety states and insomnia. Despite the initial hopes for these drugs being non-addictive and not producing tolerance, recent work has shown that there is a well defined withdrawal syndrome (Hallstrom & Lader, 1981; Petursson & Lader, 1981; Tyrer et al, 1981; Tyrer et al, 1983) and that tolerance has also been shown to occur (Aranko et al, 1983; Aranko et al, 1985). There has been widespread concern about these effects. The British National Formulary advocates that “used as hypnotics routine prescribing especially in hospitals is undesirable, and ideally they should be reserved for short courses of treatment in the acutely distressed” and that they should be discontinued as soon as possible. Indeed the Royal College of Psychiatrists' statement on benzodiazepine prescribing and the Committee on Safety of Medicines have recommended that their use as hypnotics should be considered only when the condition is severe, disabling or subjecting the individual to extreme distress. Tyrer & Murphy (1987) have recommended that these drugs are best used for no longer than two weeks in regular dosage.

Lithium is widely used in psychiatry, mainly in the prophylaxis of manic-depressive illness. It is usually prescribed long term and because of its side effects, low therapeutic index and the possibility of toxicity, it is necessary to monitor serum lithium levels, thyroid function and renal status. Clinical guidelines are unclear; Vestergaard et al (1982) recommended that serum lithium and creatinine be checked every two to four months and thyroid function every six months. However, Crammer et al (1982) suggest that once stable levels are established, serum lithium need be checked only in response to clinical indications. The most recent edition of a widely read psychiatric text states that levels should be checked each six to eight weeks for as long as the patient continues on lithium (Loudon, 1988). Accepted standard clinical practice is thus unclear. It should be emphasised that these guidelines are not based on research evidence.

This century has been characterised by a substantial increase in the number of elderly residents in the community in the technologically advanced countries. One obvious consequence of this has been a pressure on existing mental and socio physical facilities that cater for the elderly. The medico-social factors responsible for this rise in the proportion of the elderly in advanced countries are subtly creeping into many developing countries like Nigeria (Lambo, 1966). It is with this perspective in view, coupled with the dearth of literature on psychogeriatrics in developing countries, that I decided to review the socio-demographic and clinical aspects of elderly (60 years and above) admissions to the Nigerian National Neuropsychiatric Hospital and WHO Collaborating Centre for Research and Training in Mental Health over a five year period (1 January 1982 to 31 December 1986). An attempt will also be made to draw comparisons with my experience of psychogeriatrics in the United Kingdom (I trained in psychiatry at the Royal Edinburgh Hospital in the early 1980s).

From the plethora of articles examining the role of individual disciplines within the community mental health team, one discipline appears almost conspicious by its absence. How has occupational therapy become the forgotten speciality?

On 4 June 1839 the first patient walked with friends the mile uphill to the new Crichton Institution from the lunatic wing of Dumfries and Galloway Royal Infirmary. Detailed clinical records support a diagnosis of melancholia; the patient was discharged well in 1844 and follow-up confirmed her recovery.

Nafsiyat, a community based ‘intercultural therapy centre’, was set up in London in 1983 to provide psychotherapy for people from ethnic and cultural minority backgrounds.

The Alma Ata Primary Health Care Conference in 1978 marked a watershed in global health care policy and specifically a fundamental milestone for mental health. Not only was mental health defined as a right and an integral part of health generally, but also its promotion was a major recommendation of the conference.

The Yorkshire Regional Psychiatric Association is a group of psychiatrists, general practitioners, psychologists, nurses, social workers, occupational therapists, chaplains, health managers and others working in the field of mental health. Its main functions are to promote vocational, academic and social discourse between members of the professions with an interest in mental health and handicap. It has about 300 members. The Association was founded in January 1949 as the Leeds Regional Psychiatric Association. This became the Yorkshire Regional Psychiatric Association in 1982. In 1989 the Association reaches its 40th anniversary. The Association can claim the distinction of being the first multi-professional society of workers in mental health to be established in the United Kingdom.

The College is debating how to train psychiatrists for community care (CC) that is spreading – ahead of hard evidence of its value for certain problems in the UK. Much future psychiatry will be practised in the community outside hospital within multidisciplinary teams not always led by a psychiatrist, and wherein the lead-rôle changes frequently within a single meeting depending on whose expertise and readiness to accept responsibility emerge.

The opportunity to travel and practise one's skills in a variety of settings is an attractive aspect of the medical profession. However, in the current atmosphere of competition for jobs and structured career paths, deviation from which may mean losing one's place on the ladder, the prospects of working abroad are limited and the decision to do so often risky. One way round this is to arrange jobs on an exchange basis for a limited period. This is most convenient where the countries involved have similar teaching programmes and reciprocal arrangements for college recognition: in the case of psychiatry this includes Australia, New Zealand, USA, Canada and Hong Kong.

The following is a descriptive study of Willoughby Ward, a psychiatric intensive care unit, opened in Parkside Hospital, Macclesfield, in July 1986. It provides a moderately secure facility for the treatment of psychiatric patients within both Crewe and Macclesfield Health Authorities. The unit has 15 beds, of which two are funded and used by Crewe area, where, unlike Macclesfield, the psychiatric unit is located in the district general hospital. Managed as a locked ward, the patients are admitted under the provisions of the Mental Health Act 1983. As well as being mentally ill as defined in the Act, the patients were disturbed to a degree as to be unmanageable in open conditions.