For those people who have the cognitive and social impairments described as a learning disability, personal choice is more often than not a limited experience, (Mencap, 1989). Simple choices may be usurped by the preferences of carers, and more serious decisions may be correctly or incorrectly deemed beyond their capacity. We will address two questions which repeatedly face clinicians working with adults with learning disabilities. First, how do we ascertain a person's level of competence to give consent in relation to medical treatment? Second, in the case where a person with learning disability is considered unable to give informed consent to treatment, how do we proceed to make a decision regarding treatment?

Professor Jan Scott conducts a prospective survey of the ways psychiatry is presented in the media.

The practice of modern high quality psychiatry would be well served by the abandonment of the expression ‘community psychiatry’ and a moratorium on its further use for at least a decade.

In April 1987, in a back-street bar in Cardiff, the rebel regime at Radio Wales were plotting a coup. Their secret weapon was a daily magazine programme of music and current affairs called Streetlife. The would-be front-men, Ray Gravell (British Lions centre) and Frank Hennessy (Cardiff-Irish folk singer) had just persuaded the Editor that it needed an ‘agony uncle'… when I walked in.

I have spent all my professional life as a child psychiatrist working in hospitals and clinics. For many years I have been interested in helping bereaved children and conducted research on how best to help them. As the result of my interest I found myself being asked to see increasing numbers of children who were traumatically bereaved because of one parent killing the other, an event that the children often witnessed. I needed to familiarise myself with the effects of witnessing or being caught up in severe trauma, as well as the effects of bereavement. As I saw more and more of these traumatically bereaved children, I realised that child psychiatric services were not well organised to help these children who often needed emergency help. I decided, with the backing of the Royal Free Hospital, to retire from my post as head of a busy department and set up a clinic for children who had been acutely psychologically traumatised. This work is now supported by a grant through Cruse-Bereavement Care from the Department of Health. I wanted to see how others had organised services for such children so I applied for and was granted a Winston Churchill Travelling Fellowship to study trauma services for children in the USA. I spent a month visiting San Francisco, Los Angeles, Boston, New Haven and New York in September 1993.

The New Poor Law Amendment Act of 1834 led to the admission of considerable numbers of pauper “lunatics, idiots and imbeciles” to parish workhouses. The Stoke-upon-Trent workhouse, erected in 1832, had progressively to increase its accommodation for this class of inmate who, by 1899, numbered about 100. Brief details are given of nursing staff and of improvements in conditions of care following recommendations of the Lunacy Commissioners. Primary sources of information are indicated and emphasis is laid on the importance for the history of English psychiatry of documenting the care of the mentally ill and mentally impaired in Union workhouses.

Professor Patricia Casey of University College, Dublin explains why it is worth risking the microphones and phone-ins

Discussion of the need to reform psychiatric services in former West Germany started relatively late. It was only in the late 1960s, when the government changed from the conservative Christian Democrats to a coalition of the Social Democratic and Liberal Parties, that psychiatry became a public issue for the first time since World War II. Parliament appointed an expert commission, which after four years gave a comprehensive report in which the inadequate care of mentally ill patients was criticised.