Since 1960, there has been a five yearly review of the population resident for more than three months at Glenside Hospital, Bristol (Cooper & Early, 1961; Early & Magnus, 1966; Early & Nicholas, 1971; 1977; 1981; Ford et al, 1987). These surveys have particularly focused on the accommodation and employment needs of the in-patients, but have also documented the nature of the changes that have occurred in the mental hospital over the last 30 years. The results of the seventh quinquennial survey are reported.

The co-existence of physical and psychiatric illness in so much of the elderly population poses diagnostic and therapeutic problems for psychiatrists, geriatricians and general practitioners alike, with the presence of physical illness strongly influencing and sometimes limiting the options for treatment of the psychiatric illness. Recognition of this has resulted in the Section of Old Age Psychiatry of the Royal College of Psychiatrists recommending that senior registrar training in old age psychiatry should include a one month attachment to an approved geriatric medicine unit.

As long-stay patients move into the community, the relationship with the psychiatrist gets diluted. One reason is the logistical problem of visiting widely spaced residences, but another is that patients are primarily under the care of general practitioners (GPs) who provide physical care in the majority of cases. The way in which psychiatric care is delivered is variable (Horder, 1991). For the system to function a modus vivendi has to develop between GPs, psychiatrists and care staff. This study looks at current practice in Gloucester.

Mental disorders may seriously impair insight and therefore cause some patients to refuse potentially life-saving treatment which they would otherwise accept. Opinion on the ethics of current legislation regarding compulsory admission and treatment varies with open debates leading to heated and emotive exchanges. During the reading of the 1982 Mental Health Amendment Bill intense lobbying of MPs took place (Bluglass, 1984). Some argued against compulsory detention because of its infringement on personal liberty while others argued that it was necessary for the adequate treatment of mental disorders which impair insight. They pointed out one's right to receive appropriate treatment whether or not insight is impaired.

Psychiatric care is delivered by a wide range of workers (psychiatrists, hospital nurses, community psychiatric nurses, occupational therapists, psychologists, social workers, counsellors and general practitioners) who work as teams with some patients and as individuals with others. Health authority resources for psychiatric care are widely distributed among facilities both hospital-based (wards, day hospitals, out-patient departments, social work departments, occupational therapy departments) and community-based (community psychiatric nursing departments, community mental health centres and facilities funded jointly with social services and voluntary agencies).

Community psychiatry represents a major revision of psychiatric service provision, and although there is currently no consistent body of knowledge upon which training for community psychiatry can be based, in the near future most psychiatrists will be working to a greater extent in the community.

This audit examined 65 consecutive admissions to a psychiatric hospital in the Irish Midlands over six months. The admissions came from a defined sector with a total population of 39,000. In the year prior to the study major changes in the delivery of psychiatric care in the sector were instituted. These changes included the introduction of admission guidelines and extra resources in the community. The general practitioners who see mental illness at first contact were informed of these changes. Attempts were made by the sector psychiatrist team to screen for appropriateness of admission with regard to the special groups such as alcoholics, the aged and the mentally handicapped.

Following the recent reorganisation of the health service, doctors have been advised to accept the challenge of involving themselves in general management, (Ross, 1991), and the need for additional training in management skills has been recognised (Higgins, 1989; CTC Working Party Report, 1990). Local trainers, however, often do not know what sort of management training is appropriate, nor how or when it should be introduced into an eight year specialist training agenda, and the current situation for many trainees may, therefore, be described as hit or miss (Lock, 1991). Trainees need also to learn to consider not only their immediate clinical responsibility to individual patients, but also the broader concepts of preventive and public health medicine and the principles of equity, efficiency, quality and efficacy which underly the purchaser-provider contractual process.

This paper describes the development of a community orientated mental health service including the introduction of a community-based admission unit. The catchment area is a compact conurbation with a population of 56,000 in a deprived part of North Tyneside. Most people come from social classes IV and V and less than 1 % are from ethnic minorities. The male unemployment rate varies from 16–24% and the area is ranked 58th (out of 192) on the Jarman deprivation indices. The primary health care services suffer from many of the problems of inner-city general practices, with the Family Practitioners Committee being the highest prescriber in the country.

The title seems chosen to catch the eye. This it does, but as being perjorative. In contemporary writing about sexual variations only psychoanalysts and a few psychotherapists retain the term ‘perversion’; others have abandoned it as stigmatising.

In the current climate of interest in audit (Standing Medical Advisory Committee, 1990) and a desire at our hospital to embark on criterion based projects, we set out to undertake a simple audit project surveying the practice of ECT. The aim was to audit the treatment facilities, the treatment procedure and the supervision and training. It was hoped that the full cycle of audit – setting goals, measuring activity, and then effecting change – would be achieved (Shaw & Costain, 1989)

I have just finished a one-week non-residential course on management skills for senior registrars. Like many of the people who attended the course I had put my name down in order to get a better idea of what the post-1-April era would mean for my professional practice. We had by and large no major interest in a career in management and yet we were keen to acquire ‘management skills’ in order to ‘produce’ what was required of us by the ‘cultural’ changes affecting the NHS.

Electroconvulsive therapy (ECT) is reported the most effective treatment for severe endogenous depressive illness but may also be useful in the treatment of mania and schizophrenia. It seems that the seizure is a necessary component of the overall treatment but it is undecided what constitutes an adequate duration of seizure activity.

The life of an institution may come to an end. The closure of a large mental hospital is an event of great emotional importance analogous to the death of an individual. Man has developed a set of rituals to help him cope with emotional turmoil released by bereavement. Since the death of an institution is not common the need for mourning rituals is not so generally acknowledged. We describe a ceremony to mark the closure of Cane Hill Hospital, Surrey.

As community services develop, medical staff are increasingly spending more time outside the hospital, despite the most severely ill patients still being in hospital. This may lead to junior medical staff and nurses feeling unsupported by the consultant. In addition, as more disturbed patients are kept out of hospital, the general practitioner and community health workers may require to contact the psychiatrist more often to talk about patients or to request urgent assessment. Therefore the importance of communication with consultants is increased both from the hospital and from the community while they are spending increasing amounts of time in their cars. In a discipline where communication is of paramount importance, a failure to meet this growing need would undermine the effectiveness of the service as a whole.

I previously reported (O'Shea, 1989) on the experiences of national Huntington's disease (HD) organisations in Britain, Holland, Ireland, New Zealand, and the USA. The Australian experience was discussed later (Kapp, 1990; O'Shea, 1990). The earlier paper supported the contention (Black, 1988) that the medical profession in general was not supportive of HD voluntary groups. I also expressed concern that the lobbying of voluntary groups representing far more common disorders was “bound to dilute the impact that Huntington societies may have.”

Advertisers use powerful images to sell everything from cars to coffee, from banks to baked beans. That this should also apply to pharmaceuticals then is unsurprising. Whatever view we as clinicians might take of drugs, for their manufacturers they are a product like any other, and doctors are the natural targets for their promotion. In 1982 the pharmaceutical industry spent £150,000,000 on drug promotion in the UK (Medawar, 1984). We have attempted to take an objective view of drug advertisements by examining the images used in all the advertisements that have appeared in the British Journal of Psychiatry over the last 30 years.

While the term quality is not much used explicitly in clinical medicine in general and mental health services in particular, quality is implicit in much that guides us. Indeed it is at the very foundations of our health care practice – the ethical codes with their emphasis on beneficence, non-malevolence, respect for autonomy, justice and fairness.

There has been much discussion on the most suitable services for mentally handicapped people with special needs such as additional mental illness or marked behavioural disorders. A number of policy documents have advocated the use of generic services as a matter of course, such as the All Wales Strategy (1983), while others have acknowledged a possible need for specialist input when such services are used e.g. Needs and Responses (Department of Health, 1989). In 1986 the Royal College of Psychiatrists stated that the psychiatric needs of this group required a specialised service and suggested that ideally this would be integrated with other psychiatric specialities as part of a comprehensive service.

“Here is Edward Bear, coming downstairs now, bump, bump, bump, on the back of his head, behind Christopher Robin. It is as far as he knows, the only way of coming downstairs, but sometimes he feels that there really is another way, if only he could stop bumping for a moment and think of it.”