This is the kind of conference at which the Royal Society of Medicine excels – an international array of speakers, firm chairmanship, time and space to meet other delegates, abstracts published with the programme and a Consensus Overview published within a fortnight (by Professor Hugh Freeman as rapporteur).

On a recent visit to the UK, Dr Guiseppe Dell Acqua, a leading exponent of the Italian psychiatric reforms, heard the ‘Med 3’ band play and extended an invitation to visit Trieste and give a concert. ‘Med 3’, the name being an allusion to the medical certificate, were formed in 1992. A Mental Health Week was held in the City of Portsmouth that year. In association with the Arts Connection, a local organisation promoting the arts to a wide audience, and the Portsmouth Care Consortium who were organising the event, artists in many fields ran workshops for mental health service users. Guy and Emma Heape, session musicians, ran a workshop at the Social Service Mental Health Day Centre and it was so successful it led to a band being formed. The band achieved recognition by winning a Mental Health Task Force award in 1993. An invitation to accompany the band to Trieste was readily accepted.

Albania borders the Adriatic Sea and lies between the former Yugoslavia to the north and Greece to the south. Seventy per cent of the land mass is mountainous, the coastal strip containing most of the country's agricultural land and having the densest population. The total population of the country is 3.4 million while the capital Tirana has a population of 250000. Until very recently Albania was rarely visited by people from the West. It had become increasingly isolated under the Stalinist dictatorship of Enver Hoxha and the paranoid attitude towards foreigners that existed in the 1970s and 1980s is well illustrated by the concrete pill boxes that were built to repel invaders. More than 600 000 of these were built and they can be seen today scarring the attractive countryside of hills and fields around Tirana. With the collapse of communism in Eastern Europe, Albania followed the same path and went through a period of disorganisation in 1991 before electing its first democratic government in 1992. As with other former communist countries private enterprise began to develop, land was sold back to the peasants, and private cars began to appear in the streets. In 1992 there were no private cars in the country; in 1995 there were 35 000 in Tirana alone.

Diagnosis and treatment of mental health problems in individuals suffering from deafness or severe hearing impairment poses particular challenges. This is recognised for adults by the provision of specialised services based in London, Birmingham and Manchester but for children and adolescents there is only a specialised out-patient service based at Springfield Hospital in London which has itself only been in existence two years. This day conference of invited hearing and non-hearing professionals held in Birmingham in October 1994 considered how appropriate services might further develop.

Where human relationships are concerned, issues of trust and control go together. Where professional relationships are concerned, these issues require special attention.

This paper describes mental health services in the Lower North Shore (LNS) catchment area of Sydney, Australia, and is based on a visit made in early 1994. The local population of 170,000 is predominantly Caucasian, but there are also groups from other ethnic backgrounds. The mental health service has about 800 registered clients, with 60 new clients each month, the majority of whom have a serious mental illness. Since the service has won several awards, it may be instructive to review its structure and function.

I lay in the neurosurgical ward recovering from insertion of my ventriculo-peritoneal shunt and listening to the incessant talk of my neighbour. He had decided that as we shared a battle-front we were the best of friends. Much disclosure on his side called for me to reveal my way of life – as a doctor – to which he retorted “Oh, so it's a busman's holiday”!

Libya occupies an approximate area of 1.8 million sq. km in the northern part of Africa, with a population of 4.5 million. of the population, 97% are Muslims, 46.5% are under 15 years and only 2.3% are over 65 years of age. Sixty-four per cent of the population live in urban areas and the literacy rate is 60%. Tripoli, situated in the west, is the capital city of Libya and Benghazi, the second biggest city, is situated in the east of the country and the distance between the two cities is about 1000 km. The population of Benghazi and eastern Libya is about 2 million.

The Fregoli delusion is one of a number of misidentification syndromes. It is characterised by a patient recognising a familiar person, usually seen as a persecutor, in various strangers who, although they do not show physical resemblance, are believed to be psychologically identical to the familiar person. It usually occurs in the context of a schizophrenic illness but has been reported in affective disorders and organic psycho-syndromes (Förstl et al, 1991). It was first described by the French authors Courbon & Fail in 1927, who used the term ‘Fregoli illusion’ after the Italian actor who enjoyed enormous popular success on the Paris stage at the time. It has also been called the ‘illusion of negative doubles'. However, as the psychopathology is a delusional interpretation of normal visual stimuli rather than an abnormal perception the terms Fregoli delusion or ‘delusional hyper-identification of the Fregoli type’ are preferable. The original case description has recently been translated and annotated (Ellis et al 1994) but there remains little background information available on the figure of Fregoli himself. Biographies have appeared in French and Italian but there are few English language references and this paper is intended to provide an account of the life and career of one of the most extraordinary entertainers in theatre history.

This one day seminar was arranged by the King's Fund Organisational Audit team (KFOA), to take a multidisciplinary view of quality improvement in primary care. Despite the title of the day all the speakers were general practitioners and managers, and input from other professional groups was limited to questions and comments from the audience of nearly 200.

In February 1994 the Sainsbury Mental Health Initiative was launched by the Sainsbury Centre for Mental Health (formerly Research and Development for Psychiatry) in conjunction with the Department of Health and the Welsh Office to make available £3 million for selected community based mental health services. On 10 October 1994, as part of the World Mental Health Day, the eight winners were announced and invited to receive their awards at a prestigious ceremony attended by the Secretary of State for Health and many of the great and good from the British mental health scene.

Having viewed the Glastonbury Festival for many years as local residents, it seemed time for us to venture inside and see how 100,000 people can converge onto a dairy farm in rural Somerset for three days of music and assorted entertainments. We were interested in reactions to such intensely communal living and also the organisational aspects of psychiatric services in this extreme version of community care.

An account of the thoughts of a fictional Assistant Medical Officer (AMO) on duty at the County of Lancaster Asylum, Rainhill in 1890 is given. It is based on the contemporary case records and other literary sources and is as factually accurate as possible. However, any similarity to persons living or dead is coincidental and unintentional.

The term Afro-Caribbean is used to describe black people of Caribbean origin in Britain. Migrants from the Caribbean, their children and their children's children are all covered by this term. The group as a whole is reported to have a higher incidence rate of schizophrenia than white groups, (King et al 1994), and British-born children of Caribbean parents have an even higher rate (Harrison et al, 1988). These reports have led to the hypothesis that Afro-Caribbeans may have a special vulnerability to schizophrenia. While limitations to these studies have been identified, (Wessly et al 1991) none has sought to question the use of the term Afro-Caribbean as a valid and reliable ethnic grouping. If we are to be able to produce good hypotheses for the aetiology of the reported increases in incidence, or to produce research which is useful to Black and ethnic minority groups, we need a clear understanding of the people under study.

Gentle Teaching (McGee et al, 1987) has been described as a technique for working with people who have learning disabilities and severe behavioural disorders. I attended a two-day workshop from 25–27 May 1994 run by the Royal College of Nursing, Bexley MENCAP and Values Incorporated.