The definition of community psychiatry is, of course, a central issue in any personal choice of books or articles about this field. The topic may be interpreted as the study of the provision of psychiatric and related services for the optimal care of the whole community or population. Alternatively, the concept may be confined to all services except hospital residential care, or even to more restrictive definitions. My preference is to adopt the wider definition on the basis of Gestalt theory applied to organisations. That is to say, non-hospital care may have characteristics of its own, but it will also have characteristics which result from its inclusion in the whole programme of psychiatric and social care available. Hence, community psychiatry is only understandable in the context of all forms of care. The interaction of the clinical and organisational roles in community psychiatry is probably more important for good patient care than in any other clinical specialty. In reading about this topic, therefore, a balance has to be struck between clinical psychology and psychiatry and their related skills on the one hand and an understanding of management and its skills on the other.

The Inspectors of Lunatic Asylums in Ireland, in their recent report, state that the lunatic accommodation afforded in workhouses has been but slightly altered within the past decade; the little done, however, lies in the way of improvement, and is so far satisfactory. The classes in question – imbeciles, epileptics, and idiots – do not require, in the great majority of cases, what may be designated as a genuine asylum treatment, however much their condition might be benefited by a uniform and more liberal attention to personal comforts and requirements, particularly in respect to day-room provision, a better system of ventilation, and means of exercise in the open spaces, the yards allotted to them being for the most part small, rough and gloomy. Hopeless, however, as many of the inmates may be, and incapable of appreciating fully the value of domestic comforts, if not carefully looked after, they not infrequently become very excitable, and subject to outbreaks of violence, particularly epileptics; when as a rule they are transferred to district asylums for indefinite periods, and thus occupy beds that could be far more usefully reserved for acute and curable patients. Hence a double disadvantage results – asylums become overcrowded, and their enlargement a necessity – while between the expense of costly additions and a heavier personal maintenance, the expenditure of public rates is increased in probably a two-fold degree. The practical remedy would consist in obliging districts to make suitable provision in one or more of their unions for idiots, confirmed imbeciles, the utterly demented and tranquil, who should as now be supported wholly out of local taxation. In 1884 the inspectors directed the attention of the metropolitan poor-law guardians to the imperfect and painfully restricted accommodation in both their workhouses for their insane inmates, suggesting that a similar provision should be made on their behalf, as advocated at Belfast, by the erection of a pile of buildings, having commodious day-rooms, large dormitories, with some few apartments of smaller dimensions for indoor occupations, and standing on a portion of the extensive unoccupied ground belonging to the South Dublin Union. Judging from the structure at Belfast, the proposed buildings would not cost, when fit for occupation, more than £7,000, the payment of which, extended over fourteen years, would not amount to one half-penny in the pound. In the operation of such a scheme, as immediately affecting the inmates, paid attendants, with some well-conducted paupers, would be ample in the proportion of one to each forty of them.

As it is a special interest of mine, I read about suicide regularly. Most often this is because of the need to prepare a talk of some kind. I also read frequently in search of help in dealing with a clinical problem concerning a patient at risk. Less commonly, when I am not pressed for time, I am able to indulge in the luxury of reading for its own sake, out of sheer interest and curiosity, following up themes wherever they take me. Each of these approaches complements the others in an attempt to understand the complex phenomenon of suicide.