In most parts of the country today it is often difficult or impossible to fill consultant vacancies in mental handicap. According to the DHSS there were 146 consultants in mental handicap in post in 1978 compared with 102 in 1968, an overall growth of 43 per cent, compared with 34.7 per cent in general psychiatry. Nevertheless nearly one quarter of posts were vacant on 30 September 1978. The number of new consultants in mental handicap required to replace losses from death and retirement is about 6 to 10 per year. If an expansion of 10 is to be achieved some 16 to 20 fully trained senior registrars will be required each year. For this 60 senior registrar posts will be needed, assuming that senior registrars have three to four years training. At the end of September 1978 there were 34 established senior registrar posts of which 9 were vacant.

The reason for admission was early developed as a focus of work in Hill End Adolescent Unit (Bruggen et al, 1973). Boys and girls (they were all under 16) were admitted on the authority of those in parental charge, and the reason usually was that their parents needed a break from the anxiety of having them at home, or that their children's homes could no longer cope with them and that their social workers had nowhere else to place them.

Since independence in sub-Saharan Africa, decentralization of psychiatric services has been accepted as a policy, but it has resulted so far only in developing small units attached to the provincial hospitals. Because of the shortage of qualified psychiatrists, the latter are invariably staffed by locally trained psychiatric or sometimes general nurses. With one or two exceptions most of the mental hospitals were built in the colonial times and they often resemble penal institutions and are geared mainly to offering custodial care.

Of recent years psychiatry has been assailed from many sides. Psychologists, political philosophers, social workers have had their say, but the most hurtful have been assaults from within the citadel itself, such as the forceful views expressed by R. D. Laing and Thomas Szasz. The essence of their argument is that mental disorder is not a disease nor an illness and should not therefore be the concern of doctors.

Since I started to work for the College Bulletin the fan mail I have received about this column has been a pleasant bonus. It is heartening to receive letters of support, and I am glad to have them all. There is no higher reward than the approbation of one's colleagues expressed in monetary terms, so I would like to very warmly thank those of you who send me their admonitions written on the back of a postal order.