The number of drug abusers in this country has increased over the past 20 years, and the pattern of drug taking has also changed. More people now take drugs on a recreational basis, and a smaller proportion of addicts show the full-blown picture of physical and mental deterioration associated with addiction in the past. Where such deterioration is present, pregnancy rarely occurs because of suppression of menstruation and ovulation and reduction of male fertility. Perhaps because of this change, the number of pregnant drug addicts has also increased. They now create a significant problem in the obstetric departments of hospitals in major population centres where addicts tend to congregate.

The popular perception of the business world is that dog eats dog, with the executive expecting material rewards to compensate for high levels of stress and risk taking. If you fail—too bad—you had it good for a while. A caricature of course, but like most caricatures it contains a kernel of truth. Sympathy for business colleagues who do fail is not a facility prized by competitively striving senior managers, viz Robert Maxwell's statements on the launch of the second London newspaper, “It's the law of the jungle—the survival of the fittest”.

The recent substantive report Guidelines for the Training of General Psychiatrists in Psychotherapy makes explicit the expectations of the College in regard to psychotherapy training for trainees in general psychiatry. The report points out the particular difficulties in providing such psychotherapy training outside the teaching centres. This paper is a description of the organisation of psychotherapy training in the periphery of the Northern Region and of what may be achieved with limited resource.

Severalls Hospital is a large psychiatric hospital, established in 1913 and originally designed for about 2000 patients. With the changes in attitudes to mental health over the last 70 years the hospital's aims and objectives have altered several times. Now, with the number of in-patients already reduced to approximately 650 and the movement to run down large hospitals such as this, preparation needs to be made for the shift to the community as the main future base for psychiatric services. Over the years the hospital has recognised the importance of preserving close links with the patient's home and has always maintained that regular activity and work is vital in the process of re-establishing patients in the community and in employment.

The Central Mental Hospital, Dundrum opened its doors for business in 1850. We cannot be sure why our English masters at the time considered it more urgent to open a security hospital in Ireland before planning and constructing Broadmoor. Were the Irish, as a race, sick and dangerous, or does an old institution like Dundrum reflect the views of the colonists on the colonised!

Oxfordshire is a pleasant, prosperous county dominated by the City where about one third of its 480,000 population lives. Oxford itself has nearly 15,000 students attending the University or Polytechnic. The active rehabilitation of long-stay patients was started in Oxford over 25 years ago, with the result that by 1986 there were only 40 non-dementing psychiatric-in-patients with a current admission of five or more years. This successful programme of rehabilitation, now virtually completed, was achieved by creating a wide range of sheltered work and other activities, and by the provision since 1963 of over 40 group homes and hostels by the Oxford Group Homes Organisation. However, many psychiatric illnesses still have a chronic and relapsing course; 65% of all admissions, aged 18 to 65 to the Oxford District mental illness units in 1982 and 1983, were readmissions. For those diagnosed as suffering from schizophrenia the figure rises to 80%. In 1972 and 1973 Mann & Cree surveyed 400 ‘new’ long-stay patients (current admission one to five years, aged 18 to 65) in 15 hospitals in England and Wales. They found a rate of 25 per 100,000 population and concluded that for about one third continuing hospital care was the only realistic option. If the remainder were to leave hospital, hostels providing a high level of support would be needed. The recent 1982 survey of ‘new chronic’ in-patients in 14 Scottish psychiatric hospitals still showed a rate of 17.2 per 100,000 population, of whom only 38% were not thought to be in need of continuing hospital care.

At an important interview, a candidate was asked about his experience in teaching medical students. He replied with an enthusiastic and detailed account of his seemingly extensive experience in this field. However, when asked to name one psychiatric textbook suitable for medical students there followed a fumbling and paradoxical silence. When asked the same question, although able to name a small number of such books, embarrassingly I had to admit that as a student I had never possessed any one of them. I subsequently put the question to some of my colleagues and was reassured to find that my own omission was commonly shared.