Kempe, in an address to the International Association for Child Abuse and Neglect in 1979, drew the professional communities' attention to ‘the serious plight of sexually abused children’. He described this as the final stage in the communities' recognition of patterns of child abuse. This cycle had commenced with his recognition of ‘The Battered Child Syndrome’ in the early 60s.

The 1983 Mental Health Act made a requirement under Section 58 for a second opinion by an Appointed Doctor when a detained patient either did not understand the nature, purpose, and likely effects of a treatment or did not consent. The present study is confined to second opinions relating to ECT (electric convulsion therapy) and extended medication. It was noted in the Mental Health Act Commission's Biennial report that requests for second opinions varied in numbers between different hospitals and psychiatric units. In 200 personal visits by the author a Treatment Plan by the Responsible Medical Officer (RMO), which is an indication of good practice in the operation of the Act, was written in the case notes in only 66 cases (33%) and then most often by a junior doctor. This finding has been reported generally. It seemed appropriate, therefore, to explore the opinions of Consultant Psychiatrists on the legal requirement for second opinion.

A national survey in 1980 drew attention to the wide variation in frequency with which electro-convulsive treatment was being used. Yorkshire Region was at the top of the league with three times the level of the Oxford Region which had the lowest rate. Since then a good deal more research has been published on the effectiveness and limitations of ECT.1–3 Other factors which might have influenced clinicians in their prescribing of this treatment include much stricter conditions in the 1983 Mental Health Act for giving ECT compulsorily, plenty of media comment which may have reduced its acceptability, the increasing confidence of general practitioners in prescribing antidepressant drug therapies, and the greater emphasis on community care.

Since 1984, Nova Scotia has had a programme to bring a small number of senior trainees in psychiatry from Britain or Ireland to undertake one year of clinical work plus continuing medical education here. This programme is sponsored by the Nova Scotia Provincial Department of Health in collaboration with the Dalhousie University Department of Psychiatry.

A mixed audience of health professionals at a recent Mental Health Film Council screening welcomed this video which shows a variety of community-based initiatives. Most participants thought it would be useful in several contexts, for fellow professionals and for the general public. Those working with individuals who are ill, have a handicap or are old could be helped by the video, it was believed, to clarify their own attitudes to institutions: local residents might be introduced to the idea of care in their own community.

This tape deals with the transition from pre-clinical to clinical medicine as seen through the eyes of two medical students. They embark on their clinical training at Sutton Hospital where an apparently inhumane and thoughtless surgeon talks literally over the head of a recently admitted emergency. He and his entourage walk away leaving the patient unable to answer the questions of her neighbour, and presumably of herself, as to what is wrong and what is going to happen to her.