This paper examines the potential for advance directives to be used by people with mental illness. Also known as a ‘living will’, an advance directive enables a competent person to make decisions about future treatment, anticipating a time when they may become incompetent to make such decisions. In Englishlaw, if “clearly established” and “applicable to the circumstances”, an advance directive assumesthe same statusas contemporaneous decisions made by a competent adult. A psychiatric advance directive, anticipating relapse of a psychosis, develops the concept of the living will. We argue it could reconcile two apparently contradictory themes in the current practice of psychiatry - on the one hand, the call to provide for non-consensual treatment outside hospital, and on the other, the promotion of patient autonomy.

The Oxford University Department of Psychiatry was founded in 1969 during a period in which new psychiatry departments were being established in most undergraduate medical schools. It was the realisation of plans that had been formulated over at least 10 years by local psychiatrists and by leading members of the Clinical School, most notably by Sir George Pickering, the first clinically active Regius Professor since Osier.

This paper is a study of the costs and quality of life of 157 people attending specialist employment schemes for people with long-term mental health problems in southeast England. The research, work force, and the seven work settings are described and differences found between service users in satisfaction, social networks and costs at 1994–95 levels are reported. This is the first such study of work schemes in this country, and while still not generalisable, it supplies valuable empirical evidence for all those concerned with psychiatric rehabilitation.

Accident and emergency (A&E) staff completed a general knowledge and attitude questionnaire related to suicide and deliberate self-harm (DSH) before and after a teaching package. The results showed an increase in general knowledge while attitudes remained the same. Following the teaching package there was an increase in the number of patients who contacted the Specialist Service for DSH.

Child abuse could be defined from predominantly legal, clinical and research perspectives, and attempts at an integrative enunciation are fraught with over-inclusiveness. Meadow (1989) proposed that a child is considered to be abused if he or she is treated by an adult in a way that is unacceptable in a given culture at a given time. This definition usefully incorporates the essential issues including secularity and diversity of socio-cultural norms which often create controversy in case detection and are particularly relevant to the debate.

The landscape of training in child psychiatry is changing fast. In recent years the content of theory and practice within the discipline has evolved rapidly and the latest Royal College guidelines for higher training (Royal College of Psychiatrists, 1995) show a daunting array of training areas to be encompassed in four years or less. The Caiman proposals (Department of Health, 1993) will abbreviate and so inevitably further intensify postgraduate training in the speciality. We argue in this paper that the fact of entering such an intensive training at the level of senior registrar can, under certain circumstances, create barriers to learning. We describe the efforts of trainees, consultants/trainers and scheme coordinators to adapt to these difficulties as they arise.

The high rate of non-attendance for first appointments at psychiatric clinics is wasteful of health service resources. Previous studies have demonstrated reductions in the non-attendance rates when referred patients were asked to contact the clinic to confirm that they wished to be seen before an appointment was sent. The effect of introducing such a process to a community based alcohol service was investigated. Results showed that although there was a reduction in the non-attendance rate, the overall effect was to discourage patients from attending the clinic, resulting in a large reduction in the proportion of all referrals seen. Alternative approaches are discussed.

A review of standard texts used by trainees reveals a wealth of differences in the description of primary delusions. The views of 52 consultants and trainees were obtained regarding the various descriptions present in textbooks. This demonstrated a high degree of disagreement between clinicians as to which description most clearly matched their own view. A scheme for the classification and description of primary delusions is suggested.

We describe how a support group was set up and run over a ten-month period for members of a community paediatric nursing team. The views of the trainee who facilitated the group and of the nurse manager are offered.

A postal survey of old age psychiatrists was carried out to examine the pattern of services currently available for elderly people with chronic functional mental disorder, and to identify innovative models of care for this group. The opinion of respondents was sought regarding problems with service provision and additional resources that would be desirable. The majority of respondents felt that the needs of individual patients should determine whether they should be cared for by old age, general or rehabilitation services. Seventy-three per cent of respondents felt that more specialist residential care outside hospital was needed to improve the care of this group.

Many trainees in psychiatry have only a vague idea about what the Collegiate Trainees' Committee (CTC) is or what it does. The Royal College of Psychiatrists is unique among the medical Royal Colleges in having a CTC. It was established in 1979, although its roots go back to the previously established Association of Psychiatrists in Training, which was independent of the College.

The former East Anglia Regional Health Authority initiated a 3-year project beginning in 1993. This aimed to introduce audit skills and to promote sustained audit activity across a diverse group of statutory and independent sector drug and alcohol agencies. Prior to this there had been little interest in audit for this area of care and no good models of practice were available from elsewhere in the NHS which could readily be adapted to the needs of the Anglian services. Eventually 24 agencies collaborated in this project, which introduced a system of reciprocal peer audit between the agencies which was supported by a dedicated facilitator, a programme of auditor training, and an Agency Audit Representative Group to prioritise topics for audit and to agree common standards. Progress was very slow to begin with. By May 1995, 12 agencies had completed an initial audit of 2–4 topics each from a regional menu of 12 priorities. One year later, 12 more services have undertaken such an initial audit and nine out of the original dozen (75%) have completed their first ‘audit cycle’ with a re-audit of the same topics. There has been an increase in the number of agencies meeting all the standards in their chosen topics, and in the number of topics where all standards are met, wherever those topics have been audited. Two new practice guidelines have also been developed by the agency representatives.

Little advice is offered in the literature for the novice report writer, despite the gravity of the situation, for example, a patient appealing against detention. Section 20, which renews the authority for detention after periods of 6 months or a year, is a useful reminder for clinicians, as it outlines the components that must be present in order for detention to continue.

This audit established guidelines for the completion of reports for Mental Health Review Tribunals and Managers' Reviews. A structure and list of ‘features to be included’ was compiled. This was used to rate the standard of reports prepared in the Warneford Hospital between 1991–1993. Following peer consultation within the hospital, the guidelines were considered acceptable and useful. At re-audit after 8 months the standard of reports had improved in most respects.

A questionnaire addressing various aspects of research activity was administered to 172 trainees in the Eastern region of Ireland. An 80% (n=138) response rate was achieved. While 98% of trainees regarded research activity as important, almost half rated their research opportunities as poor. The commonest reasons cited for doing research included c.v. enhancement, personal interest and consultant pressure. The most frequently reported problems in doing research were time allocation, funding and adequate supervision.

Diagnosing a man who has travelled back from the future and who, in the present, speaks of the future as the past causes no problems: paranoid schizophrenia. Thus is Bruce Willis misunderstood in Twelve Monkeys (1995). Neither this, nor Brad Pitt as a patient with schizophrenia should distract us; once more we have a film in which a psychiatrist develops a dubious relationship with a patient. Despite evidence of the destructive impact on patients (Russell, 1993; Jehu, 1994), in films it has become almost normal.

Few subjects attract the attention of the public and the media more than violent acts committed by children and adolescents. All too frequently, politicians, policy-makers, practitioners, the public and media become caught up in destructive cycles of blame, engendering within society itself a sense of helplessness and powerlessness for and about violent young people.