Inner London, together with many other inner city areas, faces a crisis of funding in health services. Budgets are now allocated to commissioning authorities primarily on the basis of the sizes of resident populations. Although it is recognised that different communities have different needs and that some adjustment to this simple approach (capitation weighting) is required, there is no clarity about the best mechanism to achieve a fair resolution (Stern, 1992). Those inner city areas with high levels of social deprivation, high indices of health service need and especially those with high numbers of homeless people require additional resources to provide acceptable levels of overall care. Failure to take adequate account of these pressures may result in further gradual reductions in funding and consequently in service provision.

As part of the shift towards community care, a number of the large mental hospitals throughout the United Kingdom have now closed and many more are due for closure. In a review of deinstitutionalisation, Thornicroft & Bebbington (1989) concluded that the run-down of hospitals was outstripping the provision of new community facilities. Between 1974 and 1984 the mental hospital population fell by 25,000. However, the increase in residential places provided by local authorities and by the private and voluntary sectors totalled only 3,000. Inadequate planning and provision could give rise to discharged patients facing the prospect of isolated, segregated and impoverished lives with a high likelihood of homelessness and recurrent admission.

It is well known that there is a high prevalence of psychiatric disorder among residents in hostels for the homeless (Timms & Fry, 1989), and staff in these hostels are looking after the mental health needs of these people sometimes with little help from the institutional services. Recent studies have emphasised the plight of schizophrenia sufferers (Marshall, 1993) while other subgroups of mentally disordered homeless people have received less attention.

The number of psychiatric beds in Friern Hospital in North London was steadily reduced in line with plans to close the hospital in 1993. Meanwhile some discharged patients deteriorate, most of whom have schizophrenia, with significant and multiple disabilities of a chronic nature and are service dependent as described in the recent report of the Royal College of Psychiatrists (1993). Return to their accommodation may be prejudiced by their relapse and the attendant disturbed behaviour. The poor employment prospects too are unhelpful in rehabilitation, particularly since we are running down and closing probably one of the best industrial rehabilitation facilities in the world. The combined effects generate great pressures on the remaining beds and there are increasing numbers in prison.

Electroconvulsive therapy (ECT) involves the close collaboration of psychiatrists and anaesthetists (Freeman et al, 1987). The Royal College of Psychiatrists' audits of ECT in 1980 (Pippard & Ellam, 1981) and 1991 (Pippard, 1992a, 1992b) relied on psychiatrists rating the facilities and performance of staff in ECT clinics. In contrast we are unaware of any research assessing anaesthetists' views of ECT clinics. Considering their different roles and expectations, opinions may well differ. To investigate this possibility we conducted a survey between November 1990 and February 1991.

Increasing concern has been expressed in the psychiatric literature and general press about the use of neuroleptic medication for the treatment of behaviour disturbance in the mentally handicapped (Buck & Sprague, 1989). The issue was highlighted in a television documentary (Public Eye, BBC2, 1 May 1992) which reported a number of cases of tardive dyskinesia in mentally handicapped people who had been treated with neuroleptics. The programme, although taking a characteristically slanted view, will have made an impression on relatives, patients and the general public. It was also intimated that British families may be preparing to test the legal grounds for prescribing these drugs to the mentally handicapped, particularly where there is no formal psychiatric diagnosis.

The report of the Standing Medical Advisory Committee to the Department of Health, The Quality of Medical Care (1990), states that outcome is the most relevant indicator of quality of medical care. In addition to providing information about the appropriateness of treatments, there are important ethical and resource implications if activities are found to be unjustified. However, measuring outcome is difficult if there is no quantifiable change in symptoms or function following treatment. In child psychiatry this is a relatively common dilemma and outcome studies, while agreed to be essential, are frequently abandoned at an early stage or fail to get off the ground because of the complexity of the problems they generate. In a review of the ways in which child mental health services attempt to measure outcome (Pound & Cottrell, 1989) the authors acknowledge these difficulties and conclude that a start should be made by “Asking the customer's opinion” about the treatment they have received. In other words, “Are they satisfied?”.

In 1991 the Royal College of Psychiatrists awarded two overseas teaching fellowships. Tom Harrison and Alexandra Espejo described their visit to Chile in the March 1993 Psychiatric Bulletin. We were asked to visit Bulgaria to teach liaison psychiatry in both child and adolescent and adult psychiatry.

The rise in the proportion of female medical graduates has led to an examination of the alternatives to full-time continuous postgraduate training. Part-time training has become more common, particularly in psychiatry and non-acute specialties. The means of establishing this type of training have been described in detail (Royal College of Psychiatrists, 1987) and the training requirements are discussed in the JCHPT Handbook. However, when part-time training is written about it is presented as a daunting process, fraught with concerns about a less than optimum training and practical difficulties. The survey by Ann Gath (1988) of supernumerary senior registrars in child and adolescent psychiatry detailed problems such as prejudice, a sense of exploitation, and lack of support and advice. These issues are clearly of great importance to those considering this option but there is also a more positive and optimistic view of part-time training which seems of particular relevance to child psychiatry. At the time of writing I am nearing the end of my higher training on the PM 79(3) scheme and am in a position to describe some of these more positive aspects.

I've had difficulty in writing this review. I initially caught the last half of Tony Harrison's ‘docudrama’ about Alzheimer's disease shown at the outset of Alzheimer Awareness Week in July and hated it. My heart sank at the Brechtian device of putting the dialogue to the tune of a hymn (in this case the carol ‘In the Bleak Midwinter’), and I found the approach to the three ‘star’ patients chosen for the film from those in Whernside ward, High Royds Hospital, sentimental and patronising.

The main source of topical information in most parts of the world is through the mass media – principally newspapers and television. Television news and current affairs have a duty to remain impartial, as they provide a service for the whole population. Newspapers, on the other hand, have a greater journalistic and editorial freedom as they target subgroups. British newspapers are currently being scrutinised as to how they report both factual and speculative information of a general kind. At the same time there seems to be an increase in their interest in psychological matters. However, work on newspaper reporting of psychiatric disorders (Day & Page, 1986; Matas et al, 1986) has shown that the mentally ill are usually portrayed in a rather negative light with few positive images.

This article summarises the aims, interests and history of this Special Interest Group since its inception in 1988. It also sets out to show that psychiatry requires philosophical training and research.

The inaugural meeting of the Association of Teachers of Sexuality within Medical Education was held in London on 2 July 1993. The list of participants reflected the fact that teaching about sexuality does not fit neatly into any subject area, and although some departments of psychiatry see this as their responsibility, others seem happy to leave it to colleagues in reproductive medicine. So as well as psychiatrists and psychologists, we included gynaecologists, specialists in family planning and general practitioners with psychosexual training. We represented a wide geographical area with participants attending from as far apart as Aberdeen and Southampton. What we had in common was some responsibility for teaching about human sexuality, and a belief in the importance of this topic in medical education.

The second European Trainees Forum (van Beinum, 1992) met in the Netherlands in March 1993. Training issues were discussed by delegates from the UK, Ireland, the Netherlands, Denmark, Sweden, Norway, Germany, Belgium, Finland, Portugal, and Switzerland. A number of training topics were specifically addressed by the Forum, and a statement unanimously agreed on each of these.

In 1985, nearly two years after the announcement of the intended closure of Claybury and Friern Hospitals, the Team for the Assessment Psychiatric Services (TAPS) was set up to evaluate this policy. TAPS has now grown to a staff of six full-time researchers (three psychologists, a psychiatrist, a sociologist and a health economist) and is funded mainly by the North East Thames Regional Health Authority, but also by the Department of Health. This was the eighth annual conference, and the first since the closure of Friern Hospital in March 1993.

This Organisation (APP) has been set up to provide a forum for the exchange of information and ideas and to bring together the views and experiences of colleagues working in psychiatry in the UK.