Twenty-five years ago, the Ministry of Health recommended that 20 to 25 beds per million population were needed for treating psychiatrically disturbed adolescents, a figure similar to that recommended by the Royal College in 1956/57. The College also recommended in 1976 the provision of one adolescent psychiatric team per half a million population. None of these norms has been met, nor are they likely to be this century. The decline in the teenage population may slightly reduce the need temporarily until the anticipated increase from the late ‘90s. Meanwhile, government financial restraints call for innovative and creative alternative solutions for the treatment of disturbed adolescents wherever possible without admitting to a residential unit. Indeed the pressure is so great that a number of adolescent units have already been closed, or their beds drastically reduced.

One of the first principles on which a good service for adolescents will be based, according to the Health Advisory Service Report Bridges Over Troubled Waters (1986), is “The age group concerned from 12–19 years requires separate consideration and provision”. Up to the publication of this report, many adolescent psychiatrists dealt only with those up to the age of 16 (Bruggen & O'Brien, 1987) or up to school leaving age. Such a recommendation means a considerable change of practice, and this study was designed to assess the nature of that change.

Many psychiatrists are deeply disturbed by the changing and challenging circumstances in which they are responsible for patient care. This became evident at a conference on the role of the consultant in the clinical team, held by the Health Services Manpower Review at the Royal Society of Medicine on 14 July 1988 and attended by an entirely medical audience. The need for the consultant to act as leader of the clinical team was emphasised without identifying the nature and extent of this task, resulting in the failure to develop any strategy to tackle the many problems identified.

In a survey of district plans for Mental Health services (Kingdon, 1988) befriending schemes, where volunteers are recruited to visit isolated and lonely users of psychiatric services, were planned or in existence in 14 of the 127 districts who responded. However, lists of the components of a comprehensive community service (MIND, 1983) and Hirsch (1988) surprisingly do not include references to such schemes, although Griffiths (1988) alludes to them in his recent report. There are moreover no reports in the psychiatric literature of such enterprises. The scheme established by MIND in Bassetlaw (population (103,000) is therefore described.

Before commencing work on the Daily Living Programme at the Maudsley Hospital, in London, to compare the benefits of community care with standard hospital admission for patients with serious mental illness, a visit to Madison was arranged, where some ten years ago a similar study had been carried out (Stein & Test, 1980). We had the impression from the substantial literature which has appeared on the mental health service in Madison (Stein & Test, 1985) that they have implemented in practice their positive research findings on community care. It was felt that their lengthy experience with such a service could be beneficial to the UK, where such services are now being developed. This visit included PACT (Program for Assertive Community Treatment); a research programme investigating the long-term prognosis of mainly schizophrenic patients, and the various units of the mental health services in Madison.

There are national differences relating to compulsory admission to mental hospitals. As a visitor from Thailand, it was of interest to me (PK) to compare procedures relating to admission, treatment and aftercare of the mentally ill in England and Thailand. In Thailand there is no equivalent of the Mental Health Act 1983. Although there are some legal provisions affecting patients' rights in Thai law, there are no legal provisions concerning ‘detained’ patients in mental hospitals.

Nafsiyat, a community based ‘intercultural therapy centre’, was set up in London in 1983 to provide psychotherapy for people from ethnic and cultural minority backgrounds.

The opportunity to travel and practise one's skills in a variety of settings is an attractive aspect of the medical profession. However, in the current atmosphere of competition for jobs and structured career paths, deviation from which may mean losing one's place on the ladder, the prospects of working abroad are limited and the decision to do so often risky. One way round this is to arrange jobs on an exchange basis for a limited period. This is most convenient where the countries involved have similar teaching programmes and reciprocal arrangements for college recognition: in the case of psychiatry this includes Australia, New Zealand, USA, Canada and Hong Kong.

Since its clinical delineation, the premenstrual syndrome has enjoyed a wide repertoire of descriptive labels commensurate with the enormity of its symptomatology and the diversity of its postulated aetiologies, none of which has attained pre-eminence, although some (e.g. progesterone deficiency) have been of more enduring interest, due perhaps as much to the enthusiasm of their authors as to the presence of any compelling scientific premise. The entity thus remains of syndromal status constituting as it does an enigmatic curiosity for some and a fellowship of controversy for others, with little agreement as to its exact nature, time of occurrence or even its existence.

Suicide rates in the Eastbourne Health District have risen dramatically over the last ten years. The present study looks at some of the factors which may influence these rates and compares these with other health districts in the South East Thames Region. Suggestions for further research are made.

At the present time, changes in the NHS provision for people with mental handicaps mark the end of one era and the beginning of another. The Yorkshire Region is seeing a far-reaching change from a previously regionally organised hospital system to district-based services. It is a time to take stock of what has existed before it is altered completely.

There are two episodes which remain in my mind from the first night I was on call at the Clarke Institute of Psychiatry, Toronto in 1980. The first person I assessed in the Emergency Room was a young university student in her early twenties who had been reading “Jung” and urgently needed to discuss “archetypes and the animus”; the second incident some hours later involved a middle aged man who was manic on admission and responded rapidly to the 10 mg of haloperidol I administered intravenously in front of a silent and, as I later discovered, astonished night nurse and junior resident. The patient settled rapidly and my unorthodox treatment was a talking point for several weeks. These two vignettes alerted me to the fact that things were different here. No-one had ever used intravenous neuroleptics in Toronto at that time, and equally no-one in Newcastle on Tyne, which I had left only two weeks earlier, would consider the casualty department of the Royal Victoria Infirmary a necessary stop as they waded through Jung.