We have evaluated the effects of providing a ‘roving’ psychiatric clinic to local authority residential homes for the elderly. The clinic was well received by the staff in the homes, reduced the need for urgent domiciliary consultations and hospital admission and appeared to be highly cost-effective.

This study presents a comparison between the domiciliary consultation services in urban and suburban sectors of the Croydon Health District. Urban general practitioners requested less domiciliary visits (DV) and tended to be less satisfied with this service than their suburban counterparts. Sociodemographic factors such as population density and multi-ethnicity in the urban sector may be responsible for a smaller referral rate and the degree of satisfaction with the psychogeriatric DV service in Croydon.

Literature giving a ‘behind-the-scenes' view of community-based research is, at best, sparse. Most authors present only the finished product leaving others with the task of forever re-inventing the wheel. This paper provides a light-hearted account of the bittersweet experience of conducting a survey of community attitudes to mental illness. The survey was part of a controlled trial of an educational campaign for neighbours of residential facilities for mentally ill people. It involved Interviewing members of the local community in their own homes. The paper highlights common pitfalls and gives practical advice for the novice researcher.

Speech and language therapy is a small profession. It only reached its golden jubilee year in 1995 and misleadingly, remains for many highly associated with the elocution training in which the profession had its genesis. In the last few years the greatest developments have been in the area of cognitive neuropsychological and functional (pragmatic) models for the assessment and management of language and communication. It is the premise of this article that speech and language therapists are likely to prove flexible and valuable members of the multidisciplinary team, with the ability to contribute a further dimension to care planning – that of specific clinical input to the wide range of language, speech and communication impairments associated with the major mental illnesses (Gravell & France, 1991).

The psychiatric intensive care unit (PICU) is now at the cutting edge of acute psychiatric care. Very little guidance has been produced to ensure that the PICU structure and design is able to meet the complex demands put upon it. The creation, development and relocation of a PICU has taken place within the Severn NHS Trust. We describe the experience gained from a recently commissioned unit together with a review of the relevant literature. Recommendations are offered for core features and design.

For over three centuries we, in Western societies, have lived in an Age of Reason. The accepted wisdom is that decision-making must be a purely rational process devoid of emotion and underpinned by objective knowledge. This article draws attention to the invasion of human affairs by an ideology which makes deliberate use of one kind of rationality to the exclusion of all others. Changes in work and its organisation have been particularly driven by economic rationality which allows no thought for the effects on individuals. The clinical evidence centres around four specific cases which are presented against a background of the business practices current in the control of work. It is argued that these have a deleterious effect on mental health, especially for those psychologically disposed to respond faithfully to management calls for greater teamwork and commitment.

The prevalence of smoking is higher among chronic psychiatric patients than the general population, in spite of their lower income. The purpose of this study was to calculate the percentage of income these patients spend on smoking and to discuss the relationship between smoking and chronic psychiatric disorders, in particular schizophrenia. Ninety-six smokers were included in the study. The mean percentage expenditure on smoking was 294% of income. We discuss why chronic psychiatric patients smoke so much, why they should not, and what factors may encourage them to quit.

The Royal College of Psychiatrists has stressed that psychotherapy skills are seen as a core element of psychiatric practice. To formalise this a new set of guidelines for psychotherapy training as part of general professional psychiatric training was published in November 1993. Concerns have been expressed over the implementation of previous guidelines from 1986. We have surveyed the psychotherapy training experience in our area and have worked with the psychotherapy department to address the findings. The future of training in the psychotherapies and implementation of the most recent guidelines are considered.

The Royal College of Psychiatrists' consensus statement suggests that prescribing high dose antipsychotic medication in children and adolescents should rarely be necessary. Our objective was to study the prescribing of antipsychotic medication in a regional adolescent unit during a three-year period. We found that antipsychotic prescribing on this unit is common in psychotic disorders and often high closes are required. This is not in keeping with the recommendations of the consensus statement. Review of clinical practice on other adolescent units is needed, together with a more comprehensive evaluation of the outcome of psychotic disorders in this age group.

A survey of consultant psychiatrists identified the core characteristics of patients who require referral for specialist dynamic psychotherapy. Those are patients with neuroses, personality disorders and affective disorders who have longstanding and complex emotional and interpersonal problems which stem from their early life experiences. They need a level of expertise and an intensity and/or length of treatment which cannot safely and reliably be provided by either general psychiatric services or primary care. The survey suggests that 0.1% of the population/year would benefit from referral for specialist dynamic psychotherapy.

The CPA encourages good psychiatric practice in the continuing care in the community of people who suffer with serious mental illness. The tiered CPA has recently been proposed with a view to channel resources towards those patients who are most in need. This study assesses whether the CPA is used appropriately and effectively among patients discharged in an inner city sector where there is a high level of serious mental illness. The results suggest that it is feasible provided there is an adequately developed community mental health team.

Many psychiatrists now work successfully in the primary care setting. Although a primary care post might be considered to be a useful experience by most trainees, few undertake such an attachment, owing to lacked opportunities and concern that such a placement would delay career progress or be at the expense of psychiatric subspeciality experience (Burns, 1994). For general practice posts to be integrated into psychiatric training, these concerns need to be addressed. One solution has been a post shared with general psychiatry (Balmer, 1993). This paper describes an alternative approach, a post combining subspeciality experience in psychotherapy within the practice setting, with working as a general practitioner (GP) trainee.

November 30th 1995 saw old age psychiatry lose the active services of four men who have played heroic roles in creating and moulding the speciality.

There have been two recent accounts in the Psychiatric Bulletin (Harrison, 1989; Kisely, 1993) which have given some practical advice about getting work in Australia. They did, however, rather gloss over the details. With clear memories of the difficulties of arranging a one year training post in Sydney, New South Wales (NSW) and having been approached by numerous mainly junior colleagues asking about details of arranging a similar trip, I am writing what I hope will be a useful and accurate “Getting your Australian visa and medical registration made easy” guide.

The present trend towards community care with the continuing closure of the old Victorian institutions has given rise to much argument for and against community care. Incidents of violence by mentally ill patients against members of the public have resulted in some backlash against community care. There are fears of a return to the days of the institution. It is proposed that these changes can be predicted from a model that we have called the ‘spiral model’. An understanding of this model might help to prevent history from repeating itself.