Psychiatrists, politicians and the public continue to be concerned about the care of mentally ill people who are potentially dangerous or vulnerable. In this context the College convened a conference on ‘Managing the high risk patient’1, which addressed issues of risk assessment, resources and legislation. The issues debated were of relevance beyond ‘high risk’ patients and underscored the difficulties the College and the Department of Health face in trying to achieve a satisfactory level of psychiatric service and practice across the country.

Most long-stay patients discharged from psychiatric hospitals under community care policy are being accommodated in suburban communities. The communities' attitudes have a major bearing on the success of this policy. A census of perceptions of psychiatric services was conducted in two areas prior to the opening of long-stay supported houses for the mentally ill. Many respondents (37%) had a negative perception of psychiatric treatment in hospital. Most (82%) had heard of community care policy but few (29%) knew about the imminent opening of supported houses for the long-term mentally HI in their own street. Most respondents (66%) were against the closure of psychiatric hospitals and many saw It as a cost cutting exorcise. The majority agreed with the idea of long-stay patients being discharged into smaller units in the community although a substantial minority (20%) thought it would have a bad effect on the local community. An overwhelming majority of respondents (91%) thought it was important for local residents to be given information about new mental health facilities in their neighbourhood. Respondents were worried that patients would not get adequate support and that they might be dangerous. If community care policy is to succeed, attention needs to be paid to the community's opinions and desire for information about local services.

Evaluation studios of community mental health services require the research, often in the form of interviews, to be carried out in private homes which poses a particular set of issues relating to the interview environment and the organisation of the work. This paper describes the experiences of interviewing patients, staff and informal carers as part of an evaluation study of the mental health services in two psychiatric sectors in South London and makes recommendations for more effective community based research.

It is a common belief among staff in Nottingham's acute psychiatric services that the Rehabilitation and Community Care Services (RCCS) are slow to respond to referrals leading to blocking of acute beds. In response to this the authors examined ‘bedblocking’ while RCCS responded to referrals of acute in-patients and long stays of existing RCCS patients admitted to acute wards during exacerbations of their illness.

The psychiatric treatment decisions made by two multidisciplinary psychogeriatric teams in 100 new referrals were compared with those made by a group of psychiatrists following independent formal research assessments. There was satisfactory agreement between the team and research decisions with regard to psychiatric hospital admission, antidepressant treatment and neuroleptic treatment. Agreement was less good for psychological treatments.

The pharmacological management of acute behavioural disturbance in psychosis is not straightforward. The real, or perceived, dose:effect relationship of the various neuroleptics in common use has an important influence on prescribing patterns leading, in certain situations, to very high doses of neuroleptic medication being prescribed. Data from a study of the use of neuroleptic medication in two psychiatric intensive therapy units illustrate the potential extent of the problem. Over half of the cases were not amenable to accurate dosage monitoring due to the use of depot neuroleptics, Clopixol Acuphase or polypharmacy. The majority received doses exceeding the limit suggested by the British National Formulary. Efforts to standardise the use of such drugs would help to optimise the clinical management of this challenging group of patients.

Our moral conception of suicide is examined. It is argued that a neutral definition of suicide is difficult to achieve and that how we treat the Question of suicide shows what value we place on the sanctity of Me or on life as a means to other ends. The case is made that autonomy, the principle of self-governance, has acquired special importance in the modem world to me detriment of other ethical principles such as beneficence.

This paper discusses ethical dilemmas that arise in parenting assessments on an in-patient Mother and Baby Unit with reference to one subject, a mother with schizophrenia who had been referred for a specialist opinion. The case raises ethical issues about the sometimes conflicting needs and wishes of mothers and their infants, and considers the requirements of the Children Act.

There hat boon until recently a dearth of descriptions of locally targeted community mental health services. Such a service, developed by changing a traditional psychiatric service in an inner setting, is described. The service addresses the needs of those with predominantly severe/enduring mental health problems, by increasingly using research based treatments in an ordinary district setting.

This paper considers the possible relevance to psychiatry trainees of a period of training in public health medicine. The work of public health doctors is to identify ways of Improving the health of populations and to promote relevant change. It is of relevance to psychiatrists, who have to consider needs of whole catchment populations rather than Just of patients who seek help, and who have historically experienced difficulty in competing for resources. We discuss tasks that trainees might undertake during a brief public health attachment, the potential benefits of such an attachment and some of the practical considerations.

Previous articles have dealt with aspects of training in Canada (Green, 1985), and in particular arrangements that exist for UK trainees to undertake a year's experience in Nova Scotia (Munro et al 1987). In addition, there have been accounts of trainees' experiences in particular settings (Ferguson, 1989; Gojo, 1992). Procedures required to enter Canada to practise psychiatry are complex and involve general and specialist medical registration (licensure to practise and certification as a specialist), remuneration and immigration procedures. This article is an introductory guide and highlights recent changes in registration and postgraduate training.

The police are increasingly requesting assesments of detainees' fitness to be interviewed. Senior registrars in psychiatry are often asked to perform this task. Gudjonsson has derived a set of guidelines from a Judge's ruling following a recent court case. Our survey identifies that the current practice of a group of senior registrars in psychiatry falls short of these guidelines. Reasons for this and implications for training are discussed.

The Third European Trainees Forum met in Copenhagen in May 1995. Twenty-nine delegates from fourteen countries came together to discuss training issues in the European context. Newcomers representing France, Spain and Italy joined representatives from the United Kingdom, Ireland, Norway, Denmark, Sweden, Finland, Greece, Switzerland, Germany, The Netherlands, Belgium, and Portugal. As in previous years, the Forum addressed a number of specific training topics and discussed furthering links with other European psychiatric bodies.

Public debate on dementia has intensified recently with scientific advances being scrutinised in the media, the genetics of Alzheimer's disease regularly portrayed as inextricably linked with the personal agony of whether to have ‘the test’ (which exists only for a small number of people) and the announcement by ex US President Ronald Reagan that he suffers from the disease. Several different areas provoke interest and speculation and this brief article attempts to highlight some, based on a recent meeting on the subject.

In May 1995 a Conference on Forensic Psychiatry was held near Tel Aviv, to which psychiatrists and other health professionals specialising in forensic psychiatry from Britain and Israel and Palestinians from the West Bank were invited. Participants at the Conference took part in discussions on forensic psychiatry and visited a maximum security prison with a hospital wing at Ramleh and an Arab psychiatric hospital in Bethlehem on the West Bank. On the days between Conference events, the British group visited Jerusalem and the Dead Sea and became aware of the almost unique interflux between Muslim, Christian and Jewish religion and culture which underlies the historical evolution of this area of the world. The modern social and political landscape is of course characterised by a violent confrontation between Arabs and Jews yet permeated now by a growing realisation of the need for peace and reconciliation, even if this has its ambivalent aspects at times. In this context the participation of Jewish and Arab health professionals together is a sign that ultimately medical and health care has its universal qualities which can bridge over or supersede the differences between nations that are so endemic to history.

This Conference, organised by the Association for Psychoanalytic Psychotherapy in the NHS, brought to the St Charles Day Hospital psychoanalysts and workers from different disciplines within NHS old age psychiatry services. Over 70 delegates attended, bringing varying experience of dynamic work.

The design of community-based mental health services to replace institutional patterns of service has proved a weighty responsibility for districts engaged in the task. A major challenge has confronted clinicians, planners and managers of change: to seize the not-to-be-repeated opportunity of redeeming the investment in outdated buildings; to revitalise forms of practice that have become increasingly divorced from the needs of those who use these services; and to set up valid systems of care which can stand the test of time.