Despite the recommendations of the Health Advisory Service report Bridges over Troubled Waters (1986), there has not been any dramatic growth in adolescent psychiatry as a sub-speciality. The HAS report highlighted the largely unmet special needs of this age group, the rising risk for mental illness with increasing age in adolescence, and the need for effective liaison between professional disciplines working with this age group. Nevertheless adolescent services increasingly perceive themselves as under threat from political initiatives and continue to fight their corner (e.g. Wells, 1989).

Child and adolescent psychiatric services receive referrals from a variety of sources in addition to traditional medical channels. It is unknown whether this practice has implications in patterns of usage of time. Our hypothesis was that referrals from non-medical sources were likely to be more time-consuming than those from medical colleagues.

As general practitioners (GPs) are clinically responsible for the majority of recognised psychiatric morbidity in the community, they have an important role to play in deciding the shape of new community psychiatric services. This paper reports the results of a self-completion postal questionnaire survey of Harlow GPs' views on how community psychiatric services should be developed. Harlow is a mature new town (population 79,521: 1981 census) north east of London, served by a typical DGH department of psychiatry with in-patient wards and a day hospital, outreach services being provided largely by community psychiatric nurses (CPNs). GPs work in group practices in purpose-built health centres.

Mentally handicapped people have the same rights in terms of good quality and range of care as other members of society. This has been highlighted by the recent emphasis on community care for psychiatric patients irrespective of their disability.

Before 1977 there was little work done with eating disorders in the psychiatric unit at Burnley General Hospital. The hospital dietetic department was aimed mainly at special diets for medical, surgical, and paediatric patients and services for the obese. Many patients with anorexia nervosa were treated on paediatric or medical wards, until in the early ‘80s, following the establishment of a clinical psychology department, a principal-grade psychologist was appointed.

The management of mentally handicapped offenders has long been problematic. Three misconceptions of the relationship between mental handicap and criminality have been widely held since the turn of the century, despite there being no conclusive evidence in their support (Jackson, 1983). These are: that mentally handicapped people are more likely than others to commit antisocial acts in general; that they have a particular predisposition to commit serious crime, especially sexual crime (Robertson, 1981); and that they are unlikely to be deterred by normal sanctions. Misunderstanding breeds misapprehension. Sadly, in the past, many mentally handicapped people were admitted to hospital after committing only trivial offences. Moreover, one Special Hospital study (Parker, 1974) found that most “severely subnormal and subnormal” detained patients actually had IQs above the category to which they had been assigned.

Medical audit has been defined “as the systematic, critical analysis of the quality of medical care, including the procedures used for diagnosis and treatment, the use of resources, and the resulting outcome and quality of life for the patient” (Department of Health, 1989).

Until recently, a doctor beginning a career in psychiatry would usually apply for a combined SHO/registrar rotation lasting approximately 3½ years. Trainees could expect promotion from SHO to registrar after about 18 months, subject to passing the Part I of the MRCPsych examination and also to their educational and clinical progress having been judged to be satisfactory by the scheme tutor and organising committee. Life has changed! The emergence of Achieving a Balance (Department of Health, 1988), the proposals of which are intended to be phased in over the next ten years, has meant that scheme organisers have had to quickly change the basis on which their rotations are run. This paper is an account of how this has been done in the SE Thames Region.

Psychological and psychiatric issues represent a significant proportion of the workload of all doctors. Nonetheless junior doctors often have an unsatisfactory knowledge of psychiatry. Previous studies have examined how hospital doctors say they manage psychological problems (Mayou & Smith, 1986), and attitudinal factors among medical students (Wilkinson et al, 1983).

In the wake of legislation overseas, Western Australia promulgated a new Mental Health Act in 1966, paving the way for the establishment of private psychiatric hostels in the community and the discharge from mental hospitals of many chronically ill, long-stay patients.

In Japan the Mentally Disordered Persons Supervision and Protection Law (1901) and the Mental Hospital Law (1919) used to be the main laws for mentally disordered people. Subsequently, the Mental Hygiene Law came into force in 1950 but was criticised as it had restrained admitted patients and the provisions for procedures for the release of patients were inadequate. The purpose of the old law was to give medical treatment and custody to mentally disordered persons and to maintain and improve the mental health of the nation. In the revised law, enacted in July 1988, acceleration of social rehabilitation of mentally disordered persons and promotion of their well-being were added.

For some years, the pace of progress in clinical neuroscience has progressively quickened but none more so than with molecular biological techniques. Clinical psychiatrists have been promised (some say forewarned) that the systematic application of these techniques will swiftly cut through the multifactorial aetiologies of many mental illnesses and revolutionise diagnosis, treatment and, possibly prevention. Not surprisingly, given the fact that Down's syndrome and Alzheimer's neuropathological changes (senile plaques and neurofibrillary tangles) are so tightly linked, understanding of Alzheimer's disease (AD) was the first mental illness to benefit from these new methods. Once the amyloid β protein component of the senile plaque had been isolated and its 39–43 constituent amino acids sequenced, then it became almost a routine matter to locate the gene and describe comprehensively the much larger (approximately 710 amino acids) amyloid β protein precursor (APP). Almost simultaneously, the gene responsible for familial pre-senile Alzheimer's disease (FAD) was located, like the APP gene, on chromosome 21 (Tanzi et al, 1989). Soon, a claim was made that these (FAD and APP) were the same gene, and, in a manner akin to the presumed causal gene dosage effects in Down's syndrome, Alzheimer's disease was attributed to excess production of amyloid (by way of APP). However, this was quickly refuted and data to support a gene dosage effect in AD were not confirmed. The trail then seemed to go cold. Several studies indicated that FAD was genetically heterogeneous and distinct from senile AD (St George-Hyslop et al, 1990), and the problems of prion disease in animals and man secured more attention (Westaway et al, 1989).

Entries in the minute books of the New Bethlem Hospital Building Committee from 1813–1816 contain details of the commissioning, installation and subsequent extensive modification of a system for heating the hospital. The system adopted was chosen principally for its cheapness, but in a manner that may seem familiar in the current climate of competitive tendering, with adoption of the cheapest proposal; through the incompetence of its manufacturer it was to prove problematic and dangerous.

In my medical year there was a student who had been in the RAF in World War II. After the war he worked for Beaverbrook and the Express newspapers and went on to become a publisher. He studied medicine, while a publisher, and then came the crunch. To be a publisher or a doctor? On the first day of house jobs he inadvertently drove his Jaguar into the consultant's reserved parking spot, which caused no amusement. To add to his disquiet he found that his salary of £35 per month, after income tax, and then surtax on top, only paid for his pipe tobacco and refreshments. The rest of us were less egregious and embarked upon life with even less fiscal fun. A bottle of Woodpecker Cider on Saturday night was nirvana. Was this really the reward for all that education? (Most specialists had at least 28 years of formal education: from starting at age four to leaving postgraduate school.) Like many before me, particularly Edinburgh graduates, I crossed the high seas, at the age of 32. My naval forebears would have been surprised that it took so long, especially my father, who went to sea at 14 in World War I. There were many surprises, not least of which was that of money. In a career sojourn, from the UK to Australia and finally Canada, over 18 months, there was a tenfold increase in income.

This Consortium has a distinguished political-legal history. Its predecessor, the Family Court Campaign, was launched in 1985 by Lady Faithfull, then chairman of the all party parliamentary committee for children. Its aims were those of the Finer Committee (1974).

The 1991 annual meeting of the American Psychiatric Association (APA)∗ one of the world's most influential psychiatric organisations with a membership of over 35,000, and an annual budget of $24 million, was attended by over 12,000 persons from all over the world. (The cost of the meeting itself was about $2.5 million). Over 230 workshops and symposia were presented together with lectures from distinguished researchers, video presentations, debates and 600 posters. With up to 25 concurrent sessions, it was impossible for any one individual to attend more than a fraction of the programme. The theme, chosen by outgoing president, Dr Elissa Benedek, Professor of Child Psychiatry at Michigan, was ‘Our Children - Our Future’.

Wednesday, 17 April 1991, advertised on the Paris Metro as ‘la première journée de la minceur’ was, by an appropriate coincidence, also the morning Professor Philippe Jeammet welcomed over 800 participants from 34 countries to this bilingual conference at which 298 papers and posters were presented. In 1859 Louis Marcé, described by Dr Joseph Silverman as the “forgotten man of anorexia nervosa”, wrote the first description of the syndrome. Today anorexia nervosa is common, expensive and life threatening, responsible for an estimated 200 British deaths every year.