Most common mental disorders - becoming anxious, distressed or depressed - are dealt with by family doctors. In order to be able to understand the situation in South Manchester, we start by comparing figures for all mental disorders here with the situation in the country as a whole (Table I). The figures in the vertical columns are like Russian dolls: each figure below is contained within the figure above it!

In the past decade there has been a rapid diversification of services provided for patients with chronic psychiatric illnesses. Although these services are thought to be beneficial for those who use them, there has been little in the way of objective evaluation. As new services begin to compete for the limited resources available, it has been recommended that they should demonstrate their effectiveness. This paper reports a small pilot study on the value of an arts based service known as START (Bridges & Brown, 1989) which won a BBC ‘It's My City’ competition in 1989. It has been a popular component of the rehabilitation services of the Department of Psychiatry, Manchester Royal Infirmary since its inception in 1986.

Large mental hospitals are gradually being emptied. Patients return to the community. But often their prospective carers have little idea of what to expect when they arrive. Hospital staff often cannot give information regarding how disturbed patients might be.

Recent reports show that continuing problems are being experienced by the returned hostages and their families. The Department of Health advised at the time of the hostages return that, apart from those who needed immediate emergency treatment, the initial point of referral ought to be the persons general practitioner. General practitioners in many cases now employ their own staff who are able to offer support and counselling. In some cases the general practitioner may, however, decide that the most appropriate response is referral to the psychiatric service. All local psychiatric services should be able to respond to the needs of people suffering continuing stress as a result of traumatic experience.

That adults with mental handicap∗ are particularly vulnerable to sexual exploitation is not new, although relatively unacknowledged or investigated. Indeed successive acts under the mental health legislation have sought to protect them, particularly those with severe mental handicap. With the growing awareness and identification of sexual abuse of children, and the growing knowledge of the long-term psychological effects (Jehu, 1989), which may be even more severe for people who have disabilities (Kennedy, 1990; Sinason, 1989), it has been acknowledged that not only are the mentally handicapped particularly vulnerable to abuse (Benedict et al, 1990), but the problem may well be seriously underestimated by those working in management positions (Brown & Craft, 1989). While it is recognised that the mentally handicapped have rights and need to express their sexuality, they also have the right not to be exploited or abused. We therefore need to know more about the numbers, indicators and circumstances where this group may be sexually abused and to develop policies, systems and training to protect them (Brown & Craft, 1989). This pilot study was a step in this process.

It is the intention of the Mental Handicap Services of the Chichester Health Authority to implement a discrete electronic alert system for some of the patients who are incapable of consent. An activator, similar to the bar code in a library book, or tag in a clothing store will be kept in a pocket of the patient's clothing. When a patient who carries the activator walks through a magnetic field at the door of the unit, it will trigger a bleep held by the nurse in charge to inform him/her that this particular patient is leaving.

The word serendipity has its origins in a fairy-tale about ‘The Three Princes of Serendip’, the latter being the former name for Ceylon. The heroes of this fairy-tale were always making discoveries, by accident and sagacity, of things they were not in search of. The earliest use of this term was by Horace Walpole, the essayist, who coined it in a letter of 1754. Later, he wrote a little fairy comedy on this theme, which was produced successfully at the Haymarket Theatre, London. The term means, therefore, the gift of being able to make delightful discoveries by pure accident and this is why it is used sometimes as the name for an antique shop or a second-hand clothes store. It is likely that most people could give examples of serendipitous incidents in their lives and the purpose of invoking the concept of serendipity in relation to sub-specialty selection by trainees is concerned with the possibility that chance can be a major determinant of outcome in this process. This issue is related to wider concern that the optimum methods for the well-informed recruitment of trainees into the sub-specialties and special interest areas in psychiatry have not yet been organised satisfactorily.

The psychiatry of old age has come to occupy an increasingly prominent role in psychiatry, because of demographic trends, and also because of service developments. About a third of referrals to most psychiatric services are for the over-65s and a high proportion of beds are occupied by this age group. Recently the training recommendations for senior registrars in the psychiatry of old age have been revised and clarified (Royal College of Psychiatrists, 1989) and old age psychiatry is now recognised as a specialty within psychiatry. Nevertheless there is continued concern about the training opportunities available in this field (Wattis, 1988), reports of difficulties in filling consultant posts, and evidence that the present guidelines for consultant staffing levels are inadequate (Ballinger et al, 1989). It has recently been recommended that one-third of senior registrar posts in general and old age psychiatry should be assigned to the psychiatry of old age (Sims, 1990).

The proportion of female medical graduates has steadily risen in the past decade. Although it may be argued that men should take on an equal share of the child-rearing and housekeeping roles of the housewife, there is evidence that women doctors are falling behind in their careers because of domestic pressures (Rhodes, 1990). Part-time work is perceived in theory as being a suitable option for women doctors with domestic commitments, but the number who choose this option in practice is surprisingly small. The following study sought to establish what demand there is for part-time training in psychiatry among junior doctors and whether what is on offer meets that demand.

There are many studies in the medical literature attempting to confirm the value of a comprehensive physical examination in the psychiatric in-patient population. An appraisal of the literature and review of psychiatric admissions in a large teaching district offers some evidence to the contrary.

On several occasions in the last ten years, when interviewed by a market researcher about future developments in the treatment of schizophrenia, we have said that the biggest problem in the drug management of schizophrenia is compliance. We believed that if drug companies could manufacture an injectable neuroleptic lasting six months, then many of our problems would be over. Compared with this, the benefits of a new neuroleptic preparation appeared to be trivial.

Council agreed to sponsor the Registrar on a visit to Romania to join a team from the Wolfson Centre, Great Ormond Street, and the Newcomen Clinic at Guy's Hospital. The main focus was the Neuropsychiatric Children's Hospital at Lugos in the region of Banat in Western Romania. The Director of this hospital had asked for this visit.

Since the demise of the Ceaucescu regime in Romania, the media has been presenting a grim catalogue of life in Ceaucescu Romania. Even as these stark images were unfolding, Bristol MENCAP, independent of the national organisation, was putting together a package of humanitarian aid directed, predominantly in the first instance, to orphanages in and around the city of Cluj-Napoca in the province of Transylvania, Romania. Our department has close links with the National Executive of MENCAP and we were approached by Bristol MENCAP to undertake a fact-finding mission on the current state of professional services for the mentally handicapped in general, and that of the Department of Psychology at Cluj-Napoca University in particular.

Compliance with medication regimes is fundamental to successful treatment and hence familiarity with factors influencing the level of patient compliance is essential. In relation to the psychogeriatric population poor compliance is a major and worrying problem largely neglected by researchers.

The Edith Morgan Centre is a 60-bedded acute psychiatric in-patient unit on a DGH site, now open for three and a half years, following the closure of a nearby psychiatric hospital.

In this personal review we discuss the contemporary issues in Chinese psychiatry, the main themes in recent Chinese literature, and current psychiatric practice in China.

Although there was some specialist interest in teaching psychological medicine in the 18th century, it was the Asylum Acts of 1808 and 1845 which made the subject a speciality and was responsible for drawing attention to the need for undergraduate and post-graduate training. By 1827 Alexander Morison was giving lectures on insanity in Scotland, to be followed by Dr W. A. F. Browne who, in 1836, was giving a series of lectures at the Montrose Asylum which he repeated at the Crichton Royal Hospital in 1851. Dr D. Skae of Morningside Asylum also gave lectures and clinical demonstrations on insanity from 1846. Edinburgh students benefited from teaching in insanity by Thomas Laycock, professor of medicine following his appointment in 1851 (Crichton Browne, 1851).

Ernest (Ernie) Gruenberg was born in New York City on 2 December 1915 and died in Washington on 2 July 1991. He was the second son of Ben, an educator, and Sidonie, founder of the Child Study Association of America, who together produced one of the earliest books for the sex education of children.

The NHS and community care reforms have implications for trainee psychiatrists, but many consultants are unable to instruct trainees in these areas.

About 70 senior registrars from the United Kingdom and the Republic of Ireland spent a weekend at the Manchester Business School. The weekend started with a ‘keynote’ address by Professor John Wing on Measuring Psychiatric Morbidity: symptoms, diagnosis, handicaps, needs and outcomes. This lecture introduced us to the conceptual issues surrounding the ICD-10 classification and the need for sensitive and valid research criteria and instruments.