Any service designed to meet the needs of the elderly must necessarily embrace a wide diversity of personnel and facilities. Not only is a multiprofessional team imperative, but such resources as are available—whether in the Health Service or personal Social Services—must be used in the full.

In 1974 we published a pilot study on the use of consultant time in child psychiatry, based on detailed timesheets kept by a group of child psychiatrists in and near London (1). The group, which is still meeting, decided to see what changes, if any, have occurred over the last seven years in the way we allocate our time. The primary purpose of the group, now, as then, is ‘the provision of a forum where members can exchange views and compare experiences relating to the problems encountered while engaging in and often being professionally responsible for administering a child psychiatric service.’ A nucleus of about six consultants took part in both studies.

We get in a muddle about responsibility and in our communications. Doctors are not the only ones who can discharge patients from hospital—patients can do that themselves (Teeling-Smith, 1979) and the myths about medical responsibility (as if patients are not responsible for themselves) exacerbate feelings of inequality. We are responsible for ourselves and our work; not for our patients or colleagues, much as we may care for them.

I am a strong advocate of the provision of training in psychotherapy to all psychiatrists. In my view this should comprise the enhancement of interviewing skills, development of counselling skills, understanding of and experience in the use of a variety of psychotherapeutic techniques. Among these I would include supportive psychotherapy, short-term psychotherapy, crisis intervention and grief counselling. The trainee should acquire some theoretical understanding of and experience in the use of behavioural methods of treatment, of social skills training and of group processes.

In November 1980, two men, Mackenny and Pinfold, were convicted at the Old Bailey on several counts of murder which were of a particularly callous and brutal nature. They were sentenced to life imprisonment. In the preceding December (1979) another man, Childs, had pleaded guilty to all the murders with which Mackenny and Pinfold had been charged, and which he alleged had been carried out with them together. He turned Queen's evidence, and it was his testimony that was crucial and central to the Prosecution's case against Mackenny and Pinfold.

Until recently the teaching of dynamic psychotherapy received little constructive attention. Training was limited, like the therapy itself, to a select few whose motivation propelled them through arduous, expensive courses in the analytic institutes or the few provincial diploma programmes. Most psychiatrists and clinical psychologists qualified without exposure to or formal instruction in the dynamic psychotherapies.

The Approval exercise is an attempt to standardize psychiatric training in different hospitals, following the introduction of the Membership examination ten years ago. Very little, however, has been said about how standards are defined, who defines them, how reliable they are, or how valid in respect of the attributes required to become a consultant psychiatrist. The College is now directing its attention to these issues in considering a syllabus for the examination, a document setting out the aim of training in psychiatry and, of particular importance to this paper, the possibility that the Central Approval Panel should become more accountable to those whose interests it primarily represents—the trainees in the hospitals whose approval status it decides.

In November and December 1981 a survey was conducted of the members of the Forensic Psychiatry Section. A questionnaire invited members to report any research they were undertaking. Although the response was incomplete, the replies indicated a wide range of investigation in the specialty. This brief report indicates the main areas of study.