The present paper reviews the restructuring of the NHS that has taken place since 1991, with particular reference to the introduction of self-governing NHS trusts. Established to strengthen the financial management of NHS assets and to contain costs, NHS trusts represent a political solution to the problem of health service funding. Despite the speed of the reforms, there is no evidence yet of any improvement in the cost-effectiveness of resource deployment, and it is too soon to say what effect trusts will have on mental health services. Concern remains that the present reforms will ultimately lead to fragmentation of the NHS.

This paper gives an overview of the first year of a project in which a psychoanalytic psychotherapist worked with the staff of the ophthalmic department of a general hospital to study some psychological aspects of disorders of the eye. The purpose was to see whether semi-structured interviews based on psychoanalytic insights could increase our understanding of the disorder and, if so, how this understanding might be used to help the patient.

The aggressive, acutely psychotic patient may present in many medical settings. Drugs are usually necessary to avert or abort a crisis yet specific guidance on such management is lacking from standard psychiatric texts. Consultant psychiatrists have a crucial advisory role in these situations but information on their prescribing habits has not been published. This study aims to determine whether there is any consensus on the drug management of the aggressive, acutely psychotic patient by consultant psychiatrists.

The psychiatric discharge summary is an important means of communication between general practitioners (GPs) and psychiatrists and invaluable in the continuity of patient care. The early discharge summary therefore needs to provide relevant information for GPs during this vulnerable period. We surveyed GPs in the Grampian area in order to obtain information felt to be most relevant and the results were incorporated into a new semi-structured format which is now currently being used in the Grampian area.

The use of the term client, rather than patient, has become frequent in psychiatric hospitals. There is little evidence to justify this change, so this study surveyed the views of the in-patients in a community based psychiatric hospital to establish the term they prefer. It concludes that a dear majority of people admitted to a psychiatric hospital think of themselves as patients, not clients.

Our objectives were to identify and assess the services provided by the Mental Illness Specific Grant in Scotland and to determine whether they meet government aims for the grant. Scottish Office information proved to be inaccurate on what projects are funded and currently running. Slippage was common with 39% of projects failing to start in Year 1 and 23% in Year 2. The grant appears to have funded easy option services, self-help, drop-in, which are less expensive and only require short-term planning. Despite being given priority by the Scottish Office, housing, supported accommodation and occupation remain unmet needs.

In 1992, 46 consultants in old age psychiatry were asked to list their five most frequently used antidepressants, with reasons for their choices, and to comment on an information set for evaluating an antidepressant for use in older people. Lofepramine tied with dothiepin as the most popular antidepressant. The relatively new selective serotonin reuptake inhibitors (SSRis) were also widely used. Cardiovascular safety, lack of anticholinergic side effects and safety in overdose were important factors in choice. Some antidepressants were preferred for particular symptoms or circumstances. A modified information set for evaluating an antidepressant for use in older people is presented.

As the care of people with learning disability has shifted from large Victorian hospitals to the community, provision for in-patient psychiatric treatment has, in many districts, also moved. Purpose built district or supra-district admission services represent the most common model. An alternative is the use of existing general psychiatric beds. In this article we describe the first 18 months of the Hillingdon district service where this latter model has been adopted.

To determine the availability of career guidance within psychiatric training, the Collegiate Trainees Committee surveyed 300 trainees who had recently sat the MRCPsych Part II examination and 136 (45%) responded. Most trainees had received little or no career guidance and some had sought career advice without success. One third of trainees felt they had encountered discrimination within their psychiatric training. We urge trainees to be pro-active in seeking career guidance, identify sources of advice and make suggestions for topics to be discussed within consultant supervision sessions. We recommend that local access to career advice should be assessed by visiting College inspection panels.

In an era where management training is vital for any would-be consultant, the Kings Fund training course for senior registrars is the best known and most expensive. Examining it critically, we feel that despite its flaws it is still worth the extra money both for its wealth of practical exercises and for the unique, although not very reassuring, glimpse it affords us of management ideology at source. Local courses, although unable to reproduce the atmosphere, could benefit from its practical emphasis.