In this article, the Director of the NHS Health Advisory Service describes the task which he was given upon appointment and the new roles of the HAS. A senior registrar in forensic psychiatry illuminates one of its new roles by describing his attachment.

The Department of Health has published proposals for new legislation, which it hopes will provide a legal basis for effective community care of mentally ill people. Consultant psychiatrists and approved social workers were surveyed to determine attitudes towards the proposals. Despite the impression that new powers are provided, respondents saw little in the way of new powers, and could not see how the proposals would improve community care. Not all of the proposals were fully understood, and wider consultation with those who would be using any new legislation is recommended.

To date, there are few reports on the extent of elder abuse among patients referred to old age psychiatry services. This study examined suspected cases of abuse among new referrals to a community psychiatric team for the elderly, at a time when guidelines and procedures for the detection and management of elder abuse were about to be introduced. of 74 cases assessed, seven (almost 10%) were probably being abused. Several types of abuse were described, with no single pattern, and the professional responses therefore needed to be flexible. The impact of introducing the guidelines win be assessed later.

In the currant climate of the implications of the Community Care Act and health service reforms, defining the role and function of the psychogeriatric day hospital is crucial, particularly its distinction from day centre care. This paper describes this role and key issues in day hospital planning. It was presented to the Wessex Specialists in Old Age Psychiatry and accepted by them as a consensus document.

Views of the elderly were obtained from a cross-section of the public using 12 semi-structured interviews in the form of stratified group discussions. As a group, the elderly were generally thought of in negative terms. Furthermore, they were held partly responsible (or their perceived status, in particular by falling to keep physically active and to avoid mental deterioration and depression which were not considered conditions requiring treatment. In contrast, Alzheimer's disease was recognised as a disease, and sympathy was expressed for patient and carer. It was expected that responsibility for caring for the elderly mentally ill should pass to the State once the burden on carers became intolerable.

The bulk of transcultural research has concentrated on particular themes, which include parasuicides among British Asian women, schizophrenia among Afro-Carribeans, and clinical presentation of somatisation in different races (Littlewood & Lipsedge, 1989). The focus has largely been on clinical patterns of illness and the social determinant of distress as experienced by ethnic minorities in the community remains largely neglected. An attempt has been made, after two years experience of working in a Birmingham city catchment area with an Asian Muslim community, to highlight day to day cultural issues which directly or indirectly contribute to psychiatric morbidity.

A case-note survey was carried out on the first 50 referrals to a treatment service for adolescent sex offenders. The average rate of referral was 10.5 per year and all referrals were male. of those who attended, 66% showed evidence of psychiatric morbidity, while only a minority had a past history of child sexual abuse. The majority had offended against victims known to them. Treatment was labour-intensive with a mean of 19 sessions being provided per patient. of those taken on for treatment, 2.6% re-offended, while of those not offered treatment, 25% did so.

Residential child psychiatry units inevitably offer a form of temporary parenting to their patients. This paper explores various effects of this ‘parenting’ task on the treatment process itself and on a unit's relationship with parents. The potent therapeutic opportunities as well as potential unwanted effects deriving from this role are described. An awareness of the processes involved along with appropriate case management can maximise the benefits and minimise the unwanted effects of this factor within in-patient treatment.

This paper documents the rate of referral to an eating disorders service for adults which predominantly serves a large defined catchment area. It also defines the proportion of all new patients which presented with such disorders. People with eating disorders amounted to about one in ten of young women and one in 30 of all patients presenting to psychiatric services for the first time.

Much of psychiatric practice involves understanding a patient's perception of reality and the influences that may affect this perception, including those of the environment. In organisations, such as the National Health Service, the need for consensus and approval within the organisational culture and environment may influence the publicly expressed views of employees, a process encouraged by short-term contracts and performance related pay. This article briefly describes some diverse experiences relevant to interpreting the real and the apparent.

A Regional Gender Identity Clinic was established in Yorkshire ten years ago. It is an entirely NHS-based service and is well used by the psychiatrists in the region. The Director of the clinic is a psychiatrist and there is a cohesive group consisting of a plastic surgeon, gynaecologist (who supervises medication) and a speech therapist. The clinic has won the recognition of the Leeds Community & Mental Health Services Teaching NHS Trust which supports its continuation. An audit of outcome of the first 12 male to female reassignment procedures was conducted by a independent assessor. The result gave the team clear indication that the work should continue. A plea is made for the establishment of more regional services.

It can't be easy being the answer to the world's most obvious quiz question but Buzz Aldrin, the second man on the moon, seems to take it in his stride. Or at least he does now – there was a time when drinking and disappointment made it hard to tell what he thought. According to One Small Step, a superb mini-series of documentaries put out by BBC2 in July to commemorate Apollo 11's historic landing 25 years ago, returning from the moon left him let down and lacking direction. But that was the aftermath of the mission as a whole, Aldrin insisted, and nothing to do with having to follow Neil Armstrong out of the lunar module.

Is it possible for a Jewish woman in 1938 New York to develop hysterical paralysis of her legs in response to events in Nazi Germany? And how much are her symptoms a reaction to longstanding difficulties in her marriage to a man who is impotent, autocratic, subject to sporadic violent rages, and uncomfortable with his Jewish identity? Is it appropriate for an honest play which explores issues of prejudice, oppression, tryanny, and genocide to be simultaneously humorous and entertaining? What if at the end one feels almost as moved by the miserable (and dead) husband as the heroine, who finds the power to walk again only when her husband expires? These are the difficult questions posed by Arthur Miller in Broken Glass, his latest play recently in repertory at London's National Theatre. The weighty themes are leavened by the hallmark wry humour, sparkling dialogue and deft characterisation.

The practice of modern high quality psychiatry would be well served by the abandonment of the expression ‘community psychiatry’ and a moratorium on its further use for at least a decade.

The National Schizophrenia Fellowship (NSF) was founded in 1972 following a period of correspondence in The Times initiated by John Pringle. It currently has a membership of around 7000 people linked to over 160 groups throughout England, Wales and Northern Ireland. The majority of the members are informal carers. The organisation provides direct care to about 3000 people each week.

Primor'e is a former Soviet colonial area in the Far East. It is now part of free Russia's national parkland, rich in flora and fauna. In the present chaotic period of transition to a market economy, business leaders from Japan, China and Korea have rushed in to develop its potential.

The annual meeting of the American Psychiatric Association is always something of a jamboree but this year its Sesquicentennial Celebration (1844–1994), held in its birthplace Philadelphia PA, was especially splendid with a birthday gala held in the elegant and richly endowed Art Gallery. However, attendance at the Philadelphia meeting was disappointing with only 15,000 delegates.

In 1973 Professor D.L. Rosenhan published his classic paper ‘On Being Sane in Insane Places' (Rosenhan, 1973). In this study eight ‘normal’ researchers presented themselves on 12 separate occasions to a range of psychiatric hospitals in the USA. These ‘pseudopatients' complained of one symptom only, that of hearing a voice saying ‘empty’, ‘hollow’ and ‘thud’. No other psychiatric symptoms were described; the pseudopatients gave their own ‘normal’ personal histories and after admission to hospital the researchers ceased simulating any symptoms and apart from taking notes on their experiences acted normally.