At a time of financial stringency, it may seem perverse to speculate about the ideal. Nevertheless, recent experience of working in the psychiatry emergency room (ER) of a large teaching hospital in Texas set me thinking about the requirements for a really satisfactory emergency psychiatry service (eps); one which would run smoothly and be acceptable to the clients, their families and the agencies involved in making referrals; one the staff running it would feel comfortable with and get satisfaction from working in; one which would provide a comprehensive and really adequate service, rather than just a finger in the dike.

In recent years there has been increasing emphasis on community-based psychiatric services. If these facilities are to be comprehensive they must include ways of assessing and managing crises and avoiding unnecessary hospitalisation. One way of meeting these needs is to provide small walk-in clinics in the community. A number of clinics have been established and more are planned. Although clients may refer themselves, access is usually limited to office hours and often only to a few hours each day.

In the 19th century doctors threatened to go on certification strike unless they were given a measure of legal immunity. Provision was accordingly made in the Lunacy Act 1890 and that provision was the ancestor of S. 139 of the Mental Health Act 1983.

On 19 June, 1987 the North-East Division of the College combined with the Newcastle University Department of Psychiatry to pay a conference tribute to Professor Sir Martin Roth as he approaches his 70th birthday. The Teaching Centre of the Freeman Hospital, Newcastle was an appropriate setting for such an event for Sir Martin spent 21 years as Professor of Psychiatry in Newcastle and the large attendance indicated the affection he still evokes there 10 years after his departure to Cambridge. Several generations of former colleagues spanning the past 30 years were present and the eminent positions they had reached in psychiatry, both at home and overseas, demonstrated what an intellectual power-house this small provincial department became under Sir Martin's direction.

In 1947 Britain had its severest winter since 1881, starving sheep came off the hills looking for sustenance in the towns, and the snow went on until April. That was when I boarded the MV Batory, later renowned or infamous for its espionage traffic, to be decanted into an early heat wave in New York. Times Square was hot and hectic, the steaks were two inches thick instead of two ounces a week, so my wife and I pushed on to our destination in Hartford, Connecticut where I had been appointed psychiatrist after an impressive series of transatlantic cablegrams. Hartford was a dignified and prosperous town, ‘the insurance city of the world.’ The Hartford Retreat had been founded in 1822, one of the earliest American hospitals to be devoted to mental illness; it had undergone a radical change in the 1930s under the entrepreneurial genius of Dr Charles C. Burlingame and was re-named the Institute of Living.

Since its introduction in 1953, the preregistration year has been divided equally between medicine and surgery. The General Medical Council has recently shown renewed interest in possible modifications to this time honoured scheme. One pilot scheme at St Mary's Hospital in London has successfully incorporated a four month period of general practice in the preregistration year, reducing the preregistration medical and surgical jobs to four months each. Another pilot scheme in Sheffield involves four months of psychiatry, four months of general medicine, and four months of general surgery. A psychiatric perspective on possible changes in the preregistration year is included in a report that derives from a conference held by the Royal College of Psychiatrists, the Association of University Teachers of Psychiatry, and the Association of Psychiatrists in Training.

The Annual General Meeting of the Royal College of Psychiatrists' Section for Social and Community Psychiatry was held on 20 February 1987 at the Royal College of Physicians. The associated Scientific Meeting was organised jointly by the College and the Royal College of General Practitioners; its focus was the working relationship between psychiatrists and GPs.

Changing patterns of care for the mentally handicapped are having a profound effect on the roles of all professions concerned—not the least mental handicap nurses. Many will continue their caring role in the community. Others will work as community mental handicap nurses providing domiciliary support to families and local authority services. Those remaining in the hospital service will be increasingly concerned with the care of the psychiatrically ill and behaviourally disturbed, the profoundly and multiply handicapped and the elderly. This has important implications for training nursing staff both at present and in the future.