Diabetes mellitus in childhood is almost always insulin-dependent diabetes mellitus (IDDM). The UK prevalence is 1 in 600 children under 16 years of age (Metcalfe & Baum, 1991) and the incidence is 13.5 new cases per 100 000 children per year aged 15 years and under. One quarter of newly diagnosed cases in the UK are under the age of five years, half are aged between 10 and 14 years.

The concept of positive and negative symptoms in schizophrenia can be traced back to Hughlings Jackson (1889) who taught that disease does not create, it sets free, and accordingly positive symptoms could be seen as ‘release’ phenomena resulting from ‘dissolution’ of the highest cerebral centres of the nervous system. Crow (1980) revived the dichotomy and proposed a Type I syndrome, characterised by positive symptoms, and a Type II syndrome, characterised by negative symptoms. He thought the latter was due to cortical atrophy and responded poorly to antipsychotic medication. In their review of the distinction, Walker & Lewine (1988) found a stronger relationship between premorbid dysfunction and negative symptoms than with positive symptoms. They also found there was a stronger influence of genetic factors on negative symptoms than positive symptoms.

This article considers the use of the Mental Health Act 1983 (MHA) and application of common law principles with respect to patients with behavioural disturbances in NHS general hospitals in England and Wales. Legal issues do not apply across national boundaries; in the UK there are two other Mental Health Acts currently in force: Scotland's (1984) and Northern Ireland's (1986).

Workers in the field of learning disability drew attention to the problem of sexual abuse and learning-disabled children and adults only a decade ago (Sinason, 1986; Cooke, 1989), at the same time that British society first tolerated the knowledge that non-disabled children were being abused. Although guidelines have been produced and voluntary organisations such as the National Association for the Protection from Sexual Abuse of Adults and Children with Learning Disabilies (NAPSAC), the Association for Residential Care (ARC) and Voice UK have made vital contributions, psychiatric involvement and provision is uneven (ARC & NAPSAC, 1993).