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The roots of the modern mental retardation service can be traced to the federal legislation introduced by President Kennedy in 1963. Shortly after he took office in 1961, he appointed an expert panel to study the issues and problems and to propose a plan of action. This signified complete separation between mental health and mental retardation services.
The exercise of hospital accreditation by the Royal College of Psychiatrists has resulted in a significant improvement in the standards of psychiatric training in this country.1 The North West, more than any other region, adopted the policy of District General Hospital psychiatry2 in the sixties which had the effect of creating small psychiatric units, unable to muster enough resources, to provide comprehensive training programmes by themselves. These developments have highlighted the problems of organising viable rotational schemes for training in psychiatry.3,4,5
Fifteen years ago the College published guidelines for the training of general psychiatrists in psychotherapy and these have now been reconsidered in the light of subsequent developments. (Bulletin, October 1986, 10, 286–289). However there is considerable doubt as to the extent to which the previous guidelines have been effective and those responsible for training schemes should consider whether they are providing or can provide the training suggested.
It is an expectation of the Royal College of Psychiatrists that its members should demonstrate a knowledge of the psychiatry of childhood and adolescence. Prospective members are examined on this and a clinical placement in child and adolescent psychiatry is a recognised specialty component of general training. That this is so reflects the fact that one quarter of the population is composed of individuals under the age of 18. This group has an appreciable psychological morbidity rate with patterns of psychological disability and suffering which differ appreciably from those encountered in general adult practice. A competent general psychiatrist should be familiar with the pattern of psychiatric pathology is childhood and be conversant with the services available for its treatment. For the health of the psychiatric profession as a whole, it is important that trainees have some working experience of child and adolescent psychiatry so that they may find whether this area of practice is attractive to them. Experience at registrar level provides an important recruitment opportunity for future senior registrars and thus consultants in child and adolescent psychiatry. Successful completion of general training in psychiatry with possession of membership of the Royal College of Psychiatrists is effectively a universal prerequisite for entering the senior registrar grade and higher training in child and adolescent psychiatry.
The recent announcement of a further £5 million which has been distributed to Regional Health Authorities makes a total of over £22 million that has been made available specifically for the development and expansion of services for drug misusers over the past three years. An important element in the development of such services has been the formation of Regional Drug Problem Teams; this seemed a useful time to review the working of one such team over the past year.
The first ever Welsh Division Trainees Day took place at Whitchurch Hospital, Cardiff on 13 May 1986. Although geographically one of the larger, Wales is numerically one of the smaller Divisions of the College, with only 33 Inceptors and 27 senior trainees (as at April 1986). Nevertheless the attendance was satisfactory for such an initial event with 34 trainees attending, of whom 13 came from peripheral hospitals. Unfortunately, no doubt because of the distances involved, there were no trainees from North Wales or Carmarthen.