Health Advisory Service visits to services for the mentally ill in recent months keep throwing up a persistent theme: the apparent failure of the medical staff to provide the impetus that is necessary to develop and manage an effective comprehensive psychiatric service based upon the needs of patients rather than on professional or sectional interests.

Issues of identity and contemplation of the future have been preoccupations of Australian psychiatry recently and will be identified and contemplated in this report. While aware that to direct attention to such issues is ipso facto evidence of insecurity about identity, and is certain to be a relatively unsubtle exercise in convoluted nationalism, your reporter suggests that jingoism, if properly defined as ‘love of Australia’, is an adequate defence.

The spate of suicides and riots in unemployment-stricken towns has recently brought to public attention a feature of joblessness which had not figured in the minds of those that thought that it would only have financial and probably minor social consequences. Since then, a flurry of interest has been spurred by the media; they regularly report on studies that show some association between unemployment and ill health, quite often, and not surprisingly, to make party political meal of a long-term problem that is bound to have implications for health provision in this country, at least over the next two decades. As psychiatrists we all know the central role played by regular, satisfying employment in the mental health of our patients, and I am sure many of us are affected by our total inability to secure adequate rehabilitation alternatives on which we are sure our patients' future, and that of their families, depend to a great extent. Some of us may also have been aware of the increased demand on mental health resources over the past few years and of the worrying tendency for admissions into psychiatric hospitals to be prolonged because of the time it takes for an ex-patient to re-enter the labour force.

The question has been posed—is an examination necessary to admit to the membership of the Royal College of Psychiatrists? The College represents the views of psychiatrists, maintains the standards of the profession, regulates and monitors practise and accepts a broad overall responsibility for education. It should admit to its membership those who practice as psychiatrists. Who then are the psychiatrists? Should the membership be open to anyone who makes such a claim or should it be linked with appointment to specific jobs as a psychiatrist at a level yet to be determined? What of private practitioners, interested GPs? Surely anyone who wants to be a psychiatrist, to paraphrase Sam Goldwyn, ought to have his head examined by his peers to establish that his claim to be a psychiatrist is acceptable. It is the College which should regulate entry into the profession of psychiatry, not the National Health Service, an employing authority, or even the universities. Some membership entrance conditions are needed which lay down minimum requirements for becoming a psychiatrist and it is important to exclude or reject, in my view, before higher psychiatric training commences.

Much has been written concerning Higher Psychiatric Training, in respect of both the training and research opportunities which should be provided for senior registrars, and the degree of responsibility which should be expected of them. However, one area over which there is some dissension, and which appears in practice largely to be left to the discretion of the individual hospital, is the matter of on-call duties.

Since independence in sub-Saharan Africa, decentralization of psychiatric services has been accepted as a policy, but it has resulted so far only in developing small units attached to the provincial hospitals. Because of the shortage of qualified psychiatrists, the latter are invariably staffed by locally trained psychiatric or sometimes general nurses. With one or two exceptions most of the mental hospitals were built in the colonial times and they often resemble penal institutions and are geared mainly to offering custodial care.

Since the publication of the Trethowan Report (1977) psychologists have been encouraged to expand their role outside the more orthodox psychiatric setting. As a small and steadily developing professional group, they have attempted to gain visibility by seeking alliances with medical specialties other than psychiatry, which had provided them with a kind of sheltered environment since the inception of the National Health Service. General practitioners have probably most often been solicited in these attempts to obtain a wider recognition. The favourable response of many general practitioners created the necessary climate to stimulate clinical psychologists to carry out systematic evaluations of their contribution to primary care (McPherson and Feldman, 1977; Johnston, 1978; Ives, 1979; Koch, 1979; Earll and Kincey, 1980).

If Child Psychiatric Services are to survive into the 1980s, we believe that practitioners will have no alternative but to make sense of the complicated administrative network on which their future depends. This is an account of one such attempt by three Child and Family Psychiatric teams working in a Health Authority Area.

‘Prominent among the obligations of those who provide postgraduate education’, wrote Aubrey Lewis in 1961, ‘is the duty to recognize and further whatever talents for research their students possess’. He was largely responsible for introducing a system whereby those who wished to train at the Maudsley were expected to carry a modest research project as part of their DPM examination, although he was aware that ‘it is profitless, and can be unkind, to encourage competent clincians to attempt scientific investigations beyond their powers’. In the 14 years since his retirement, research by trainees has gone into a decline, so that even at the Maudsley only a minority are actively engaged in research. Crammer (1979) writes ‘People thought (research) would help them to a consultant post. Now they know it is not necessary. Training has become more formalized, with day-release courses and rotation schemes …’ Creed and Murray (1981) have made a detailed study of the views of Maudsley trainees about the way they were taught clinical skills; they have shown that between 1974 and 1977 there was a decline in the number of units which encouraged the trainee to undertake research, and that over the whole period only 27 per cent of the units gave trainees such encouragement. These investigators found that encouragement to do research was transmitted quite independently of other clinical teaching, so that it bore no relationship to variables such as the excellence of the academic instruction, feedback from the consultant, or workload.

Sir Martin Roth and Professor Linford Rees have well documented the achievements of the past ten years, to which I can add but little except to say how proud I am to have been able to join in with these activities and try to continue their far-sighted policies. Nevertheless, there is much that remains to be done, not so much because of what we have failed to do as because of the constantly changing situation in which we work.

The Medical Research Council's formal responsibility for research in psychiatry dates from 1921 when it took over from the Boards of Control. To meet this additional responsibility its budget was increased by £5,000 to a total of £130,000 per annum.

MIND could not function without the help of individual psychiatrists and a basic sympathy and understanding on our part for what psychiatry is trying to achieve.

Right from the beginning, and that is not a very long time, the Royal College of Psychiatrists has been concerned with research. In the Charter, the Research Committee is set up as a Standing Committee of Council, of the College. Our membership is entitled to know what the Research Committee has been doing for the last four years. What are the concerns of the College for research?

Few postgraduate medical examinations have attracted so much comment and criticism as the MRCPsych. The main participants in the debate have been the College and its various training sub-committees, and APIT which has always been opposed to the MRCPsych examination in principle (Bulletin, April 1979). In a recent Newsletter (March, 1980) APIT stated that only 5 out of 90 trainees in their 1979 survey felt that passing the MRCPsych examination proved that one is a competent psychiatrist. It felt that the examination had ‘crystallized’, with no fundamental changes despite a number of Examination Forums held by the College. Radical changes in order to improve the examination were therefore advocated.