This paper, produced by the Child and Adolescent Specialist Section of the Royal College of Psychiatrists, is a revised version of the document of the same title published in the Bulletin in 1978.

The Bahamas is a group of islands, just off the coast of Florida, extending southwards to near the island of Hispaniola. There are approximately 25 inhabited islands and numerous small islands and cays that are uninhabited. The population of the Bahamas is approximately 230–240,000. A census taken in 1980 showed that approximately 65% of the population is aged between 15–45 years. The major industries lie in tourism and off-shore banking. The Bahamas has not always had a drug problem; the diagnostic records at the mental hospital, Sandilands Rehabilitation Centre, reveal that in the sixties drug-related admissions were negligible. In the early seventies, however, there was a rapid increase in cannabis use and at the same time the number of drug-related admissions increased. The patients were mainly admitted in acutely disturbed states which were thought to be drug psychoses caused by cannabis inhalation. There do not seem to have been many patients requesting help to stop using cannabis, and generally there has been no significant change in this pattern. The major difference is the vast increase in the quantities smoked by an individual user. In the mid-seventies, the pattern of drug use began to change in that more patients were using a number of drugs at the same time. Methaqualone enjoyed a period of popularity and was known on the street as Quaaludes, Mx or Disco Biscuit. The drug's ability to potentiate the action of alcohol made it both dangerous and alluring, as it was possible to get ‘stoned’ almost immediately for the price of only one drink and one pill. It was about the same time in the mid-seventies that cocaine hydrochloride began to arrive on the market in increasing quantities and start gaining in popularity. The major problems at that time were associated with drug-induced psychoses, acute intoxications and occasions of violent bizarre behaviour due to the disinhibition and release of aggression caused by these drugs. One drug addict from this era, interviewed in the prison, said that a good night out was to smoke some grass, drink a Guinness stout, take a quaalude and then snort some cocaine. There is really no literature as to what effect these combinations may have on the brain. It is of interest however that very few patients were presenting for treatment of addiction, though by the late seventies a trickle had begun to come forward. Cocaine was not that plentiful and was being used by snorting, i.e. the inhalation of the finely ground white powder into the nostrils. A less popular method of use of cocaine at that time was smoking the finely ground powder as a constituent of a tobacco cigarette or mixed into the contents of a marijuana cigarette. The quantities of cocaine available on the Bahamian street market at that time were small.

Liaison psychiatry is in a developmental stage in the UK and the opportunity to be trained in this special area at Senior Registrar level is rare. The Wessex Rotation for Senior Registrars is therefore privileged to be able to offer an attachment to Odstock Hospital, Salisbury, where the Spinal and Plastic Regional Units are based. The local psychiatric service offers consultations to both Units, the senior registrar having opted for one session a week with the Burns Unit. He is supervised by the consultant psychiatrist who spends two weekly sessions in liaison with the special Unit.

A liaison is a union or effective conjunction with another unit or force. A liaison officer is seen as one who forms links or integrates such units or forces. This is a simple definition obtained from a standard dictionary but a further attempt at defining what is meant by liaison psychiatry is not so easy. This problem of definition and the lack of uniformity in such services in different settings may partly result in the marked under-utilisation of psychiatric expertise in dealing with the large number of medical patients who have a psychiatric disorder regardless of the presence or absence of a physical illness.

On 21 February 1884, a sub-committee of the Medico-Psychological Association meeting in Glasgow was appointed to prepare a handbook ‘in the hope of helping Attendants on the insane to a due understanding of the work in which they are engaged’. With commendable speed the four gentlemen concerned, Drs A. Campbell Clark, C. McIvor Campbell, A. R. Turnbull and A. R. Urquart, completed their allotted task, and in 1885 The Handbook For The Instruction Of Attendants On The Insane was published.