Part IV of the 1983 Mental Health Act (Sections 56–64) introduces new safeguards and procedures relating to Consent to Treatment for detained patients and in limited situations to informal patients. Many psychiatrists have expressed misgivings about these provisions and many are unfamiliar with the new requirements. One medical member of the Mental Health Act Commission visited twenty different hospitals for the purposes of issuing a Certificate of Second Opinion during a four-month period between October 1983 and February 1984. This paper discusses some of the practices and misunderstandings encountered.

On the whole, when psychiatrists get together in meetings or conferences, they have a fairly good idea of what they are talking about. Discussion flows in a more or less coherent way. Even if the topic involved is problematic—say, the diagnostic criteria for schizophrenia—there is a general sense of agreement about what is meant by the words ‘diagnosis' and 'schizophrenia’; even if the meanings are fuzzy at the edges. In areas of psychiatry made complex by the number of variables involved, statistical methods help to clarify the information gleaned, so that in the assessment of, for example, social factors in mental disorder, some clarity of conclusion prevails.

I have now returned to work as Senior Registrar in general psychiatry after six months' maternity leave. I was extremely anxious about returning after a long leave and realized that this was something I had often warned patients about. I have now experienced it myself, and recognizing its value to my practice prompted me to review my experiences whilst on leave and to write about them.

The second symposium to be arranged for nurses and psychiatrists by the Nursing Committee was held at the Quarterly Meeting of the College in London on 17 November 1983. A criticism of the initial meeting held in Liverpool in April 1982 was that although nursing attendance had been excellent, the response from the psychiatrists had been poor. This was disappointing as the aim of the meetings was to provide a forum where topics of mutual interest or concern could be freely discussed. However, on this occasion, when the Chairman of the meeting, Dr Birley, called for psychiatrists in the audience to identify themselves, out of the ninety or so present, two-thirds were psychiatrists.

Participation in a sensitivity group as part of the general training of a psychiatrist is recommended.1,2 There are, however, obstacles to obtaining this experience, which may be practical or personal. Particularly in a peripheral hospital, there may be no such group available. A conductor should have sufficient experience as well as enthusiasm, and if the conductor is well known to the trainees or perhaps a member of the consultant staff, this may provoke personal anxieties in the participants. Finding a time in the widely differing schedules of participants, when all are free to attend is a problem, and further difficulties are presented by duty rotas and trainee rotations.

The current trend towards community care for mentally handicapped people means that general practitioners have greater opportunities to meet mentally and multiply handicapped people living in the family home or in small units in the community. In addition, an increasing number of large long-stay mental handicap hospitals have delegated the reponsibility for primary care to local GPs, frequently employed as clinical assistants for this purpose. This is having the welcome effect of allowing the psychiatrist and the trainee in psychiatry to follow their particular interests and develop their own treatment skills.

The increased fees for postgraduate trainees from overseas and their difficulty passing the MRCPsych examination have made some British teachers question whether Departments of Psychiatry should continue to provide training for such doctors. The change in the relationship between old and new Commonwealth countries, and the increased availability of postgraduate training in Nigeria, Kenya or Zimbabwe are other factors to be considered.

The police are now the only laymen in Britain who can pass judgement on a person's mental state and compulsorily admit them to places of safety.1 Various papers have looked at how the police use this power, and one paper in particular2 has shown that police are as efficient at recognizing persons in need of psychiatric care among those called to their attention as are medical practitioners who are not approved psychiatrists.

Florid cases of GPI of the classical type described in the older text books do not nowadays commonly occur. There must be many psychiatrists who have never had the opportunity of seeing such a patient and it is for this reason that this case history is detailed.

Most people come into psychiatry from behind the white coat of more technologically orientated medicine. In psychiatry, with its slower pace and greater intimacy, it is seen as more important to consider the patients' feelings and there is time to do so. But here one's role is less clearly defined and assumptions carried over about the relation of the junior doctor to other staff may be inappropriate.