A retrospective comparative study of violent incident forms covering the acute general adult wards at a London teaching hospital and a district general hospital was performed. Although no significant difference was observed between the overall rates of reported violent incidents, there was a significant increase in the proportion of violent incidents directed at persons in the inner city hospital. Grade 3 incidents were rare. Caribbean patients were over-represented among the perpetrators.

Actual and perceived safety of male and female in-patients in an inner-city psychiatric hospital were examined. Using semi-structured interviews, 59 inpatients were asked to report on their direct experiences of physical or sexually threatening behaviour towards them during their admission. Of the sample, 75% reported unwanted physical or sexual experiences: female patients were significantly more likely than males to report sexual harassment. Most incidents were not reported to staff and both staff and patients appeared to perceive the ward environment as safe despite fairly high levels of verbal and physical aggression. This study has implications for the way that ‘violent incidents' in psychiatric hospitals are defined and recorded and raises questions about the provision of women-only space in hospitals.

Prediction of in-patient psychiatric violence is difficult: longitudinal appraisal during environmental change may identify Influential factors. Incidents on a secure ward fell substantially in number and severity over 31 months during which staff were trained in control and restraint techniques (CAR) and a monthly audit of incidents was carried out. A few patients caused many incidents. Women were disproportionately violent: both sexes preferred a victim of the same gender. Most incidents occurred in clusters by the same patient. Perceived antecedents were patients' psychosis, inadequate CAR and other staff. Increasing C&R staff was the only factor associated with reducing violence. Patients attacked each other rather than nurses as violence decreased.

In a retrospective study at a medium secure unit, the incident reports where a degree of restraint was used in dealing with in-patient aggression were examined for management strategies used and their relationship to various factors. There was a decrease in the use of seclusion over the period of study, seclusion being more likely to be used when agression was aimed at staff and property, following staff-patient interaction (demands) and younger age of perpetrators.

Staff in nursing homes specialising in the care of the elderly mentally ill were trained to screen for psychiatric morbidity by members of the local psychogeriatric service. They were then involved in the planning and delivery of appropriate treatment, both medical and behavioural. Residents in the homes were screened again six months later and marked reduction in morbidity was found.

An attempt to categorise the nature of the work done by an inner city crisis intervention service (CIS) which is part of a comprehensive community mental health service is described. The work of the CIS as it relates to models of crisis intervention recognised in the literature is outlined. The role of this CIS in providing additional intermittent support to individuals receiving long-term community care is commended.

Complaints made against doctors are increasingly important given the current emphasis on consumerism in the National Health Service and the publication of the report of the Wilson Committee which reviews complaints procedures. There have also been recent changes in medical indemnity and increased litigation. The origins of complaints made against psychiatrists were studied. Most complaints were made by relatives and advocates rather than the patients themselves and half were made after the patient was discharged from hospital. It was found that most complaints arose out of a breakdown of communication between psychiatrist and patient.

The views of psychiatric day hospital patients on the helpfulness of components of their treatment programme were surveyed. Ratings given to social activities were significantly higher than those given to therapeutic activities. Patients rated having a bus pass and access to hairdressing services as the most helpful parts of day hospital attendance while community meetings and ward round attendance were regarded as the least helpful. Ratings were, however, generally favourable. No significant effect of patient age, gender, or duration of attendance was found. Possible explanations for these preferences are discussed. Patient preferences such as these are likely to influence purchasers of care, and thus the use of resources by providers.

Recent surveys have shown that general practitioners have begun to employ practice counsellors. The recent establishment of fundholding practices has made it possible for general practitioners (GPs) to be direct purchasers of health services. The number and nature of counsellors and specialist mental health professionals directly employed by fundholding practices is reported.

In order to inform planning decisions, we aim to show how an in-patient consultation-liaison service has changed in 30 years. A year's referral of 175 inpatients was compared with surveys carried out in the same hospital 20 and 30 years previously. Neurosciences continue to refer the greatest percentage of its patients while general medicine produces the greatest demands on the service. There has been a large increase in substance misuse referrals, although other diagnostic groups have similar referral rates. Liaison service planners should be aware of the unmet demand for psychiatric services of the general hospital in-patient population.

Part-time training has been available for over 25 years. However, women remain under represented in the higher grades. Following the report of the Joint Working Party on Flexible Training, April 1993, we aimed to investigate awareness and attitudes towards flexible training in Birmingham among psychiatric trainees and their consultants. The results suggest that while most had heard of flexible training, many had little knowledge of the recent registrar flexible training scheme locally. A substantial minority of doctors agreed with pejorative statements about part-time training and more of these were Juniors. Senior psychiatrists did not perceive part-time training adversely and many would consider part-time work in the future.

Jack London's autobiographical account of his long struggle with alcoholism was first published in 1913, three years before he committed suicide by taking an overdose of drugs; he was 40 years of age.

As human beings we are each invited to fulfill expectations. We are asked to prove ourselves, to achieve, and we are encouraged in strong allegiances to family, community and culture. We identify with and take pleasure in, or alternatively dissociate ourselves from and dislike, certain people, places, possessions, and later theories, philosophies, even what we call ‘facts'. Thus we form strong (but in the final analysis relinquishable) attachments and aversions.

The frequency and content of articles of psychiatric interest in the Irish print media were investigated. Issues of psychiatric interest were commonly featured. Contrary to popular opinion most articles are either supportive or neutral in tone. Where negative imagery occurred it was more frequently associated with articles in the tabloid papers. Mental health professionals, in particular psychiatrists, contributed very little towards articles of psychiatric interest (especially in the tabloid press) and need to become more actively involved in shaping the portrayal of mental illness in the print media. Their involvement is associated with a more positive portrayal of psychiatry.

Albania borders the Adriatic Sea and lies between the former Yugoslavia to the north and Greece to the south. Seventy per cent of the land mass is mountainous, the coastal strip containing most of the country's agricultural land and having the densest population. The total population of the country is 3.4 million while the capital Tirana has a population of 250000. Until very recently Albania was rarely visited by people from the West. It had become increasingly isolated under the Stalinist dictatorship of Enver Hoxha and the paranoid attitude towards foreigners that existed in the 1970s and 1980s is well illustrated by the concrete pill boxes that were built to repel invaders. More than 600 000 of these were built and they can be seen today scarring the attractive countryside of hills and fields around Tirana. With the collapse of communism in Eastern Europe, Albania followed the same path and went through a period of disorganisation in 1991 before electing its first democratic government in 1992. As with other former communist countries private enterprise began to develop, land was sold back to the peasants, and private cars began to appear in the streets. In 1992 there were no private cars in the country; in 1995 there were 35 000 in Tirana alone.