Until the mid 1950s, the management of persons suffering from chronic mental illness in Australia was the responsibility of the large mental hospital. With the advent of psychotropic drugs and concern about the ‘negative’ influence of the institutional environment on patients there was a shift to shorter but more frequent periods of hospital admission. As the pattern of shorter admissions increased, community services for the mentally ill were expanded in the early 1970s. Between 1950 and 1985 in the state of New South Wales, the numbers of patients in large mental hospitals decreased from 256 to 55 per 100 000 population. However, no special arrangements for accommodation, as distinct from treatment, were made for these ex-mental hospital patients. The decline in hospital numbers can be attributed to a general reduction in the length of hospital stays. Initially, there seemed to be no pressing need for extra accommodation in the community as the provision of social security benefits was adequate to allow patients without homes to afford basic accommodation, a situation different to that in the United States (Lamb, 1984).

Addenbrooke's Hospital is large (approximately 1,000 beds) and serves the functions of an academic and teaching centre, as well as providing acute care in medicine, surgery and the specialties for the inhabitants of Cambridge and the surrounding area. Before January 1989, all psychiatric beds were located at Fulbourn Hospital, three miles from the main Addenbrooke's site and all liaison psychiatric cover was provided by links between individual medical and psychiatric teams. However, since that date, a small in-patient psychiatric unit has been established on the Addenbrooke's site and at the same time, in order to gain closer compliance with the Royal College Guidelines (1988), arrangements were made for one of the registrar posts associated with this unit to form part of a liaison psychiatry team.

I was requested at short notice by Christian Solidarity International, a Swiss-based human rights group, to attend a court hearing in Czechoslovakia concerning a married couple who were being compulsorily detained in a psychiatric hospital. CSI had been alerted by a local Catholic activist, himself a former patient of the same hospital. The Czech authorities facilitated my attendance at the court hearing along with an English solicitor and provided an interpreter.

Medical care in general hospitals is a collective activity and liaison psychiatrists may become part of this process. Cornerstones of successful management are co-operation with colleagues and ‘teamwork’, although these elusive goals are not always achieved. A shared uniform is one possible solution to improve this teamwork, the white coat being the livery of the hospital doctor. Furthermore, patients may appreciate a uniform. One survey of 200 North American general hospital in-patients showed the white coat to be surprisingly popular (Dunn et al, 1987); 65% of those replying wanted to see their doctor in a white coat. But the white coat is often unpopular with doctors and perhaps a more relevant question is whether it makes any difference to patient behaviour.

The presence of the Official Secrets Acts of 1911 and 1920 precludes comment from doctors working within Her Majesty's prisons on the state of remand prisons in Britain. Her Majesty's Chief Inspector of Prisons, Judge Tumin, has described them as “intolerable, and representing much human misery”. In an article entitled ‘Under the prison outrage: a quieter scandal’, Kilroy-Silk (1989) refers to a report implying that, at any one time, one third of remand prisoners suffer from mental illness.

Out-patient clinics are widely used to asssess and treat patients. In psychiatric practice, out-patient clinics are used both to assess new referrals and follow up existing patients. More than three-quarters of psychiatric out-patient attendances are for follow-up (DHSS, 1984). With modern emphasis on community psychiatry, the role of out-patient clinics may become less prominent and more refined. Very little appears to have been published on the subject of psychiatric follow-up clinics.

Trainees beginning their careers in psychiatry sometimes view research as an additional hurdle that they have to surmount in order to gain senior registrar or consultant status. Conversely, research enthusiasts may see research as an exciting and rewarding activity which enriches and informs clinical practice. The aim of this article is to strike a balance between these two divergent views to help trainees in their selection of the research option most suited to their temperament and aspirations. As a result of our own experiences of full-time and part-time research, in addition to research conducted during full-time clinical posts, we intend this article to be practically rather than theoretically orientated.

This very large training scheme was formed at the suggestion of the then newly appointed Professor of Psychiatry, Ian Brockington, who saw that in the existing rotations the balance between specialty and general posts was very uneven. He also argued convincingly that it would attract more trainees of high calibre and improve the morale and enthusiasm for training of the consultants, particularly in those rotations which had difficulty recruiting junior doctors or had failed to achieve more than provisional approval by the Royal College on repeated accreditation visits. The new scheme was launched in 1984 following the establishment of a Steering Committee including representatives of the psychiatric divisions of the five Birmingham Health Authorities and the adjacent Sandwell and Solihull Health Authorities, of the University Department and of the various specialties such as child psychiatry. All the Authorities agreed to pay jointly for a clerical officer to service the scheme and Solihull undertook to provide accommodation and a Medical Personnel Officer with specific responsibility for the scheme. A senior universally respected Clinical Tutor, Eddy Sethna, was elected Organising Tutor and given full authority to manage the rotation, reporting twice yearly to the Steering Committee which would advise on any difficulties which he could not resolve directly with trainees, trainers or divisions and would agree additions or modifications to the scheme.

The library of the Institute of Psychiatry is undoubtedly internationally oriented; it stocks writings in languages ranging from German to Chinese. As a foreigner one is bound to be on the look-out for texts in one's own language. In my case this search has until now been unsuccessful. After the librarian asked me whether the Dutch write about psychiatry at all, I have actually given up but at the same time I decided that it was my task to increase awareness of Dutch psychiatry among my colleagues. Although it is true that the Dutch have accepted English as the international scientific language more than any other members of the European Community, Flemish and Dutch psychiatrists do continue to publish in their native language by means of the Tijdschrift voor Psychiatrie, a journal which differs from, for example, its British counterpart by the emphasis it puts on case studies, psychotherapy and philosophical/historical issues rather than on research in the internationally accepted format.

Training in psychotherapy for junior registrars is often piecemeal and relegated to an after hours out-patient and supervision. We are fortunate in having had the opportunity for a whole-time psychotherapy placement at the Cassel Hospital, Ham Common, Richmond, itself an internationally renowned clinical and training centre devoted to psychotherapeutic treatment of in-patients and out-patients.

Much of the information generated in the practice of psychiatry is manipulated by microcomputer. Program packages allow text to be structured and viewed before it is printed, information to be filed so that it can be accessed from several parameters, and columns of figures to be manipulated and displayed graphically.

The Institute of Psychiatry accepts approximately 30 postgraduate students each year from overseas countries. The composition varies, largely as a result of international economic changes, and since 1977 students from 60 countries have attended (Appleby & Araya, 1990). Knowledge of English also varies and can influence the training of a student in many ways. Difficulties in understanding and communicating with patients, colleagues and teachers can adversely affect study, clinical practice and examination performance. MRCPsych results are poorer for non-UK than for UK doctors (Cawley, 1986): one reason may be poor communication.

The Mental Health Services have been accused of providing a ‘soft option’ to offenders and this charge is highlighted in cases where the mentally disordered offender absconds (hereafter called the absconder) from the hospital. Society just about manages to accept the disposal of disturbed offenders to hospital, which it sees as providing at least some limited incarceration, but in the event of an offender absconding the whole dilemma of offenders considered to be in need of treatment is thrown into question. The Responsible Medical Officer (RMO) is concerned with issues of treatment, public safety and his/her responsibility to the Courts and society; and thus finds himself/herself in the conflicting roles of a doctor and an agent of social control. This paper attempts to address some of the issues surrounding the areas of the rights of the patient, the dilemma faced by the clinicians and the rightful use of the powers of the doctor and of the State in relation to Hospital Order and the absconder.

John is a 30-year-old man suffering from severe mental handicap (IQ:30) and epilepsy, without other physical deformities or illness. He is sociable, would initiate social interaction (physical), enjoys a cuddle and going out on trips. He has no communication skills but is able to understand basic commands like ‘open your mouth’, ‘sit down’ and so on. He has been a long-term in-patient in a mental handicap hospital for the past 15 years. He is from an affluent family and had been admitted because of his family's inability to cope. He has visits from his mother once a month, and from his father less frequently. A few months ago his mother left a verbal instruction to the ward staff to make arrangements to donate his organs and to ask me, as responsible medical officer, to leave written instructions to inform the local Organ Transplant Team before his death, whenever it becomes imminent, so that the Organ Transplant Team can remove the necessary organs on his death.

A month's residence in an elegant stately home, situated among the manicured lawns and gardens of 150 acres of parkland, sounds ideal; when allied with comfortable accommodation, delicious food and thoroughly professional service, it sounds idyllic. When it is being paid for by Kenneth Clarke, it becomes irresistible.

When planning new service initiatives it is important to review the role and functioning of existing services. As more patients are discharged from long-stay beds, there is increasing concern regarding the quality of community care and the accessibility of urgent psychiatric help. The Department of Health has recently expressed concern over the level of such services provided (DoH, 1989). In Edinburgh, alternative methods of delivering psychiatric emergency care are currently being considered. Community-orientated crisis intervention teams may be useful, but only a small proportion of people presenting to general psychiatric services fit into the stereotyped model of crisis. Centres with short-term admission facilities have been developed in other countries and within the United Kingdom many general hospital casualty departments have a psychiatrist available on call. Walk-in or self-referral psychiatric clinics provide an easily accessible service but few have been systematically reported (Lim, 1983; Haw, 1987). Such clinics have been described as seeing mainly chronic patients of the hospital who are already in current contact and who present with less severe psychiatric disorders than GP-referred cases. In a climate of NHS financial restraint it is pertinent to ask whether such clinics are needed.