‘Welcome To Reality’ announces the bright orange graffito, in English, on the perimeter wall of The City Psychiatric Hospital Number 3. A superfluous arrow points to the gate house. This is a large general psychiatric hospital of 2150 beds serving a population of 1.7 million people and also providing my first experience of Russian psychiatry. The buildings, some wooden, date from 1870 onwards and are set in a large area of mature woodland enclosed by a high wall in the northern suburbs of the city.

On 31 December 1992 Ben Silcock, a 27-year-old man, climbed into the lion's den at London Zoo where he was mauled by a lion. In the newspaper accounts it was evident that he suffered from schizophrenia. His father Bryan Silcock added that “he would sit up in his room smoking dope”. One national newspaper asked why people like Ben were not in hospital and his father blamed the health authorities for letting his son down.

One of the few joys of moving house, is the rediscovery of books you haven't opened for years. I was sitting among the dust-sheets rereading Francis Wyndham's anthology of criticism (Wyndham, 1991), when I came across his description of the erstwhile Blue Angel going through yet another reincarnation on the stage of the Queen's Theatre in 1973.

We describe our training experience as members of a drug and alcohol liaison service within a major general teaching hospital. This type of liaison work offers valuable experience in the joint management of patients with well established substance misuse problems and also provides the opportunity for early recognition and preventative interventions.

“In cottage gardens sweet flowers drink Last dregs of colour from the fading light. Their scent floats on the dusk, to link With the now distant thunder of the engines In a strange deceit; As if the world went well …”

The efficacy of training in dynamic psychotherapy was assessed by sending a questionnaire to all visiting therapists (trainees) in the Leicester Psychotherapy Department. Questions were directed towards the effect of training on trainees' work in non-psychotherapy settings. Trainees noted improvements in communication skills, assessment/referral skills, anxiety and boundary management and overall management of the therapeutic relationship. Improvement was also noted in job satisfaction and motivation at work. These improvements were more prominent in trainees who had had more than two years' training.

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.

Psychiatric trainees in the Wessex Region gave their own lectures on an MRCPsych course and received feedback on their performance from their peers. The form and content of the lectures were given high ratings and the presentations were considered at least as good as those given by more experienced lecturers. The experiment can serve as a model to supplement existing courses for trainees and as a ‘do-it-yourself form of education for areas and countries that have inadequate access to centres for postgraduate education.

At the time of independence (1947) Pakistan with a population of 40 million had three asylum-like hospitals with a total of less than 2000 beds. The hospitals were prison-like and they provided custody with little care. Patients were mostly brought in chains. Detention and reception orders were used for admission as provided in law and the law was and continues to be the Lunacy Act of 1912. The common man referred to them as pagal-khanas (mad houses) or jail hospitals. The doctors appointed were mostly general duty doctors with no training and often no interest in psychiatry and their average stay was two to three years. In place of nurses there was a cadre of attendant staff, most of them illiterate, untrained and acting more like police sepoy or jail warder than nurse.

The New South Wales Mental Health Act (1990) heralded a number of important changes to mental health legislation in the state. One of these was the option to give compulsory treatment to mentally ill clients living in the community. This article briefly explains community treatment under the Act, and the perceived benefits and the limitations of such legislation. A case example is used to illustrate some of these points. Involuntary community treatment is seen as a less restrictive alternative to hospitalisation for a number of mentally ill clients, but the use of such provisions demands significant resources from the supervising agency.

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.

As an expatriate psychiatrist, working in a new culture has exposed me to the difficulties in practising my profession, and in particular, its limitations. In search of understanding common psychosocial distress in the communities we serve, I have sought to work with traditional healers in the high-density suburbs of Harare city.

The paper by Curran & Bingley (Psychiatric Bulletin, 1994, 18, 328–332) is most clear and helpful. While much is written in our Bulletin about the operation of the Act, little is written about the Commission itself. The Commission visits most of us far more frequently than does the College and makes much wider and more critical comments on our services. The account given, quite properly, gives little discussion to the role of the medical member. Many psychiatrists are or have been members of the Commission – currently 16 out of a total membership of 90. One year after completing a four year stint some very personal and subjective views may be of interest to colleagues about to be proposed, or propositioned, for membership of the Commission.

Close links have developed between the Institute of Psychiatry at the University of Verona – a town in North-East Italy – and the Maudsley Hospital in South London. Reciprocal visits, exchanges and cooperation in clinical practice and research have led to interesting experiences and comparisons between the different cultural settings and mental health services. In 1993, one of us (MP) visited the South Verona Psychiatric Service for two weeks, and a year later VP spent six months attached to the South Camberwell Community Team and at PRISM (Psychiatric Research in Service Measurement), a research team at the Institute of Psychiatry. This paper records our impressions and observations during these visits. The two services are not representative of all services in the respective countries but the visits did give us the opportunity to consider details not revealed by formal comparative research studies.

The purpose of aftercare is to enable patients to return to their home or accommodation other than a hospital or nursing home, and to minimse the need for future in-patient care. Under section 117 of the Mental Health Act 1983, local health and social services authorities have a legal duty to provide aftercare for certain categories of patients when they leave hospital (Department of Health and Welsh Office, 1993).

This article describes a part-time attachment to the public health department of a purchasing authority, during my senior registrar training in child psychiatry. This London purchasing authority was responsible for researching needs and priorities, planning services and drawing up and administering contracts for an area previously administered by several separate health authorities. In carrying out these tasks it worked in close collaboration with its local public health department, but was not directly linked to a Family Health Services Authority.

Hong Kong is an international trade and finance centre situated on the southern coast of China, offering a unique blend of Western culture and Chinese tradition. With a largely private primary health care system, psychiatric services here have been predominately hospital centred. Following the 1992 Government Review of Rehabilitation Program Plan (Secretary of Health and Welfare, Hong Kong, 1992) development of community-based services has become the major local issue. Psychogeriatrics is the first sub-speciality to have achieved major progress in this area. Such a development illustrates how local psychiatrists faced the challenge of applying Western models to suit an Oriental population with a different socio-cultural value system.

Thought disorder, perhaps the most telling symptom of schizophrenia, presents itself in an infinite variety of ways. This ranges from unintelligible gibberish on the one hand to far more subtle disturbances on the other, disturbances which in other circumstances might be construed as examples of donnish games with twisted logic. Here is one that sticks in my memory.