Most research on electroconvulsive therapy (ECT) has focused on technical aspects, such as indications for treatment, efficacy, side effects of treatment, and theories of mechanism of action. Little investigation has been made of the attitudes and experience of patients receiving ECT and less regarding patients' understanding and knowledge of this treatment. Earlier studies have looked at specific aspects of patients' perceptions of ECT, such as subjective side effects, (Gomez, 1975), or the effect of the media on attitudes towards ECT (Bird, 1979). Other studies have investigated these and related issues more comprehensively (Freeman & Kendell, 1980; Hughes et al, 1980). These studies were carried out some time after the ECT course had been completed; in some cases, over a year. It may be that patients' perception and knowledge of ECT are different before and after treatment. Attitudes and knowledge may also change or fade over time.

The arrival of HIV has challenged the traditional services for intravenous drug users providing the impetus to re-examine working practices. Only 10% of intravenous drug users attend hospital based treatment centres offering out-patient programmes based on reducing doses of oral methadone with an ultimate goal of abstinence (Hartnoll et al, 1985), yet for public health programmes designed to limit the spread of HIV it is important to increase the contact between high-risk groups and health professionals. Satellite clinics originally introduced to provide low cost help for drug users at a more local level may also be effective as a means of reaching intravenous drug users at high risk of HIV who would otherwise not be exposed to treatment and health education. Strang has described how a satellite clinic may be established with few resources, with staff who can be supervised by more senior workers at a central site (Strang & Creed, 1985). In this study the client groups of a satellite clinic and a conventional drug dependency unit were compared in order to characterise the clientele of the satellite clinic and to discover whether it was indeed fulfilling a useful role in terms of attracting such high-risk individuals for treatment.

With the rapid expansion in the number and variety of psychotherapy courses in this country, it is perhaps timely to review some of the issues influencing these courses. One purpose of this paper is intended to draw attention to the fact that not only are there interesting conflicts in establishing such courses but also establishments whose power relationships affect the educational effectiveness of these complex teaching ventures. These issues will be discussed with reference to the trainees, trainers, patients, and host organisations.

As I walked into the waiting room, I remember being struck by his appearance. Although he was almost exactly my age, I saw an old, tired-looking, white-haired man, his face deeply lined and drawn. I wondered what I had to offer this survivor of torture. Would I be able to help him recover from such a dreadful trauma? How could anyone come to terms with an experience which seemed to threaten some of the most basic human needs?

The depot clinic has long been part of the traditional British psychiatric service. With moves towards care in the community many of the traditional, particularly hospital based, methods of service delivery are becoming unfashionable. The depot clinic has been criticised (Beveridge, 1987) for being out of date, not geared to the needs of the patient, inaccessible and unable to provide personalised care, especially regarding the family factors recognised to be important in the management of chronic psychosis, and is portrayed as a facility designed for the convenience of the staff not the patient. This has led to suggestions for alternative methods of administering treatment to these patients, e.g. at home, from GP, health centre based.

With growing concern – both professional and lay (Ashton, 1986; Lacey & Woodward, 1985) – about the adverse effects of long-term benzodiazepine use, many GPs are wondering how best to tackle the problem. In this paper, I describe a strategy adopted by a GP, CPN and psychiatrist (the author). This strategy centred around a meeting of all patients who had been taking benzodiazepines for over six months.

The Mental Health Act brought a number of signficant changes to psychiatric practice. Among the most important were changes in the process of compulsory admissions. Other notable alterations have been a change in the definition of the nearest relative; a reduction in duration of treatment section by a half; a right to appeal against their detention by all patients; the observation section becoming an assessment and treatment section; the introduction of nurses holding power; the removal of age limits for admission of patients with psychopathic disorder and mental impairment, and the introduction of the treatability clause. These and other important differences could be expected to interact with social work and psychiatric practice to influence the number of compulsory admissions. Previous correspondence has examined this question, to which we add our findings.

Since their introduction in the 1960s, benzodiazepine drugs have been widely prescribed for anxiety states and insomnia. Despite the initial hopes for these drugs being non-addictive and not producing tolerance, recent work has shown that there is a well defined withdrawal syndrome (Hallstrom & Lader, 1981; Petursson & Lader, 1981; Tyrer et al, 1981; Tyrer et al, 1983) and that tolerance has also been shown to occur (Aranko et al, 1983; Aranko et al, 1985). There has been widespread concern about these effects. The British National Formulary advocates that “used as hypnotics routine prescribing especially in hospitals is undesirable, and ideally they should be reserved for short courses of treatment in the acutely distressed” and that they should be discontinued as soon as possible. Indeed the Royal College of Psychiatrists' statement on benzodiazepine prescribing and the Committee on Safety of Medicines have recommended that their use as hypnotics should be considered only when the condition is severe, disabling or subjecting the individual to extreme distress. Tyrer & Murphy (1987) have recommended that these drugs are best used for no longer than two weeks in regular dosage.

The benefaction for the award of an annual medal and prize to a member of the Royal Medico-Psychological Association was made by Mrs Elizabeth Holland, in memory of her brother, Samuel. She was herself a remarkable woman, who married a banker, had ten children, translated poetry from the German, began a social club for unemployed men, founded a cottage hospital, and was well-known for her wit, conversation and unflappability. However, she came from a remarkable family. Her older brother, William, was a noted Unitarian minister, philanthropist, and writer. Her sister-in-law, William's wife, was Mrs Elizabeth Gaskell, author of North and South, Wives and Daughters, and a celebrated, and for a season notorious, Life of Charlotte Brontë, as well as several other novels and short stories. Two of Elizabeth and William's children, Meta and Julia, were so well-loved in Manchester that flags flew at half-mast on their deaths.

On the night of 16/17 November 1988, fire destroyed a male ward at Friern Barnet Hospital in North London. Two patients died in the conflagration and one was injured.

Good Practices in Mental Health (GPMH) is a national charity set up to disseminate information about local mental health services which are found to work well. Its general aim is to promote and assist the development of good mental health services. By providing an exchange of information about effective services in both hospitals and the community, GPMH encourages others to build on what is already proving successful. GPMH developed from a survey of mental health in big cities carried out by the International Hospital Federation (IHF) and was set up in 1977 with the support of the IHF, MIND and the King's Fund. It has the backing of all the major professional organisations concerned with mental health in the United Kingdom, the World Health Organization and the World Federation for Mental Health internationally. It is now funded mainly by the DHSS; some funding comes from the London Boroughs Grants Committee and charitable sources. There are three units within the organisation: information, development and evaluation.