Recently, concern has been expressed by mental health professionals, MIND, and the police regarding the management of Section 136 referrals, which at present varies according to the local psychiatric services available. In the majority of London Metropolitan Boroughs a person deemed to be in need of care and control is taken first to a police station where the necessary documentation is completed and then transported, often a considerable distance, to a mental hospital for the purpose of assessment. This can result in lengthy delays in a police cell for the patient, time-consuming negotiations with hospitals for the police, and problems completing the assessment procedure due to lack of availability of social workers. The importance of considering alternatives, particularly with the move towards community care, has been stressed.

It seems that increasingly patients are being referred to primary care teams and GPs in health centres rather than to psychiatrists in a hospital setting. With the growth in the number of patients being maintained in the community, it is becoming more important to pay attention to this sphere and to aid primary care teams to be clinically effective. It was from this perspective that I became involved as facilitator to a primary care team on a one year project.

In spite of the somewhat disordered development of day care for the mentally ill, the Psychiatric Day Hospital (PDH) has become accepted as an essential element in the mental health services. Several recent studies have defined a role for the PDH in the management of more acute psychiatric disorders (Creed et al, 1989), and this is likely to become increasingly important with the continuing reduction in the availability of in-patient facilities.

The MRCPsych Part II examination takes place twice a year at a number of centres in Britain and Ireland. It comprises five components. Three are written exercises and the other two, a viva voce and a clinical examination, are practical assessments characterised by face-to-face interaction with the examiners.

In the peripheries of excellence, providing a service is the main task. Professor Nichol says that describing a child psychiatry service to managers is easy (Third Section Newsletter). I say it is and it is not. The way he does it follows the traditional bioscientific medical pattern and logic - number and range of cases and diagnoses etc. Health managers at a first glance may be quite happy with this ‘biomedical’-looking picture. But I believe that in their second glance they can tell that these expensive child psychiatrists, who just sit in rooms talking, are not dealing with the same thing as surgeons and physicians.

“One fine day, after he had joined a fighter squadron, it would dawn on the young pilot exactly how the losers in the great fraternal competition were now being left behind.” (Tom Wolfe)

Clinicians, in particular consultants, are and always have been operational managers (Kennedy, 1989). Senior registrars also exercise considerable day to day management responsibility, often without any formal training (Hindle, 1990). Attitudes to management training have changed rapidly over the last five years from the “support” offered by the College Working Party (1985) to an “intrinsic part of psychiatric training” (CTC Working Party Report, 1990). Constantly increasing expectations of the clinicians' management role have led to an increasing recognition of the need for clinicians to develop specific management skills and have resulted in rapid expansion of training available. A further survey examining the extent training needs are currently being met is therefore justified.

Communities and psychiatrists differ with regard to how they have been ‘conditioned’ to accept responsibility for caring for the mentally ill. Some are reluctant to change the style of care they have become accustomed to (Lancet, 1985). The White Paper (Community Care in the Next Decade and Beyond) has emphasised the added ‘where/how/who’ meaning of psychiatric care: from treatment to prevention, clinical to management skill, and from a position of superiority to one of equality. Some psychiatrists feel threatened by the possibility of a ‘non-medical takeover’. Mental health care is not a social service priority and future consultants should equip themselves to take an effective lead in ensuring that adequate resources are made available (Freeman, 1985). Appropriate training opportunities are scarce (Scott, 1988) and we have only two years grace.

There have been several surveys of prescribing for psychiatric patients (Muijen & Silverstone, 1987; Johnson & Wright, 1990) indicating inappropriate prescribing and a tendency towards polypharmacy. Most studies have looked at prescriptions for psychiatric patients in all settings (out-patients, day-patients and in-patients) in conglomeration rather than just out-patients. Out-patients experience a comparatively lesser degree of supervision (hence a greater risk of non-compliance) and have other opportunities to acquire prescriptions (e.g. through general practice). With this in view a pilot study to observe prescribing pattern in a follow-up clinic was performed.

Complaints of delays at out-patient clinics are common; a Newham patient's complaint that she had not been kept waiting long enough was correspondingly puzzling but has subsequently proved very fruitful. Her explanation that discussions with other waiting patients and the OPD nurse were often more helpful than the interview with the doctor triggered the development of a clinic designed for fuller participation of patients and staff.

The Code of Practice for the Mental Health Act, 1983 “has now passed through the necessary Parliamentary procedure” but may still be subject to amendment by Parliament, and in this context it is useful to consider the expressed intention of Parliament over the last 70 years in relation to short term treatment orders and the Code's current guidance on S.2 of the Mental Health Act 1983.

First of all, some definitions. In general, psychotherapy is what happens when a doctor speaks to a patient. More specifically, psychotherapy is talk as therapy: it involves the physician assuming a role of expertise in talking.

Managerial and administrative personnel are increasingly to be seen using desk-top computers. With medical staff, however, it seems to be commoner to find their computers sitting at home. This is likely to be because clinicians are essentially mobile in their working, and although the career structure dictates that publications are essential, there is no time-slot during the clinical day for such activity.

We intend to discuss recent developments in Japanese psychiatry and matters of major concern, i.e., psychiatric services following the amendment of Japan's Mental Health Law, schizophrenia, dementia and culture-specific problems to Japan.