Although the process of psychiatric reform is taking place across Europe, national political, economic and historical factors determine to a large extent the manner and pace of its implementation as well as its final shape. The degree of centralisation of health care systems and the degree of prominence of primary care affect how efficiently change can be achieved. Various forms of professional resistance may, in different degrees in European countries, hamper the implementation of community care. The widely varying contexts in which psychiatric reform takes place throughout Europe, should provide a fertile area for future comparative research.

This paper discusses the theoretical foundation of QALY and examines the assumptions which underlie these theories. It argues that there are methodological flaws in the construction of QALY and that there are inherent risks in its possible application to psychiatry. It also draws attention to fundamental ethical problems with the concept of QALY as a tool for valuing the quality of life or well-being of persons.

Mental Health Review Tribunals (MHRTs) are intended to protect the liberty of the detained patient. In practice, however, they have been said to fall short of providing this safeguard. This is frequently for administrative reasons. We report a systematic examination of the pattern of delays in holding MHRTs. Our main finding is that delay cannot be attributed to a single factor but rather reflects the inherent complexity of some cases.

We describe the operation of a substance misuse clinic for adolescents as a Joint venture between a voluntary organisation ‘Streetwise’ and the Adult Substance Misuse Services and Child and Adolescent Psychiatry Services in Newcastle upon Tyne. A number of issues are discussed relevant to improving clinical services for adolescent substance misusers.

Doctors working in psychiatry have been shown to lack practical skills in basic cardiac life support (BCLS), but these have not been regarded as priorities for training. This study assessed levels of experience, confidence and skill in BCLS, in psychiatrists, and examined the effect of a single training session on practical skills. Levels of skill were generally poor but significant improvement was seen following training. It is recommended that all psychiatrists undergo brief regular practical training in BCLS.

One hundred and fourteen psychiatric trainees in the South Western region were canvassed by questionnaire concerning their knowledge of and attitudes towards the recommendations of Caiman Report, (DOH, 1993). Of the 78% of senior registrars and 80% of registrars who replied, the majority knew of the major recommendations mainly from reading articles and talking to colleagues. The 50% response rate from the senior house officers perhaps reflected a lack of knowledge and an erroneous perception that the report was of less relevance to them. The article reports responses to both structured questions concerning the facts, and comments received on more controversial aspects.

We offer an account of training experience within an inner city service dedicated to home treatment as an alternative to hospital admission for acute psychiatric illness. The Ladywood service in Birmingham is described and the challenges and opportunities for trainees outlined. A dominantly institutional based training seemed to us deficient, after this exposure. We regarded home treatment very positively and felt that it enriched our professional development in both clinical and conceptual terms.

This is the second of two interviews with Sir Aubrey Lewis at the time of his retirement. The first interview by Professor Michael Shepherd in 1966 was published in the Psychiatric Bulletin in 1993 (17, 738–747).

Roisin Kemp explores the fact and fiction behind Guy de Maupassant's Le Moria

Dr Kwame McKenzie of the Institute of Psychiatry contrasts the publicity and the evidence behind drugs that are claimed to make us brighter.