There has been a rapid growth in the number of patients receiving secure and special care in private hospitals, although their overall numbers are still comparatively small. The behavioural modification unit at St Andrews Hospital, Northampton, has the largest concentration of detained patients outside the National Health Service (NHS), but there are plans to increase the number of beds at Kneesworth House, Royston, Herts, and Stockton Hall, Yorkshire. St Andrews Hospital has been run as a charitable trust but Kneesworth House and Stockton Hall are currently owned by a private French company, Generale de Santé division of Generale d'Eau, together with Langton House, Dorset, which provides places for disturbed adolescents. Marks & Thornicroft (1990) noted that recent entrants into the private sector have been from private for profit rather than voluntary non-profit providers, catering for what are seen as “market niches” such as eating disorders, impotence, alcohol or substance abuse, and stress reactions. They criticise these developments, claiming that few people benefit and that the “bull market” in private hospital development challenges the catchment area concept and seems to be producing a two-tier system of psychiatric care in Britain.

In 1975 Sims published his celebrated paper on ‘Factors Predictive of Outcome in Neurosis’ (Sims, 1975). A big chart was associated with a poor prognosis.

The run-down of the psychiatric institutions has led to innovative and novel methods of treatment of the mentally ill in the community. In New Zealand, as in other countries, deinstitutionalisation of the more traditional psychiatric services is proceeding rapidly and the statutory and non-statutory community services are straining under the burden. Amid the turmoil of change and the crying out for alternative provisions, a pilot scheme was proposed to serve the mentally ill in the population of West Auckland. In early 1988 the Extended Hours Team (EHT) was born. It is based on the model used in North Sydney, Australia (Hoult, 1986) and Madison, Wisconsin (Stein & Test, 1980). At the time of conception of the EHT, cost cutting was the rule which led to a difficult gestation but a surprisingly easy delivery and subsequent development over the first year.

The Southsea Mental Health Team serves a geographically-defined catchment area of 80,000 adults under the age of 65. The area lies on the south coast of England, merging on its northern boundary with the naval city of Portsmouth. There is a variety of housing types including council housing estates, private housing and a significant number of large houses in multi-occupancy use as flats, bedsits or bed and breakfast accommodation.

Supported lodgings are an important means of achieving the successful rehabilitation and resettlement of the chronically mentally ill into the community (Anstee, 1978, 1985). In a survey of 15 psychiatric hospitals in England and Wales, it was estimated that 9.3% of the long-stay patients (i.e. in-patients from one to five years) under 65 years of age were ideally suited to less supervised accommodation outside the hospital. In Gloucestershire the Supported Lodging Scheme is provided by the Psychiatric Social Services Department. It was started to enable ‘new’ and ‘old’ long-stay patients at Coney Hill and Horton Road hospitals to be settled in the community. Now any psychiatric or mentally handicapped patient can also enter the scheme if appropriate.

The 17th century saw the transfer of Bethlem from its original monastic site to more spacious accommodation at Moorfields in 1676, the development of an organised admissions system, and the establishment of an admissions register in 1683. The register contains often no more than the patients' names and the dates of their admission and discharge. Examinations of the admission register for the period 1684–1700 however, reveals 20 cases in which the entry is a copy of a warrant for admission in the form of a letter from the referring authority.

The Mental Health Act Code of Practice has recently been published. Its introduction has been discreet, low-key and virtually unnoticed. Yet in a quiet and determined way it points out the direction that all professionals involved in the case of mentally disordered people must now anticipate. It has a smart, blue cover and is eminently ‘user-friendly’. Its contents will make it essential reading. Indeed it would not be an exaggeration to suggest that it might soon be any ambitious lawyer's pocket vade mecum as he prepares his case. Its arrival has been anticipated since 1983. There have been a few miscarriages on the way which probably explains why its mother finally consented to artificial insemination techniques and conceived of her Code without formal consultation with its potential fathers.

The speciality of substance misuse has expanded way beyond the treatment of alcoholism and drug addiction as incorporated in the now defunct term ‘addictions’. ‘Substances’ include the illegal (e.g. heroin and amphetamines), socially acceptable (e.g. alcohol and tobacco), medically prescribed (e.g. benzodiazepines) and household products (e.g. glue and lighter fuel). ‘Misuse’ covers that use of substances which has resulted in or may lead to physical, psychological and social problems.

The Huddersfield crisis intervention team began crisis intervention work after visiting well-established crisis intervention centres and reviewing the literature. In Huddersfield health district there are four adult psychiatrists, each covering a sector of about 54,000 population. At the time of the establishment of the crisis team, the health district was not sectorised. Since 1 February 1989 the district has been sectorised into four parts and the Huddersfield Crisis Intervention Team covers the Huddersfield West Sector

Present guidelines for the prescribing of antidepressant medication, with particular reference to the duration of treatment, are unclear (BNF, 1989). Evidence suggests that continuation of treatment for at least six months is valuable in the prevention of relapse of the acute illness (Mindham et al, 1975). Other workers have demonstrated a prophylactic effect similar to lithium over a three year period in patients with unipolar depression. There is, however, a paucity of information about the benefits (or lack of benefits) of longer term maintenance treatment. This study focuses on a population of a type which has been previously studied elsewhere – of patients in general practice receiving long-term (greater than one year) antidepressant medication. The implications of this to the psychiatrist and general practice–psychiatry liaison are discussed.

Recently there has been an increasing awareness of the need for medical audit. Medical audit in the health service is not a new thing across the Atlantic. Many centres accept it as a normal part of health management. The findings of audit are made known to the individuals who have been audited with the aim that this would produce future improvement. Hence it is an effective way of increasing efficiency and highlighting inefficient and costly procedures. There is debate as to who should be doing the auditing. General practitioners have been suggested as being in the ideal position to be able to audit specialist services such as psychiatric services (Ferguson, 1990). GPs can be approached by questionnaire to gain their views as to the level of satisfaction on things such as communication, availability and usefulness of referral to a local specialist service (Markantonakis & Mathai, 1990).

One week before Christmas in the crypt at the Church of St Martin-in-the-Fields, Dr Malcolm Weller addressed a conference for CONCERN (Care of the Neglected: Combining Education, Rehabilitation and Nursing). The purpose of the conference was to highlight the plight of mentally ill, homeless people and to emphasise the strengths and shortcomings of the professional care available for them.

It is hard to believe that this coming together of the Royal Colleges of Physicians and Psychiatrists to discuss the patients that so often bounce back and forth between the specialists was the first of its kind.

The 1983 Mental Health Act gave increased responsibility to the Mental Health Act Commission and the Mental Health Review Tribunal to ensure safeguards in the treatment and detention of patients compulsorily admitted to hospital. Although most are agreed that the civil rights of patients admitted to hospital against their will are better protected under the new Act, some psychiatrists are irritated by the necessity to involve these bodies in what they regard as primarily clinical management. The North-East Division of the Royal College of Psychiatrists believed that debate on this issue might benefit both psychiatrists and others involved and this topic was chosen for the Annual Meeting of the Division in York on 28 September 1990. The meeting attracted other mental health care professionals and of the 144 participants almost one-third were not psychiatrists, but mainly social workers and psychologists. The sessions were chaired by the President of the College and Professor Donald Eccleston.

The Matthew Trust has argued that ex-offenders and ex-patients of the special hospitals should not be allowed to do jury service until they have had at least ten years without offending or have been out of an institution for at least ten years. Mr Peter Thompson, Director of the Matthew Trust, argues that this period is necessary, in order to overcome the effects of institutionalisation and adjust to life in the community. The ex-offender or patient is held to be under such psychological pressure during this ten years, largely as a result of society's prejudices, that he would be unable to perform objectively on a jury.

‘The Heart has Reasons’, scheduled for broadcast on 21 February, is the film which launches a major new Channel 4 series of films called ‘Affairs of the Heart’. The series purports to be a broad view of how the health of the heart is “… central to our whole well-being, both spiritually as well as physically …”.

One curious image of the earliest Gulf fighting was a TV journalist standing in front of an acre of rubble in Tel Aviv and insisting, “The main effect of this Scud attack was psychological.‘’. What made it more curious was that after what had gone before, it was easy to believe him. Because, deprived of substantial news by a lack of action and the censorship of both sides, journalists had for weeks presented a procession of “psychological” angles, although they were more a clue to what the word means to the press.