The concept of a ‘crisis card’ originated in the voluntary sector as an advocacy tool for use in mental health emergencies. This type of self-help initiative, and variations which include advance planning for mental health crises, are becoming more common, and have received Government and media attention (Brindle, 1993). The Health Committee's Fifth Report to the House of Commons (1993) on ‘Community Supervision Orders' included evidence given by Survivors Speak Out on the use of crisis cards or treatment contracts as an optional alternative to community supervision orders. Survivors Speak Out described how a user, “when in a rational state of mind, can set out in writing (on a crisis card) how they would like to be treated in circumstances when they are not the best judge of their own interests”. The Government's response was to encourage the informal use of crisis cards and the development of best practice and guidance on their use bearing in mind the central role of the user (Department of Health, 1993). They also recommended that ways of amending the law to provide for crisis cards to be legally effective should be examined. The Report of the Inquiry into the Care and Treatment of Christopher Clunis recommended that the Royal College of Psychiatrists should design a card for mentally ill people. This appeared to be a response to the identified need for improved provision of information, communication and liaison across geographical boundaries where necessary (Ritchie et al, 1994).

User centred services as an ideology have not become a reality of everyday clinical practice. In this paper we introduce a series of articles which describe user centred practice in a south London community-based rehabilitation service for the severely mentally ill. We emphasise the medical consultation style adopted, the service management style and specific initiatives allowing users to influence our practice and shape functional and structural components of the service.

The British National Formulary (BNF) entry for clozapine clearly distinguishes the treatment dose (200–450 mg daily, maximum 900 mg) from the maintenance dose (150–300 mg daily). We looked at 44 patients maintained on clozapine locally and found that 36 (82%) received doses above the BNF guidelines. This has considerable cost implications. While it is always good practice to maintain patients on the lowest possible dose of antipsychotic, the BNF guidelines are not based on objective outcome data, and should be treated cautiously.

A postal survey of 222 patients receiving long-term antidepressants in a training general practice showed that the majority were GHQ-12 cases and 62% of respondents reported moderate or severe depressive symptoms on the BDI-13. Although these patients received significantly higher doses than those reporting few or no symptoms, only 40% were prescribed at least a therapeutic antidepressant dose. All patients reporting mild, moderate or severe depressive symptoms consulted their general practitioner significantly more frequently than those without symptoms and the content of these consultations suggested that the general practitioners were aware of these patients' psychological morbidity. Monitoring and appropriate management of patients receiving long-term antidepressants could lead to reduction in morbidity and consultation rate.

This study investigated the links between aspects of cultural life and response to ethnic monitoring questions, and compared parental and adolescents' responses. Questionnaires were given to consecutive attenders at a child and adolescent psychiatry department situated in central London. Forty-seven parents participated, and 24 adolescents (aged 12–16 years) also completed questionnaires. Parents came from many parts of the world and their offspring were mostly born in the UK, but had varied cultural life with respect to language, peer group and diet. Just over half of the offspring were regarded as ‘White British’ by parents but the second largest group was that marked ‘other’, who all had mixed identity. There were differences in how parents described adolescents, especially in relation to peer culture. Since ethnic categories have limitations the data should be used carefully, and for many aspects of health planning and delivery other cultural variables would be useful. Consideration should be given to the need for specifying whether adolescents or their parents should respond to ethnic monitoring questions.

A study of all trusts in England and Wales providing specialist health services for people with learning disabilities attracted an 83.9% response rate. Considerable variation exists with regard to the quantity of services. The relationship between the learning disabilities psychiatrist and National Health Service learning disabilities bed-numbers and learning disabilities health professionals from other disciplines is explored. An appropriate balance needs to be kept in these ratios to reduce stress and burnout.

This paper reports a retrospective case note study of all patients with learning disability and challenging behaviour admitted to Kneesworth House Hospital between 1986 and 1991 (n=70), describing their demographic and clinical characteristics. The subjects had high levels of psychiatric morbidity, in addition to learning disability. Patients whose stay was relatively short, or who were discharged to community placements, were not able to be differentiated on clinical grounds, suggesting that the provision of local facilities determined the length of the admission. There is a need for more regional and sub-regional services for this group with multiple long-term problems.

This survey evaluates current views of non-medical professionals on the style of court report writing. A random sample of 120 solicitors who worked in the criminal field in London participated in this survey. The usable return was 72%. Up to 76% favoured changes in standards of report writing because of problems concerning clarity of style and use of jargon. The majority objected to reports being prepared by non-consultant psychiatrists.

People with violent or dangerous behaviour represent a considerable health care burden. The health needs of this group have been considered a priority in recent years. Both health commissions and psychiatrists need to know the numbers of patients that they are responsible for and whether their needs are being met. The appropriateness of placement was used as the measure of need for this study.

Despite the widespread belief that the involvement of users and carers in the training of psychiatrists would provide a valuable addition to the training process, it is clear that many trainees do not receive this input as part of their current teaching. This article explores some of the questions and concerns that all those parties involved have raised and draws on the experience of users, carers and psychiatrists to address some of these issues and promote the further development of this practice.

Following the recommendation by the College that all general psychiatric trainees have the opportunity for psychotherapy training, we describe a pilot scheme for supervised dynamic therapy, commenting on organisational and training issues.

On the opening page of Daniel Hack Tuke's 1892 Dictionary of Psychological Medicine, is a statement which reads: