The persecution of civilians by the Iraqi forces in Kuwait and subsequent acts of revenge on the Palestinian population have caused widespread revulsion throughout the world. Stories of torture and rape have been described in the Western media and issues of human rights have gained considerable prominence of late. Perhaps now is a good time to examine how Britain responds to the needs of survivors of torture who seek asylum here.

Recommendations in the White Paper Working for Patients will have a major influence in the field of child health. District consultants have been asked by colleagues and managers to explain and account for current practice in child and adolescent psychiatry, and to plan for the future against a background of serious financial constraint. Similarly, child and adolescent psychiatrists will need to evaluate current levels of use of regional services and consider a relationship where these services may have to be bought from a limited child and adolescent psychiatry budget.

“Quality of life” (QOL) appears intrinsically important but difficult to measure. As a mental health professional, one might wish to know whether patients moving from the security of hospital to “the community” improve their QOL, or to evaluate their QOL against that of other groups in society. Simply looking at symptom change or economic cost-benefit misses much of the point behind innovations in psychiatric services. From previous QOL assessments (e.g. Lehman, 1983) one would focus upon positive aspects such as living situation, personal relationships, and general health and on negative aspects such as lack of money or being a victim of crime. Literature from the 1950s and 60s attests to the adverse effects of institutional care but more recently writers such as Kathleen Jones (Jones et al, 1986) have drawn attention to the benefits of living in such an environment. Also, various well-publicised “scandals” have suggested the pitfalls of inadequately thought-out discharge into the community.

There is now an increasing emphasis on the views of the consumers of health care, but little is known of psychiatric patients' opinions on their care and treatment. This may be due to an assumption that their reports are unreliable. Much of the research in this area has been carried out in the USA, although there have been reports from the UK and elsewhere (Freeman & Kendall, Hansson et al, 1985; Lazare et al, 1975; McIntyre et al, 1989; Weinstein, 1981).

It is known that in most traditional psychiatric hospitals a significant minority of patients can have a better quality of life in hospital-hostels. With ample hospital-hostel places it was decided to interview and/or review the notes of all the non-demented Gloucestershire patients under 75 years whose stay in psychiatric hospitals exceeded one year on a census date of 26 September 1990. The characteristics of these long stay or residual patients are described.

This article describes the response of some RAF and RN mental health personnel and civilian mental health teams to the challenge of dealing with the psychological needs of wounded Servicemen. The preparation for war casualties could be seen as a useful exercise for future conflicts.

Long stay patients who continue to require 24-hour nursing care can be divided into two main groups: those who need to remain in hospital and those who could receive their care outside hospital. The Hostel Ward, with a multidisciplinary team providing input to individualised rehabilitation programmes, has been conceived as a possible solution to providing care for the second group. Some of its clinical, social and economic benefits have been reported (e.g. Hyde et al, 1987) and there now seems to be increasing agreement about its potential value within the range of rehabilitation services needed by a health district for people with chronic psychiatric illnesses (Abrams, 1988). However, it is still a relatively new concept and as the experience of this type of service may vary from one district to another, further reports of its utility and limitations are still needed (Garety et al, 1988).

Working for Patients (1989) demonstrates the Government's intention to “encourage all Royal Colleges to make participation in medical audit a condition of a hospital unit being allowed to train doctors”, suggesting this may also become a requirement for psychiatric trainees. The Psychiatry Department at Fazakerley Hospital moved into the rather uncharted territory of clinical audit with monthly unit audit meetings in 1989. At each meeting randomly selected cases are reviewed and data presented which are relevant to clinical practice on the unit. The majority of topic audits have been presented by trainees with support from consultants. Most Colleges agree that casenotes should be available for scrutiny (Warden, 1988). Consequently I undertook a casenote audit.

In an attempt to discover what can be learnt from records kept on suicide victims, all data collected by one health district about suicides occurring in patients in close contact with psychiatric care over four years were examined.

The presentation of factual material to an audience has become a routine part of psychiatric training, be it a case presentation, a journal article or original data. It can be seen as an anxiety-provoking task that bears little relevance to everyday practice. But it can become a creative endeavour with its own reward. Organising the material so that it can be easily understood clarifies your own thinking on the subject. The medium of a presentation both passes on information and enables quick and useful feedback. And, most importantly, it provides a deadline to work towards. Over the year a tradition of oral advice about conference presentation technique has been built up among research workers with the Team for the Assessment of Psychiatric Services. This team is evaluating the closure of Friern and Claybury Hospitals and has presented preliminary work at a yearly conference since 1986. This advice has usually been passed on during the frantic weeks that build up to our annual conference. This essay is an attempt to set down in writing some of those guidelines.

The West Midlands Senior Registrar Rotational Training Scheme in General and Geriatric Medicine has established links with the Senior Registrars in Psychiatry of the Elderly and their trainers. Reciprocal attachments to one another's specialty are encouraged and expected, much along the lines of the Royal College of Psychiatrists and British Geriatrics Society recommendations. This has been gratifyingly successful: the attachments have proved very satisfactory in themselves and have led to joint research and to friendships, some of which may form the basis of harmonious and constructive working relationships in years to come.

Hamilton is New Zealand's fourth largest city. Situated on the banks of the Waikato river in the central North Island, it was my home during a year's experience as a psychiatric registrar in the Waikato Hospital. This paper describes aspects of a medical and psychiatric practice, including training in New Zealand, and offers general advice to trainees planning or considering overseas placements.

The anxiety of staff working alone with overdose and deliberate self harm patients can be high, and demands more recognition. In assessing and treating such patients, staff often feel that they are being required to take responsibility for someone's future in the face of an enactment of extreme despair. This article looks at one way to deal with such anxiety.

In May 1988, the greater part of an issue of Archives of General Psychiatry was given over to reports of the results of a clinical trial of alprazolam for panic disorder. More recently, in March 1991, supplement no 365, of Acta Psychiatrica Scandinavica (APS) was devoted to a further trial of alprazolam for panic disorder. Few other psychotropic compounds have received such concentrated coverage. What, if anything, emerges from the studies reported?

There is a serious flaw in much current thinking about the development of ‘community’ psychiatry because of the failure to consider the function of admission wards and to resource them adequately. Excessive emphasis is placed on the value of non-hospital psychiatry with an implication that psychiatrists can manage patients adequately without beds (see Dean & Gadd, 1990). Although I have not met a consultant who literally believes this to be true, the managerial consequences of this attitude leads to in-patient units being yet further under-resourced, and so becoming more disturbed and having lowered morale. Yet in Better Services for the Mentally Ill (HMSO, 1975) the District General Hospital In-patient Unit was regarded as a main component of a comprehensive psychiatric service. Clinical experience does suggest that without an effective admission ward the management of patients in the community, including those with intractable mental illness, is unsatisfactory and sometimes totally impossible.

In mid-1963, Dr Harry Richard Bailey admitted a patient to Chelmsford, a small private hospital in a north-western suburb of Sydney. Between then and April 1979 he, and subsequently a handful of associates, treated a large number of patients with deep sedation, often combined with ECT. The patients' diagnoses included schizophrenia, bipolar disorder, alcoholism, and drug addiction; nothing suggests that the diagnosis and the treatment had any particular connection. Records exist for some 1,100 patients, 24 of whom died as a consequence of the treatment; 16 of them were under the age of 50. Others suffered brain damage, convulsions, delirium, pneumonia, hallucinations, cardiac irregularities, abscesses, urinary tract infections, fractures, and other complications.

Exchange visits with Soviet colleagues are being encouraged. I recently had the opportunity of spending two weeks visiting services for drug misusers in the Soviet Union with two colleagues, a visit sponsored by the British Council as a UK/USSR collaborative project. We spent most of our time in Leningrad and the surrounding region, and a short time in Moscow. Since then a party of Russian specialists has visited the Wessex Region to see drug and alcohol services.