If the Health Service were perfect there would be no suicides among hospital patients. The first aim of all doctors and nurses is to preserve life, and patients are admitted to hospital in part so that they will not harm or kill themselves. Yet every year over 100, perhaps 200 or more people in the UK, deliberately end their lives while receiving in-patient psychiatric care. The exact number is not known, partly because of the way the statistics are collected, and partly because of a pall of secrecy spread over such deaths.

In a study to investigate how many ex-patients died since 1974 from sudden or violent causes among all the residents in the catchment area of a general hospital psychiatric unit, the identification of the ex-patients was completed with minimum use of the local coroner as a source of names. Since much of the information available from coroners is available elsewhere, and in view of the considerable pressure of work on coroners, it was felt that alternative sources of information should initially be explored. Three alternative sources, available from death registration procedures, are described and the usefulness of the data available from each source discussed.

In the beginning of the 19th century Italy was in the forefront of psychiatric reform. The question as to whether it was Chiarugi (1759–1820) or Pinel (1745–1826) who was the first to unchain patients in mental hospitals has remained unanswered. With the death of Chiarugi, however, the age of enlightenment, which he had heralded, faded and conditions in Italian hospitals reverted to their former state.

The last year has been a fascinating one for me as a British medical graduate in many ways, constituting, as it did, my introduction to both American culture and a career in psychiatry. I have just completed my first year of a three-year psychiatric training programme (residency) at Harvard Medical School, roughly equivalent to a combined SHO and registrar training in Britain.