This paper gives information about people attending a counselling centre and a psychiatric out-patient clinic in London. Data were collected in order to clarify the extent to which the counselling centre deals with people with significant psychiatric morbidity, rather than people with distress and life problems not amounting to illness; and also to define groups in society currently using the counselling services, by systematically recording socio-demographic information about them.

In its present state the law has little to contribute towards the solution of the problems arising from the medical treatment of mentally incapable, but informal patients. This is because there are no relevant rules; there is no legislation governing the situation because Parliament has not acted; and there are no Common (i.e. judge-made) Law rules because these problems have never come before a judge for decision.

Despite recent advances in the understanding of Huntington's Chorea, treatment remains, at best, symptomatic and many sufferers end their days in institutional care. A recent survey established the prevalence of Huntington's Chorea in South Wales as 7·65 per 100,000. From this figure, 4,000 or more sufferers of this condition are living in the United Kingdom at present of whom 20% are in hospital or other institutional care. Although some studies have looked in passing at the degree of disability of Huntington's Chorea sufferers in hospital and found it to be considerable, staff and relatives often feel that long stay psychiatric wards are inappropriate or unnecessarily restrictive settings for these patients. This study looks at the disability of Huntington's Chorea sufferers in hospital and other institutions in order to determine the suitability of their placement and to see whether their physical and psychological needs are being met.

At the recent sixth international conference of the Pakistan Psychiatric Society (11–14 December 1986) in Lahore, it seemed appropriate to give an account of the state of psychiatry in that city half a century ago. Such an evaluation, granted the circumstances of history, might be expected to start with a comparison with English psychiatry at the time. That association had not worked altogether to the advantage of the speciality in a city such as Lahore. Progressive ideas about the care of the mentally ill in the thirties percolated very slowly into a central administration, far removed from the local community and occupied with other urgent issues of public health.

Over recent years Central Manchester GPs have supplied over 50% of the referrals to the Gaskell House Department of Psychotherapy. Yet there is no formal channel for feedback from these GPs concerning the services provided and for opportunites for realistic enhancement of the relationship between them and the predominantly hospital-based psychotherapists. It would appear that this communication gap applies to many psychotherapy centres in the UK though Tyson and Reder1 have specified the opinions of GPs as one variable to be considered when planning psychotherapy service.

This course was organised so that future general practitioners might learn those aspects of psychiatry which are relevant to their future work. It has been recognised that six months working in a mental hospital is only helpful to the future GP in terms of assessment and treatment of severe psychiatric illness of which the general practitioner sees relatively little. The vast majority of psychiatric illness seen by a general practitioner in his day-to-day work is not represented at all in an in-patient psychiatric unit.

I have recently addressed myself to the problems of teaching medical students. In my case it is that of teaching the principles of psychotherapy. It is difficult to teach about the doctor–patient relationship in the normally accepted lecture form. Definitions of transference, psychological defence mechanisms or empathy can be given, but this gives no impression of what is meant at an experiential level.

The relatively rigid structures of the medical and nursing professions hamper the development of an adequate mutual understanding of the experiences and contributions of each in the care of patients. It is not uncommon for medical staff in psychiatric institutions to be patronising in their attitudes to work done by nurses; and vice versa. McGuire, in her submission to the Report of the Royal Commission on the NHS (1979) commented that “decisions made by nurses may go unrecognised by doctors and even by nurses themselves”.1 Such failure to recognise decisions is symptomatic of an underestimation of the role of nurses in general.

Sexual abuse in children is a common problem. The Department of Psychological Medicine at Great Ormond Street Hospital, London, have developed a treatment approach based on six sessions of small group work with sexually abused young children. It is evident that they have considerable experience and have produced a training package to help other professionals working in this field. The package consists of a video, detailed manual and flash-cards. The video begins with a brief introduction to the whole subject. The major portion of the tape is given over to clinical illustrations from sessions and these are briefly commented on. The tape shows the children progressing and the staff coping with problems such as shyness. At the end of the tape there is a discussion between the presenter (Dr E. Vizard) and Dr A. Bentovim about the project and its successes, failures and limitations. They also discuss how the group work fits in with other treatment strategies.

“We are confident that at least 10% of children have been engaged in sexual activities with adults…” opens this important trilogy of teaching videotapes on sexual abuse of children, “… and of children alive today in the UK., 1,117,000 will have been sexually abused by the age of 15”.