The Court of Protection, in carrying out its task of managing and administering the property and affairs of those who are incapable of managing for themselves, normally works by appointing a receiver to stand in the patient's shoes. The application for appointment of a receiver may be made through a firm of solicitors or by personal application to the Court. In either case, it needs to be supported by medical evidence, which is usually given on Form CP3. The Court is always conscious that its jurisdiction only extends to people who are incapable of managing their affairs by reason of mental disorder, so medical evidence there must be. (In rare cases, in an emergency, the Court is empowered to act even before receiving formal medical evidence, provided it has reason to believe that the person in question is suffering from mental disorder, but this power is exercised sparingly and only when its use is essential for the patient's protection.) It is an extreme step to deprive a person of his financial liberty and it must be reserved for cases where it is really necessary.

In 1968 the Royal Commission on Medical Education recommended that ‘every psychiatrist should be familiar with the conduct of community psychiatry’. This seems an uncontroversial piece of advice, but what is ‘the conduct of community psychiatry’? At the time of the Royal Commission, there was certainly no special training at all in anything that could reasonably have been regarded as such.

Stimulated by the First International Conference on Organization and Management of Psychiatric Services in Montreal in Spring 1983, an idea arose which was translated into the first UK Workshop on Psychiatric Service Management held from 17 to 20 July 1984 in York. The theme was economics, addressed by a talented group of British health economists. The meeting was structured into a series of presentations followed by group discussion, culminating in group exercises involving informed criticism of selected research papers on economic appraisals of psychiatric services. Seminar topics included: What do we mean by efficiency in the delivery of psychiatric care? (Professor Alan Williams); What are the costs of delivering psychiatric care? (Ron Akehurst); Switching resources (Professor Alan Maynard); Measuring outcomes of health (Professor Alan Williams); Choosing options with a limited budget (Mike Drummond and Ron Akehurst). A special evening discussion was led by Tim Nodder (Deputy Secretary at the Department of Health and Social Security) who gave an eloquent account of Health Service Strategy vis-à-vis mental health over a thirty-year historical perspective.

Cognitive therapy (CT) is now widely recommended as an effective form of psychological treatment for a variety of psychiatric disorders, particularly depressive and anxiety states. The therapy itself consists of a specific treatment ‘package’ derived from the cognitive theory of psychopathology and seems to have developed because of a growing dissatisfaction with dynamic psychotherapy on the one hand, and a strictly behavioural approach to the patient's difficulties on the other. A further factor has been the unwillingness of some patients to continue for long periods on psychotropic medication and the unwillingness of medical practitioners to prescribe it in patients who have expressed suicidal ideas, or have not previously responded well to medication. The main thrust of the CT is problem orientated, and treatment itself is an active, moderately directive, time-limited, structured approach set in the present in which the patient and therapist work in collaboration to relieve the patient's symptoms.