The possibility that estimates of psychiatric manpower needs could be informed by knowledge of what doctors do and should do with their time was discussed in a previous paper. In this paper, we outline a procedure for calculating the psychiatric manpower needs of a Health District. The basic assumption is that the numbers of psychiatrists in a District ought to be sufficient to do the work that needs to be done. We suggest that this work should be assessed in terms of the amounts of doctor time required for specified activities.

The Report of the Social Services Committee of the House of Commons in 1981 (the ‘Short Report’) recommended the establishment of consultant posts without the support of trainee medical staff as part of a strategy to correct the situation where too many doctors occupied training posts for the number of consultant posts available.1 The Royal College of Psychiatrists has endorsed this policy,2 and the withdrawal of approval for training from an increasing number of hospitals around the country is leading rapidly to a situation where a large number of them need to look at alternative arrangements for providing medical cover. We would like to report the establishment and early development of such an arrangement based in a district general hospital.

I count myself most fortunate to have been living at this time, working in our profession, and to have chosen psychotherapy as a main interest, for it has been a period of quite extraordinary growth and constructive development. Exposed as one has been to such an exciting series of new discoveries, each following so hard on the heels of the last that one scarcely had time to absorb each new understanding and regain some equilibrium before it was upset again by the next wave of new ideas, it seems it would have been far more difficult to narrow down than to stay open.

The DHSS/College recommended establishment for consultant posts in the psychiatry of mental handicap is one whole-time equivalent per 200,000 population.1 In 1982 the theoretical average in the English∗ regions was 1:321,000, varying between 1:153,000 (South West Thames) and 1:620,000 (North West). There were, however, 41 vacant posts, 19 of which were occupied by locums,2 so the actual substantive average was 1:612,000. By 1983 the number of vacant posts had risen to 49 and the substantive consultant/population ratios varied between 1:202,000 (South Western) and 1:2,170,000 (North Western).3

Since taking the decision to pursue a career in mental handicap, I have been increasingly aware of the debate surrounding the role of the consultant psychiatrist in this field. Nowhere else in medicine does there seem to be such uncertainty about the continued need for an already established specialty. I believe that one of the major reasons for the continued difficulty in attracting trainees into mental handicap is precisely this uncertainty about its future, which is in no way ameliorated by the College's view that a full time specialist appointment in the psychiatry of mental handicap is not superior to a joint appointment either with adult or child psychiatry.1

Psychiatry has a long past but a short history in Iran. References to causes and treatment of mental disorders can be found in parts of the Avesta, the holy book of pre-Islamic Iranians. Early muslim physicians like Tabari, Majusi, Razi and Ibn Sina, who were mostly born and brought up in Iran, have devoted long sections of their books to a discussion of mental disorders under the general title of ‘the diseases of the head and the brain’. In fact, the oldest medical textbook in modern Persian—which was completed around 970 A.D.—was written by a practising physician who claims to have been known as a ‘doctor of the insane’ by his contemporaries.

There has been increasing interest in recent years in the care of the terminally ill. Much of what has been written has been focussed on medical management and centred in hospices. The psychological dimension often appears neglected. The objective of this article is to outline the evolution, practice and problems of a liaison psychiatry input to the care of patients with terminal illness treated in a general hospital.

Liaison psychiatry is in a developmental stage in the UK and the opportunity to be trained in this special area at Senior Registrar level is rare. The Wessex Rotation for Senior Registrars is therefore privileged to be able to offer an attachment to Odstock Hospital, Salisbury, where the Spinal and Plastic Regional Units are based. The local psychiatric service offers consultations to both Units, the senior registrar having opted for one session a week with the Burns Unit. He is supervised by the consultant psychiatrist who spends two weekly sessions in liaison with the special Unit.

Psychotherapy is unpopular in Hong Kong for various reasons. There is a gross deficiency of psychiatrists in our population of five million, and individual psychotherapy, being time-consuming, is regarded as a luxurious treatment to be chosen as a last resort. Moreover, there seems to be some reluctance among psychiatrists to accept psychoanalytic theory as relevant to Chinese culture. Although experience in psychotherapy is regarded as essential in training, it has been difficult to learn psychotherapy in Hong Kong because good training programmes are impossible without the availability of qualified supervisors. In the past year, we have gone through a training programme in dynamic psychotherapy involving a series of seminars, individual supervisions and Balint groups. The programme was made possible by the joint efforts of the three senior lecturers in our Department, who all came from abroad and were experienced in teaching psychotherapy. We would like to report our experience of the training and give our viewpoints as trainees. It will be helpful to describe the training in stages which bear striking similarities to the actual psychotherapeutic processes of our patients.

Provision for dealing effectively with psychiatric emergencies has never been more important than now, with the current increasing emphasis on community care. There follows a description of the psychiatric emergency clinic in Southampton and the changes in its organisation and practice which have taken place over the last few years. It is hoped that this will stimulate discussion on the best methods of providing emergency psychiatric care.