The community mental health movement remains an important force in American psychiatry and a shift towards community orientated mental health care is now being actively promoted in Britain. Nevertheless, concepts of community mental health care are not clearly defined, and the term has been variously misused, as a label applied to existing facilities without real change in philosophy, as a political justification for closing large mental hospitals, and as a platform for the propagation of anti-medical ideology. The development of community orientated services involves a change in role for the psychiatrist, which many find difficult to accept. Psychiatrists have been warned that they are at risk of being left behind in the current moves towards community mental health care in Britain.

Admission to hospital for psychotherapy facilitates communication with patients and allows more ways of influencing them than do conventional out-patient situations. Small and large groups can be added to individual interviews, and living together allows the development of many potentially therapeutic relationships with other patients and staff. This additional influence can be ignored. If it is assumed to be an integral part of treatment and organised rationally, the whole hospital becomes its instrument; psychotherapists, nurses, patients, domestic staff and administrators can be seen to be subordinate to that whole, and their traditional activities, attitudes to each other, and theories, are inevitably modified. Traditional boundaries between the roles of different workers become blurred, while how they get on with each other has important consequences for patients, so that their separate roles and functions must be clearly defined.

The introduction of a systematic approach to their work by nursing colleagues in the last decade provoked a great deal of comment and literature some of it amusing if perhaps slightly dismissive. Not a great deal is known about how widespread is the practice, or how well it is working in places where it has been adopted. Indeed the DHSS has set up a working party within the Nurse Education Research Unit of King's College to obtain enough basic information with a view to developing a research project into the effectiveness of the nursing process.

In manufacturing industries, measuring productivity is relatively easy. In many service industries where the job is discrete (e.g. mowing a given area of grass or serving a number of cups of tea), work study methods are still easy to apply. In medicine and nursing where both the product and its process of ‘manufacture’ are hard to measure, things become more difficult. Nowhere is this more so than in psychiatry. Perhaps because of this, the standard often applied in the past has been professional judgement, and the Royal College of Psychiatrists, for example, has suggested appropriate levels of nurse staffing in psychiatry of old age. Such standards are now being questioned and an alternative is being propounded, at least in the Yorkshire Region, based loosely on work study methods. Psychiatry and psychiatric nursing have nothing to fear from work study, provided that acceptable standards of service are defined, and work study methods are properly applied. The first of these is partly a political task although it is to be hoped that the politicians would take guidance from patients, their relatives, and the appropriate professionals. Work study can ensure that such standards are achieved in the most economic way. It cannot set the standards. The authors are concerned because an exercise has recently been mounted throughout Yorkshire that purports to be a measure of nursing load, but which neither defines the standards of nursing care to be achieved, nor uses adequate methods to measure the work involved.

A day workshop on the subject of psychosynthesis was held in June 1985 by the Action Therapies Group. The group consists of health professionals working in psychiatry and related fields, who meet regularly to educate themselves about the ‘new’ therapies, including gestalt, transactional analysis, psychosynthesis. Teaching is carried out by group members, the emphasis being on experiential rather than theoretical learning, though time is given to theoretical issues.

Representatives from 19 countries met by invitation to discuss their most recent research findings at the Third Biannual Workshop on Schizophrenia, Schladming, Austria 26–31 January 1986, organised by Dr T. J. Crow (MRC, Northwick Park Hospital) and Professor S. R. Hirsch (Charing Cross Hospital Medical School). The thrust was highly biological with biochemistry and brain structure much in the fore, assisted by much greater resolution of imageing techniques and the development of specific ligands for synaptic receptors.

Much of the initiative for this symposium, held between 6 and 8 January 1985, came from Professor Shridhar Sharma, President of the Indian Psychiatric Society, and the 38th Annual Conference of the Indian Psychiatric Society, at which there was a record number of participants, was held immediately before and in the same place as the Symposium. Many of the psychiatrists who attended the IPS Conference stayed on for the Symposium, where they somewhat outnumbered their foreign colleagues. The premises were the Medical College and Hospital named after Sawai Man Singhji, a Maharaja of Jaipur. The complex is a little way outside a crenellated pink wall surrounding the equally pink and fascinating Jaipur in Rajasthan, North India. The site, enhanced by a large marquee for refreshments, was very pleasant.

On 21 February 1884, a sub-committee of the Medico-Psychological Association meeting in Glasgow was appointed to prepare a handbook ‘in the hope of helping Attendants on the insane to a due understanding of the work in which they are engaged’. With commendable speed the four gentlemen concerned, Drs A. Campbell Clark, C. McIvor Campbell, A. R. Turnbull and A. R. Urquart, completed their allotted task, and in 1885 The Handbook For The Instruction Of Attendants On The Insane was published.

This memorandum concerns training in psychotherapy during the initial three year period of general professional training in psychiatry. A brief statement on this training was included in the statement on approval of training schemes for general professional training (1984). This document also stated that every trainee should have a minimum of one year's training in general psychiatry and some experience from among a variety of sub-specialties. At present none of the sub-specialty experience is mandatory, but all training schemes should provide as wide a range of sub-specialty experience as possible.