The development of ‘community care’ for the elderly, mentally ill, mentally handicapped and physically disabled has been Government policy in Britain since the 1950s. Problems with implementation of this policy led the Audit Commission (1986) to conclude that “the one option that is not tenable is to do nothing about present financial, organisational and staffing arrangements”. Sir Roy Griffiths was commissioned to review “the way funds are used to support community care policy …”. Radical solutions were proposed and subsequently incorporated in the Government White Paper Caring for People (Department of Health, 1989a). However, two very significant measures were not accepted: the ‘ring-fencing’ of community care monies and the creation of a ministerial post within the Department of Health with specific responsibility for community care.

The needs of people with mental health problems transcend agency boundaries. Service-planning, however, has often been carried out within the confines of individual agencies. Although inter-agency collaboration has been an integral part of official policy since 1974 (DHSS, 1974), joint planning has often been limited to the allocation of centrally-earmarked joint finance (DHSS, 1976). In the ten years following the introduction of joint planning, few authorities prepared, let alone attempted to implement, any broader joint strategies.

From November 1987 until March 1990 I worked as a researcher with the TAPS project. So far this project's task has been to evaluate the reprovision of hospital services for the long-term mentally ill from two hospitals in the North East Thames Region (Team for the Assessment of Psychiatric Services, 1988). My work involved gathering clinical and social data from over 250 patients and their carers after they had spent a year out of hospital. Most of these patients were suffering from schizophrenia. The design and first results (Team for the Assessment of Psychiatric Services, 1990) provide an objective account of this research. In contrast, this paper intends to put forth a subjective view of some of the problems encountered while obtaining these data in the community. This situation faced the researcher with unique and challenging circumstances that are not normally discussed in the scientific presentation of follow-up data. Its aim is to pre-empt similar difficulties for other community reserarch by providing guidelines. I am going to cover three areas: arranging interviews, conducting them safely, and handling situations that necessitate stepping out of the interviewer role.

Units to admit psychiatrically ill mothers with their babies to psychiatric hospitals were pioneered follow ing Main's description (1958) of the treatment of mothers with their children at the Cassel Hospital. Particular interest in puerperal psychosis and dis orders of bonding and attachment led to units usually providing for babies below six or 12months. Suggesting older infants should also be admitted, Main referred to the benefits in admitting parents to paediatric wards with ill children, and described how toddlers had been admitted with their mothers at the Cassel. Another early unit at Banstead Hospital cared for schizophrenic mothers with their babies and found that joint admissions lead to faster recovery, lower relapse rates and more babies continuing to live with their mothers (Baker et al, 1961).

The main aim of this pilot study was to identify factors influencing acute psychiatry bed use. The reasons for occupying a bed vary with time, so patients in the study were assessed on a weekly basis to monitor the changes in the factors thought to be responsible for continued stay. The reasons for bed occupancy also are often only known to those professionals directly involved in day to day care of patients, and it is suspected that the reasons often have little to do with manifest psychiatric illness. The reason for this study was to investigate this question.

In 1979 a survey of Hackney's psychiatric in-patients revealed that many were resident simply because there was nowhere else for them to go. (Lomas, 1979). As a response to this, the Community Psychiatry Research Unit (CPRU) was set up, and a team of support workers appointed (from nursing, social work and occupational therapy backgrounds) to assist in re-housing and to provide continuing care. Developing projects have meant that the role and job description of this support team have constantly changed. To review their present role, we decided to assess the day-to-day activities of three workers so as to improve our understanding of their function, training needs and work load. Details of the assessment criteria for taking on patients have been outlined by Rich et al (1989).

Within psychiatry there are two distinct tendencies. On the one hand there is the tendency for the subject to expand beyond its concern with psychological medicine and encroach upon diverse aspects of society. “The psychiatrist who believes that the phenomena of mental illness can be explained on the basis of a universal theory … finds little difficulty in inflating his theory to explain not only mental disease but also normal human behaviour, interpersonal relations, and ultimately human affairs” (Miller, 1970)

The career paths of many trainees in psychiatry are influenced by their experience of a six month SHO/registrar training post in a particular speciality. Not all trainees, however, may be aware of the training requirements for a specialist consultant post, career prospects and most importantly of the practicalities of working on a day to day basis as a specialist consultant or a consultant with special interest or responsibility. Furthermore, some SR trainees may have a limited choice of placement in a SR training scheme and with the diminishing availability of pure general psychiatry consultant posts, a year's training at senior registrar level may determine a trainee's whole career.

Addenbrooke's Hospital is large (approximately 1,000 beds) and serves the functions of an academic and teaching centre, as well as providing acute care in medicine, surgery and the specialties for the inhabitants of Cambridge and the surrounding area. Before January 1989, all psychiatric beds were located at Fulbourn Hospital, three miles from the main Addenbrooke's site and all liaison psychiatric cover was provided by links between individual medical and psychiatric teams. However, since that date, a small in-patient psychiatric unit has been established on the Addenbrooke's site and at the same time, in order to gain closer compliance with the Royal College Guidelines (1988), arrangements were made for one of the registrar posts associated with this unit to form part of a liaison psychiatry team.

The Institute of Psychiatry accepts approximately 30 postgraduate students each year from overseas countries. The composition varies, largely as a result of international economic changes, and since 1977 students from 60 countries have attended (Appleby & Araya, 1990). Knowledge of English also varies and can influence the training of a student in many ways. Difficulties in understanding and communicating with patients, colleagues and teachers can adversely affect study, clinical practice and examination performance. MRCPsych results are poorer for non-UK than for UK doctors (Cawley, 1986): one reason may be poor communication.

Consumer attitudes are of the utmost importance in achieving adequate care of a psychiatric population and may directly influence compliance with drug treatment, attendance at out-patient appointments and willingness to accept admission to a psychiatric unit. It is therefore surprising that despite the original Griffiths Report (1987) highlighting the need for consumer input into the psychiatric audit process, little research has been undertaken in this area and knowledge into the quality of inpatient care is especially sparse.

The view (Anon, 1990) that “drugs for Alzheimer's Disease (AD) are generally ineffective” is a reasonable conclusion to draw from the results of treatment studies to date. However in recent years there has been a rapid expansion of knowledge of both basic neurobiology and the pathology of AD. Future advances may be expected to arise from this, so when the authors of Drugs and Therapeutics Bulletin next review this subject they may well be able to draw a more optimistic conclusion.