One of the main concepts in the new Children Act (1989) is that of parental responsibility, which will significantly alter the practice of family law and that of mental health professionals dealing with the troubled family. Instead of an assumption that parents have absolute authority over their children, there is the notion of a partnership between parents and children, with the power of the parent decreasing as the child grows in maturity and understanding. There is an emphasis on partnership between parents and those who will have to share in having parental responsibility when it has broken down. Thus the new Act is essentially child centred. It affirms the principle, current in Wardship proceedings, that the child's welfare shall be the court's paramount consideration.

Community orientated mental health services are rapidly developing in Britain today, and as part of this development many community mental health teams (CMHTs) are being established. This study looks at some of the relationships between members of one CMHT and local primary health care team members and social workers, with particular emphasis on communication between these various professionals.

Lithium is a drug used extensively in psychiatry for the treatment of depression, acute mania, and the prophylaxis of recurrent affective disorders. Lithium also has a place in the management of schizoaffective disorders and has been suggested for aggression and alcoholism. The side-effects, dangers of toxicity, and need for monitoring are well documented and should be considered before starting anyone on lithium. Likewise patients should be adequately informed of the benefits and hazards of treatment.

Lithium therapy for affective disorders has been estimated to result in savings of hospital beds in the National Health Service of £23 million each year. In order to maintain and justify this saving we must invest to provide careful monitoring of serum lithium concentrations in patients living in the community. In recent years the advent of lithium clinics has done much to improve the compliance and safety of lithium therapy (Masterton et al, 1988), but we believe that there may be scope for further improvement both in the service to the patient and in encouragement of the patient to comply.

Although childhood psychiatric disorders are commonly seen in general practice, only a few children in the community gain access to professional help. Whether a child is referred or not depends on various factors to do with the child and family and others, such as what the GP expects from the referral. Severity per se is not the only referral determinant. Whether GPs know what the child psychiatric services in the area have to offer could also be expected to affect referral (Markantonakis & Mathai, 1990). We are aware of the need for general practitioners to be made more aware of the services that we have to offer.

The North West Thames Regional Health Authority rationalised its in-patient service in 1989 to fund an eight-bedded five day unit for children under 13 years of age at Collingham Gardens. Riverside Health Authority's District Child Psychiatric Day Unit was also relocated to provide ten places primarily for pre-adolescent children. The unit is staffed by a multidisciplinary team of child workers, nurses, occupational therapists, psychologists, psychiatrists, teachers, and a psychotherapist, social worker and speech therapist.

Roundway Hospital provides all rehabilitation and continuing care (rehab) beds for the Swindon Health District (Swindon), population 245,000; the Wiltshire sector of the Bath Health District (Wilts) population 200,000; and the Bath City sector of the Bath Health District (Bath), population 85,000.

An instrument for a systematic assessment of mental handicaps and associated disabilities has been needed for a long time. Recent legislation, for example the Education Act 1981 and the Disabled Person's Act 1986, introduced new statutory responsibilities for education and local authorities to assess an individual's needs. There is no standard assessment or screening tool currently available which covers all aspects of the lives of people with mental handicaps and their interaction with the environment. Ideally a data-base providing such knowledge will also be required by all professions concerned with mental handicap, particularly during the transition to community care.

It has long been felt that there sometimes occur certain dire situations, often involving the police, where our special experience has been felt to be valuable. I am unsure how well established this claim is but wish to describe one recent occasion when I was called upon in this way, in the hope that it might help others in deciding what they might have to contribute.

Recent reports have highlighted the continuing lack of adequate provision for the difficult or offender patient. The move to community care, coupled with the closing of the larger institutions, has put a strain on traditional forensic services. They are being increasingly asked to deal with the difficult, nonoffender (Glancy) patient in addition to their more traditional offender-type (Butler) patient. This paper describes how one unit has developed to serve the needs of Rotherham and neighbouring health authorities. We do this by illustrating the current lack of provision and by describing the types of patient treated over a two year period.

Forensic psychiatry is a relatively new subspeciality concerned with giving advice on, and with the assessment and treatment of, mentally abnormal offenders. The forensic psychiatrist works at the interface between psychiatry and the law.

There is an increasingly large population of those who are chronically disabled as the result of brain injury (Jennett & Macmillan, 1981). These injuries can be the result of trauma, infections, tumours, hypoglycemia, anoxia or other damaging conditions. The large majority of rehabilitation units cater for physical problems only. However, it has been recognised that patients with brain injury often develop behavioural disorders during the early recovery phase and in a few cases these persist (Eames & Wood, 1989).

The importance of interview skills in psychiatry cannot be underestimated, and the acquisition of adequate interview skills must be one of the foremost aims of training. The College requirement that MRCPsych candidates must interview the patient in front of the examiners (in both parts I and II) rightly stresses the fundamental importance of interview skills in clinical practice. Maguire (1982) has questioned the adequacy of standard methods of training psychiatrists (usually reporting and discussing interview findings with a senior colleague) in interview skills. In a study of medical students, he has shown that audio/videotaped observation of interviews with feedback is superior to traditional methods (Maguire et al, 1978). Gask et al (1988) demonstrated that use of group video feedback training was effective in improving psychiatric skills in a group of general practitioners. Rutter & Cox (1981) published a series of studies examining the effects of interview style on the quality of factual information obtained and the emotional response elicited. Such work has generated interest in interview skills training and specialised courses are now run in some centres.

There has been considerable interest in doctors' interviewing skills during the last few decades (Nuffield Working Party, 1978). Despite this interest, there has been no consensus as to how these skills may be taught to medical students. We describe the ongoing evolution of a teaching package for these skills as taught by the Liverpool University Department of Psychiatry.

Scottish Action on Dementia had its origins in informal meetings of individuals drawn from a variety of health care professions with a shared concern about the inadequacies of provision for dementia sufferers in Scotland in the mid 1980s. At the heart of these concerns lay the absence of any effective response to two major documents – the Timbury Report and SHAPE (Scottish Hospital Authorities Plans for the Eighties). Both accorded the highest priority to care of the elderly, particularly those suffering from mental illness, and had been accepted by all the principal parties concerned as the blueprint for health care policies in Scotland in the 1980s. The sober realities of 1985 prompted the founding members of Scottish Action on Dementia (SAD) to set themselves up as a multidisciplinary forum with three principal functions – to promote public education and awareness of dementia and its implications for sufferers, families and society at large; to act as an independent pressure group; and to monitor activities in the field of dementia care with a view to promoting and maintaining high standards. Five years later these objectives remain unchanged.

The dilemma of the medical practitioner as to when to break confidence and when to keep silent has again attracted the attention of the courts recently in the case of R v Crozier (The Guardian, 1990).

In the centre of Norwich stands a red brick building which has a rare place in psychiatry. Its history began on 12 December 1712 when a lease on a small piece of waste ground was granted by the Corporation of the City of Norwich to four men. The men were acting as trustees for an elderly widow, and the deed specified the purpose of the lease: it was to build a house, or houses for “the benefit and use of such as are lunatics.” The term of the lease was 1,000 years at an annual rent of one peppercorn. The widow was one Mary Chapman. Born in 1647, she was the daughter of Thomas Mann, Mayor of the city and one of the richest and most influential men in Norwich. It is thought that she grew up close to the city's Bridewell, where many difficult lunatics would have been housed, and she is known to have had immediate experience of mental illness in her own, and her husband's families. In 1682 she married a widowed cleric, Samuel Chapman, some years her senior and the vicar of a local parish. Together they made plans for the Bethel but in 1700 she was widowed and left childless. Despite this she continued to develop her charitable project. The final choice of name, Bethel, or house of God, was her husband's.

The above quotation comes from the general public group discussions which were part of MORI's survey on public attitudes to mental health. This investigation was commissioned by the Mental Health Foundation as part of the events making the charity's 40th anniversary appeal.