The way in which residential and other forms of continuing care have developed in the United Kingdom has been reviewed (Lewis & Wattis, 1988). It has been a story of unclear policy and confusion, especially in respect of people with dementia. At present there is a lack of clarity about who is responsible for providing continuing care for demented people. Traditionally, their care was shared between social services Part III (including EMI – for the ‘elderly mentally infirm’) homes and NHS psychogeriatric and geriatric beds.

The quality of care which patients receive within the NHS is dependent upon the communication between general practitioners (GPs) and specialists and the letter is the most widely used instrument in this process (Freeling & Kessel, 1984). There are only a few studies which have evaluated the efficiency of communication between the GP and the hospital specialist. For example, de Alarcon et al (1960) showed that 96% of specialists' reports to GPs were found to offer a definite contribution to the understanding of the case, whereas 4% were “vague and useless”.

Following the 1983 Mental Health Act, Mental Health Review Tribunals (MHRT) now provide the opportunity for patients to have their detention reviewed and give a right of appeal against compulsory hospital detention or guardianship (Bluglass, 1983).

The purpose of this study was to establish whether any agreement existed about the side-effects of lithium carbonate between the consultant psychiatrists in a single health district responsible for care of patients maintained on lithium therapy.

As more people with mental handicaps∗ (MH) live in the community, in line with government community care policies (Department of Health, 1989), referrals to CMHTs∗ and other community based services will increase. Such referrals may be routine, urgent or emergency, come from various sources, and concern health and social care needs.

With the move towards community care, the problem of wandering behaviour in psychogeriatric patients may pose a barrier to their placement in residential homes. The prevailing wisdom that this behaviour increased around twilight was looked at by Evans (1983) whose study showed increased restlessness in the late afternoon in a nursing home population. Cohen-Mansfield et al (1989), however, did not find any clear pattern of behaviour related to sundown. This study examines only wandering behaviour and controls for seasonal change in twilight times.

Adolescent psychiatric services differ considerably in terms of the patient groups they seek to address and in their modes of treatment (Health Advisory Service, 1986). The Prestwich Adolescent Unit is a general purpose, seven day, regional service for adolescent psychiatry, based in Salford Health Authority. Serving a population of 4½ million, it offers a mix of in-patient, day-patient, out-patient and consultation/liaison work, specialising in the treatment of mental illness.

The life of an institution may come to an end. The closure of a large mental hospital is an event of great emotional importance analogous to the death of an individual. Man has developed a set of rituals to help him cope with emotional turmoil released by bereavement. Since the death of an institution is not common the need for mourning rituals is not so generally acknowledged. We describe a ceremony to mark the closure of Cane Hill Hospital, Surrey.

At a meeting of the United Kingdom Standing Conference for Psychotherapy on 7 March 1992, a series of working papers describing the organisation of a register of psychotherapists was discussed, amended and accepted.

It is increasingly recognised that all consultants have to undertake management responsibilities at several levels. Consultants are an expensive resource and it is therefore fundamental that they manage themselves and their time effectively. Secondly, consultants need to manage their resources, both the clinical team and the facilities available to it. Thirdly, the consultant has a strategic role in developing the service to meet the changing needs of the population served. Finally, some consultants may choose to undertake executive management roles such as clinical director or unit general manager. In these roles a broader view of overall service provision is necessary.

Trainees are often called upon to organise educational events. We hope that our experience will be helpful and that some of the lessons we have learnt will be of use to others.

It is considered valuable for senior registrars to have experience of liaison with other agencies and of setting up and evaluating projects as part of higher training in community psychiatry (Guthrie, Black & Osborn, 1991; Royal College Of Psychiatrists Working Group, 1990). However, this may not be easy to arrange due to, for example, lack of suitable opportunities and insufficient time for initiating a project and carrying it through. Such projects are often difficult to establish and the trainee may find that a good idea founders on a variety of unexpected problems.

Violence is an important consideration in the management of psychiatric patients. Probably one in ten psychiatric patients assault staff (DHSS, 1988), although this may be an underestimate (Lion et al, 1981). Fellow patients are assaulted less frequently (Nobel & Rodger, 1989). Several factors have been associated with violent behaviour in patients: suffering from schizophrenia, delusions, hallucinations (Noble & Rodger, 1989); being young, compulsorily detained and an increased use of temporary nursing staff (James et al, 1990).

The Audit Commission has drawn attention to local champions of change in mental health services. Good Practices in Mental Health (GPMH) (1985) has highlighted a district which has overcome some of the myths about the impossibility of transforming the service, and recently the Institute of Health Services Management (IHSM) Working Group (1991) has entered the debate with “good psychiatric services can be developed in areas where managers are determined to introduce improved services”. The Audit Commission singled out Torbay Health Authority, GPMH highlighted Exeter Health Authority, and the IHSM Working Group have listed 12 exemplary health authorities (including Torbay and Exeter) where good local services have been developed.

In mid 1988 after Piper Alpha but before the Lockerbie disaster, the Social Work Department and the Mental Health Unit independently began to discuss plans for a post disaster counselling service. Over the next few months a joint working party was set up which during 1988 and early 1989 evolved the service described below.

An important emphasis in developing community psychiatric services has been to increase accessibility of psychiatric services to the public (Department of Health, 1989). This might mean not simply informing people about available services but also providing advice about mental illness and where individuals might seek further help, either for themselves or for others about particular problems.

The main body of Jelgava Psychiatric Hospital, in which I spent my week, consists of 14 or so adult and psychogeriatric and two child psychiatric wards. It was built about ten years ago. An alcohol and drug abuse unit, an out-patient department, and a small day hospital catering mostly for the ‘neuroses’ are found near-by.

It is widely acknowledged that the medical profession can be highly stressful. In addition, practitioners in many developing countries face the peculiar problems of poor remuneration, lack of necessary clinical facilities and a heavy clinical case load (due to the lack of qualified manpower). Such a scenario can easily aggravate those medical practitioners with pre-existing deeply rooted emotional conflicts as well as personality vulnerabilities and can result in mental decompensation.

You have all used a database at some time or other, although perhaps not on a computer. For example, every time you look up someone's phone number in your address book, or look up a patient's registration number in the card index file in medical records, you are using a database. Information of any type is easier to sort and find if it is organised into categories.