Recent developments in psychiatry have required increased inter-disciplinary collaboration to ensure co-ordination of specialist skills. Simultaneously, changes in management structures of participating disciplines have produced vertically organised systems of management with multiple tiers often referred to as line management. The membership of multidisciplinary teams (MDTs) now comprises individuals at varying levels in management hierarchy and with different abilities to contribute to the decision making process. Managers usually impose attitudes, expectations and obligations on staff working in MDTs which are often major obstacles to effective teamwork by causing ambivalence and opposing loyalties leaving individual workers in invidious positions (Fagin, 1985). This paper reviews current thinking on multidisciplinary teams and present day management structures among disciplines in psychiatry and discusses the practical problems and areas of conflict resulting from their interaction in settings where MDTs are expected to operate.

The desire to provide care and services for people with mental health problems in a community context, rather than in large institutions, is a long-established feature of Government policy. In the more local context of the Portsmouth and South East Hampshire District Health Authority, a strategy of decentralising both the organisation and the delivery of services for adults with mental health problems began to be implemented early in 1986. Five multi-disciplinary area community mental health teams would work with and alongside other service-providers in their localities to provide a range of support, including residential, day and other community and domiciliary services.

Over the last ten years it has been shown that it is possible to treat the majority of patients with acute psychiatric illness in their own homes. Home treatment has been shown to produce a superior outcome to hospital care on measures of symptomatology, subsequent independent living and employment status (Hoult, 1986) self-esteem (Stein & Test, 1980) and may decrease the need for re-admission. Additionally, home treatment decreases the burden felt by the relatives (Pai & Kapur, 1982) and may enable them to cope better with the patient after the acute episode.

It was with some surprise that I learnt I should be settling but a stone's throw away from Baron von Münchhausen's birthplace in today's West Germany. The house at Bodenwerder on the Weser where he was born now serves as the town hall; the Münchhausen family had obviously been influential in the area for when I began to work in the psychiatric hospital at Moringen, I found that the original building had been erected by them in 1738.

The nature, management and disposal of patients who present to casualty departments and receive psychiatric diagnoses by the assessing doctor are areas that have received scant attention by psychiatric researchers. The aim of this study was to analyse the records of such patients to see how they had been managed, in particular to document the degree of psychiatric intervention provided or offered, and to see what follow-up arrangements, if any, had been made.

In recognition of the fact that schizophrenia disorders remain a major public health problem presenting a severe limitation to the success of community-based approaches to mental health care, a programme was started in 1985 with the goal of developing family care of schizophrenia within the NHS.

SafetyNet is a computerised, networked patient care system currently under development in the South Camden sector of Bloomsbury Health Authority. The project is primarily targeted at the clinical monitoring of people suffering from schizophrenia and the system incorporates measures which can provide a basis for quality assurance of care and a clinically driven approach to audit. SafetyNet is being designed to help keep track of individual sufferers, chart their needs as they change over time, prompt the services to action and knit together the responses needed from different agencies. It is a modular system which can be adapted to the needs of people with different kinds of mental illness and to different community populations.

Last year, I was very fortunate to be able to attend a workshop at Sheffield University on Rational Emotive Therapy – fortunate because Dr Albert Ellis of New York, who conducted it and who founded RET, is surely one of the most remarkable figures on the international scene in psychiatry. His presentation is frankly dramatic, but he insists that far from being undesirable, this quality may be essential in transmitting a therapeutic message to the patient.

The first Pan African Conference in 1961 made a number of recommendations to guide the development of psychiatric services in emergent African countries. The purpose of this paper is to show that the application of these recommendations, admittedly serendipitously at times, led to a considerable measure of success in Zimbabwe.

The decision concerning who is fit to practise medicine is rightly considered a serious one and universities hand this responsibility to a small number of senior clinicians. However, it is on patients that the doctor will practise and while all patients have a concept of what makes a good doctor, their views are never canvassed in the Final MB.

Little did we know, as fledgling conference attenders, what lay in store for us when we learnt that our papers had been accepted for the VIIIth World Congress of Psychiatry in Athens, October 1989.

The Maudsley Hospital Junior Common Room (JCR) Complaints Book was opened on 28 January 1959 by the secretary of the JCR, Dr R. H. Cawley (RHC). Complaints were to be entered on the left-hand page only leaving the right “for replies thereto”.