Those working with families in the field of child abuse often find themselves becoming intimately involved with Family Law. Although the involvement may produce confusion and frustration in professionals untrained in the law, it may also help facilitate appropriate and effective treatment of severely disordered families. I believe not only that legal framework can help those working in the mental health field, but also that a psychotherapeutic understanding of individuals, families and groups can aid lawyers steer families more effectively and humanely through the legal process. By the term psychotherapy I mean a body of theoretical and clinical knowledge concerned with looking at people's conflicts, feelings, anxieties and reasons for actions, which includes an understanding of the unconscious processes of the mind. A psychotherapeutic approach cannot provide a substantial basis for legal theory, for the latter is heavily weighted towards the notion of the ‘reasonable’ man, whose unconscious ideas and emotions are significant only if they lead to an intention to act illegally and the carrying out of the illegal act. However, the day-to-day practice of law may perhaps be enriched by a more rigorous attempt to understand human emotions, particularly in the often emotionally painful areas of Family Law. Moreover, I suspect that there are a number of shortcomings in the current complex, sometimes muddled, way that families have to deal with the law, which the proposed new legislation (DHSS, 1987) may not address. A psychotherapeutic understanding of some of the reasons for this muddle as well as of the general issues in this field may have benefits for lawyers, mental health workers and clients.

The 1983 Mental Health Act was introduced to increase the safeguards of the civil liberties of patients. One of the new provisions is that it is now the statutory responsibility of hospital managers to inform detained patients of their rights; this is done by giving them a leaflet explaining the appeal procedures. Doubt has been expressed (Dunlop, 1979) about whether this is an efficient means of conveying information to acutely ill patients.

Psychiatric patients often break society's rules and find themselves before the courts. Sometimes an offence is the first sign of mental illness. The coincidence of mental disorder and an offence complicates both assessment and management, but particularly the latter.

Our aim in this paper is to examine the current practice of psychiatry in relation to race or ethnicity in England. The problems that European psychiatry has in relation to black people in a white and predominantly racist society and the responses to these from within the professional sphere are only one aspect of our current topic. We merely mention these to contextualise the problems black people experience as a result of institutional psychiatry. Our main aim in this paper is to articulate the oppression black people experience in relation to conventional psychiatry and to seek ways of confronting and changing this, very much as part of the larger, black struggle in the UK. We believe that the alternative that we propose, based on black experience of psychiatry, is equally valid in other contexts where questions of disadvantage and discrimination are the overriding themes. Although the theoretical basis of our work is grounded on issues such as inequality and structural oppression and the need to confront and change them, a detailed analysis of these topics is beyond the scope of this paper. Instead, we examine the practice of professional psychiatry in relation to black people in the UK and argue that the model that is imposed on us is antithetical to the interests of black minority groups. We also look at practical ways in which our community is beginning to organise in challenging such professional orthodoxy.

A method for estimating the psychiatric manpower needs of a district has been described in the Bulletin (Watson, 1986), and while the data presented in that article were for general psychiatry the approach to this issue can be modified for specialist services.

Over recent years a number of non-hospital based services have been developed that can be subsumed under the title of Community Mental Health Centres (CMHCs). Conferences held by the King's Fund (McAusland, 1985) and the National Unit for psychiatric Research and Development (Sayce, 1987) have highlighted the importance of CMHC-like services in health authorities' plans to develop community based psychiatric services. There is no single view of CMHCs in the United Kingdom and, while many such centres already exist, they are diverse in nature and their activities have been sparsely documented.

The David Lewis Centre for Epilepsy has approximately 300 adult residents. All have epilepsy, which is often only partly alleviated by available treatments; many have mental handicap or psychiatric illness, adding to their total disability. The Centre's explicit aim of understanding and caring for people with epilepsy implies concern not just for clinical measures such as seizure frequency, but for our residents' quality of life.

Although psychiatric hospitals contain a population at risk of suicidal behaviour compared to the community at large, suicide in hospital in-patients and recently discharged patients is relatively rare. It has been suggested that hospital admission itself reduces the risk of suicide (Tenroche et al, 1984). Factors considered important are a calm ward routine carried out by staff confident in the immediate future, and the opportunities for social contract offered by the ward environment.

Privatisation of psychiatric care is an increasing phenomenon in the USA. This is a relatively new trend and has followed on the heels of other trends like the deinstitutionalisation of the 1960s and 70s. Until recently the majority of in-patient population was in public hospitals, with some in psychiatric units of general hospitals. In the 1980s, the private hospital corporations seem to have discovered that there is money to be made in the business of psychiatric care and started building and marketing psychiatric hospitals on a wide scale.

A previous article in the Bulletin describes the ‘BTC’ (Been to Canada) scheme sponsored by the Nova Scotia Department of Health to bring psychiatric trainees to Canada in order to undertake a year's clinical work in addition to ongoing medical education under the auspices of the Department of Psychiatry at Dalhousie University. Over the years the scheme has attracted a number of graduates, some of whom have been prompted to stay on and develop rewarding careers. The original article by Munro and colleagues (1987) describes the programme from the sponsor's perspective and might well be complemented by this account from a BTC graduate who has now returned to the National Health Service.

This short paper is an aperitif that touches on the main issues involved in research methodology for the psychiatric trainee but which understandably cannot explore any of them in depth. It accompanies publication of a book published simultaneously by the College (Freeman & Tyrer, 1989), the orientation of which has been affected greatly by experience gathered during a series of courses in research methodology organised under the auspices of the Research Committee. These courses have demonstrated the need for a basic text on research methodology that is sensitive to the aims and resources available to trainees and also a guide that helps to avoid the pitfalls in research that often are discovered too late to be overcome.

The emphasis of psychiatric care is being moved from the large mental hospitals towards community-orientated care and there seems also to be a need for a shift in the training of psychiatrists to include greater emphasis on the special issues involved in this approach to service provision.