People working in the field of social psychiatry concern themselves with social factors which may affect the onset, duration or outcome of psychiatric disorders. This concern encompasses the full range of psychiatric conditions and virtually every aspect of the structure of society, so that in this short review we can only attempt to convey the flavour of the subject and to highlight some salient contributions.

The paper describes the therapeutic programme of the Young People's Unit, Macclesfield. Admission is based on a therapeutic contract agreed with the youngster and family. Data on the first 150 admission to the Unit are presented. The information was collected from all referring agencies and a sample of youngsters and parents after an average period of two years since discharge. Results were similar to those of other follow-up studies of discharges from adolescent units, i.e. 78 per cent of neurotic disorders, 53 per cent of mixed neurotic and conduct disorders and 47 per cent of conduct disorders showed improvement. There was a high incidence of recurrence of the most significant presenting symptom (72 per cent). Nevertheless, referrers and youngsters showed a positive attitude to the treatment experience. The possible relationship of this to the contract system is discussed. A longer period of stay was found to correlate positively with improvement in conduct disorders. There is a need for further research into what aspects of a treatment milieu produce significant and lasting changes in conduct disorders.

A two-year follow-up inquiry was made of the residuum of a cohort formed by all senior registrars in general psychiatry in post in late 1974. Of the original 155, nearly half are in permanent posts, but only three-quarters of these are in general psychiatry in the United Kingdom. Twelve have already emigrated.

Two child observation and assessment centres run by a Social Services Department have quickly filled up with older children who stay indefinitely. Many of these children have physical as well as emotional problems and have been admitted as family emergencies in an unplanned way. The paper discusses how, if at all, the psychiatrist called in for advice by social workers can help. This is thought to be a widespread problem.