It is in the nature of Health Services that there should exist a balance between the general and the specialised; between the treatment of common conditions with generally applicable techniques and the handling of more unusual diseases. Services which require scarce skills and treat less patients who need more time are expensive. In a cost-driven situation, these skills are likely to be constrained in favour of more generally applicable, lesser standards which are cheaper.

In recent years, the care of people with long-term and persistent mental illness has been shifting from institutional to community care with a consequent increase in the use of informal carers. Given that both professionals and carers are human resources contributing to the health and well-being of patients, it is surprising that so little research on the needs of carers or means to improve their effectiveness has been undertaken.

This report describes the use of the needs for care assessment (NFCA) in measuring symptom and social function in patients with long-term mental Illness. The schedule recommends specific care interventions and these were implemented where appropriate. The problem status of the patients was reassessed using the needs for care schedule after the interventions had been offered and tried. The recommended care items were within the compass of our rehabilitation service, were rarely refused by the patients and there was an improvement in symptom and social function. These findings provide some validation for the concept of unmet need.

A survey of 101 new attenders at a regional drug and alcohol service found that 46 adults had a total of 88 children at home. Twenty-three children were considered by their carers to show signs of emotional or behavioural disturbance. Difficulties had only been discussed with professionals in a minority of cases. Help for troubled children from primary care services was preferred to secondary services. Closer liaison between child psychiatry and primary health care workers should be considered.

The views of referring general practitioners (GPs) on a psychogeriatric service were obtained through a questionnaire. Most GPs were satisfied with the service. A number of GPs wanted faster responses to referrals, telephone discussions after initial psychogeriatric assessments and more communication with consultants. In response to these findings, secretarial staff was increased and telephone discussions with referring GPs are to follow initial assessments of all urgent and emergency referrals.

A postal survey was conducted within four regional Health Authorities to ascertain how widely the supervision register had been applied in its first year of operation in adult mental health. A 72% response rate was achieved. The results showed that the register has been absorbed organisationally but is less accepted professionally. One hundred and nineteen of the 367 consultants in the sample (32%) had no entries on the register at 31st March 1995. The provision of training on its use had a significant effect on compliance, although London-based services had marginally less registrations per consultant than their colleagues elsewhere. Very few outside agencies had required access to the register.

The Internet, a military creation, is a collection of services shaped by its users, and offers the rapid transfer of vast quantities of information. Already there is concern that Developing World countries may be left behind by this revolution in information availability. Psychiatrists need to be aware of the type of facility the information in the superhighway provides, so that the useful aspects can be refined and directed. The type of facilities in use now by psychiatrists around the world is briefly described.

A postal survey of the drug treatment of behavioural emergencies by senior registrars and consultants in psychiatry revealed that 90% would initially use a non-depot antipsychotic (including 24% who would combine it with a benzodiazepine if the situation warranted), and 10% the short-acting depot, zuclopenthixol acetate, with another antipsychotic or a benzodiazepine, or both. The choice was made from a restricted range of drugs, with haloperidol being the most popular antipsychotic and diazepam the most popular benzodiazepine. Half of respondents did not consider British National Formulary maximum dose recommendations to be useful for rapid tranquillisation and many would exceed them. A substantial minority did not consider that adequate resuscitation was available at their unit and deficiencies were revealed in the training of junior doctors and in the audit of rapid tranquillisation. Very few psychiatrists reported that their units had written guidelines.

Patients waiting for psychotherapy show high levels of morbidity and distress from psychiatric symptoms and a high frequency of personality disorder diagnoses. They constitute a group at risk of completed suicide. Local NHS provision is less than half the minimum amount of treatment needed.

Psychosis is often associated with Parkinson's disease. The cause of the psychosis cannot usually be confirmed but it may be due to disease progression or, more commonly, to the drugs used in the management of Parkinson's disease.

In contrast to other professional groups, psychiatrists currently receive little formal training in the use of the Mental Health Act (MHA). This article describes a locally organised training day for senior registrars and reports on their previous experiences and future training needs in the use of the MHA.

Freeman (1992) advocated the setting up of a network of College Research Training Coordinators to provide practical assistance and supervision for trainees engaging in research for the first time. A recent debate held at a College Research Training Coordinators meeting in York under the Chairmanship of Dr Chris Freeman debated the motion “All trainees should undertake research”. This has stimulated us to think again about our own attitudes towards this question.

I am foolish enough to believe that just because I was successful at my senior registrar appointment interview, my preparation was good enough and my wisdom worthy of passing on to the next generation of candidates!

The greatest unnameable fear for all of us who are parents is that of losing a child. We hear about it in others, we read about it in the papers and a cold chill touches us. The most common deaths are sudden in accidents but many parents have to cope with the long drawn-out trauma, alternating hope and fear, of sickness. No-one can ever know if or when or where they may experience the policeman at the door or the embarrassed compassion in the doctor's face.

The major problem of manpower planning in psychiatry has until fairly recently been one of securing enough posts in the training grades to place doctors wishing to train in psychiatry and to ensure an adequate supply of applicants for consultant posts. Numerous consultant vacancies and a ‘bottleneck’ between registrar and senior registrar grades was the frustrating combination largely consequent upon the failure of some regional health authorities to fund the posts which Joint Planning Advisory Committee (JPAC) had approved.