In November 1992, Lord Clyde's Report of the Inquiry into the Removal of Children from Orkney in February 1991 was published. This showed that there were similarities with what had happened in Cleveland.

Over the last few years, there has been a considerable increase in public awareness of the sexual abuse of children and the incidence of violence, often with sexual aspects, to women in their homes and elsewhere. Questions about such occurrences are now frequently asked as part of the psychiatric assessment of women patients (Palmer et al, 1992). However, only comparatively recently has the issue of sexual assault within psychiatric provision begun to be raised (Gath, 1989; Subotsky, 1991; Tonks, 1992).

Few psychiatrists have had much experience of guardianship (Section 7, Mental Health Act, 1983). The two cases described have been successful and suggest wider use of this section. It seems apposite in view of the Royal College of Psychiatrists' advice on discharge of patients from hospital, and discussion on a community treatment order; the continuing drive to community care, as codified in the ‘Care Programme Approach’; and the need in the future to treat increasingly disturbed individuals in the community as envisaged in the Reed report.

For almost four decades social policy has been directed at the closure of old mental hospitals and the resettlement in the community of large numbers of patients. Research into resettlement shows that, on the whole, individual needs are recognised, service responses are reasonably well planned, and that individual welfare has not deteriorated, at least in the short-term (Knapp et al, 1992; TAPS, 1993). Furthermore, those who receive services under the resettlement schemes are said to be better served than those who receive routine care on discharge from hospital (Allen et al, 1992).

This paper reports the results of a nationwide survey of social services responses to psychiatric emergencies. The survey is a companion to that by Johnson & Thornicroft (1991) (J&T) who reviewed the emergency service options available in psychiatry, including the emergency clinic, general hospital services, the emergency ward, acute day hospital and crisis intervention and residential services, as well as considering the role of sectorised services, and community mental health centres (CMHCs). For the purposes of our respective surveys of health and social services in England and Wales, we have defined a psychiatric emergency as “occurring when someone (patient, friend, relative or professional) requests urgent intervention on behalf of someone in the community who is suffering from a mental disorder”.

The main principle of the Children Act 1989 is that the welfare of a child at risk of abuse or neglect takes precedence over all other considerations. In complying with the Act, these considerations may include the principle of medical confidentiality and the health and safety of some adult patients. Nowhere is this more poignantly illustrated than in the case of childhood sexual abuse disclosure by a distressed psychiatric patient who may be unprepared or unwilling to cooperate with the immediate reporting and ensuing investigation of their abuse as required by the Act.

It is only in the very recent past that health care professionals have accepted the reality of child sexual abuse (CSA), and it has only been classified as a separate category in Index Medicus since 1987. Since then, the literature has expanded enormously and various treatment strategies have developed.

In April 1991, the government announced the development of a new research and development programme for the NHS. Professor Michael Peckham was duly appointed Director and the first strategy document appeared in September of the same year (DOH, 1991). The suitably broad objective of the strategy is to “ensure that the content and delivery of care in the NHS is based on high quality research relevant to improving the health of the nation”.

In December we held the last dance. Shortly after 1 a.m. the ghosts of long dead patients would have heard the strains of Auld Lang Syne drifting down the hospital corridors. Perhaps they should have joined us.