Compulsory treatment in the community has engendered considerable differences in opinion, and the recent rejection of a supervision order by a Parliamentary Committee. The arguments were recently debated, at a Section meeting of the College. More detailed research and a wider discussion within the College, and between the College and other interested parties, is needed. Refining these issues, whatever the legislative outcomes, should lead to improvements in community care.

This paper examines the relationship between noncompliance with depot medication and readmission to hospital of patients with schizophrenia. Noncompliance is associated with being of no fixed abode and readmission under the Mental Health Act. The merits of a community supervision order are discussed.

There has been much recent government legislation affecting mental health services. Some relates to the delivery of general health and social services, of which mental health care forms only a part, and some specifically to the delivery of mental health care. The complex interplay of the legislation is explored and there are suggestions for the further involvement of psychiatrists.

A case report is presented which highlights two important, but rarely evoked, aspects of mental health law. In this case, the mentally ill person's nearest relative did not wish to act as such and rescinded his responsibility in favour of another. This other person objected to the use of section 3 of the Mental Health Act 1983 and displacement of her as nearest relative was considered. Some cases from the literature are cited to help clarify the meaning of “unreasonable objection” as used in the Mental Health Act 1983.

The Introduction of the new contract and budget-holding practices hat given general practitioners more say in the care given to their patients by secondary care units and other providers of health core. It is therefore important that the views of GPs be taken into account when service requirements are determined. This study compares the treatment choices of GPs with those of consultant child psychiatrists in the management of childhood psychological disorder. The doctors were also asked to indicate treatments they thought were harmful or ineffective. To the best of my knowledge this is the first UK study to compare child psychiatrists' and GPs' treatment priorities.

The extrication of seriously mentally disordered offenders from all stages in the criminal justice system from arrest to imprisonment is a major role for both general and forensic psychiatry. A survey of inmates in Cardiff Prison referred to an ‘out-patient’ forensic psychiatric service held weekly is presented. An alarming number of referrals were patients with schizophrenia.

This paper contributes to a debate about the nature of religious belief and its relevance for the practice of psychiatry. The need for dialogue is recognised not only because of multi-faith UK society but also because mental health services are now more tailored to the expectation of patients. To understand the possible relevance of spiritual and existential dimensions to mental illness, even in a secular society, has become more necessary. Training, service delivery and research issues are briefly addressed.

The contribution of the chaplain to patient care is rarely discussed and is sometimes forgotten. This paper discusses the role of the chaplain in a regional secure unit.

A survey of the medical management of 75 mentally handicapped in-patients with epilepsy was carried out between June and December 1991. The study focused on the number and type of anti-epileptic drugs used, the frequency of monitoring of serum anti-epileptic drug levels and the nature and frequency of other blood tests carried out. Quality standards were then agreed and the survey repeated a year later. The results show that the agreed standards were generally achieved, although a large number of patients continued to receive more than one type of anti-epileptic drug.

Registrars in psychiatry do not routinely have the opportunity to learn about systems theory and its application to psychiatric practice. The authors describe their experience of organising and teaching a course on the application of systems thinking to psychiatry and family therapy. The trainees and their tutor welcomed the broad and interactive approach to teaching which was thought to be very relevant to training in all psychiatric sub-specialities.

The importance of thorough induction courses for junior doctors when they start new Jobs has been highlighted. This paper describes an induction course for trainees in psychiatry starting work in a community trust which included information on how to interact with the personnel department, on the services provided by the trust and on the organisation of education within the trust. The results of feedback from the trainees are presented showing that they found it a valuable experience.

For the devotee of Wim Wenders, the German film director, London was the place to be this summemr. The National Film Theatre showed all his films, his latest (‘Far Away, So Close’) opened, and the full five hour cut of Until the End of the World’, was shown in July.

Two years ago, the government set out a strategy for improving health in ways that can be measured. Health of the Nation set down specific targets, including those for reductions in death rates from heart disease, cancer and accidents. For mental health, targets are more difficult to specify. The goal the government set is “to improve significantly the health and social functioning of mentally ill people”.

For those people who have the cognitive and social impairments described as a learning disability, personal choice is more often than not a limited experience, (Mencap, 1989). Simple choices may be usurped by the preferences of carers, and more serious decisions may be correctly or incorrectly deemed beyond their capacity. We will address two questions which repeatedly face clinicians working with adults with learning disabilities. First, how do we ascertain a person's level of competence to give consent in relation to medical treatment? Second, in the case where a person with learning disability is considered unable to give informed consent to treatment, how do we proceed to make a decision regarding treatment?

“We have no credibility”. That was the response of a woman with a mental illness who put a complaint to the Health Service Ombudsman. Unlike many – not just patients but also a significant number of NHS staff – she had heard that the Ombudsman could carry out a completely independent investigation of complaints although she was not clear about the extent of his jurisdiction. Some people feel intimidated when trying to take on what they see as a powerful and defensive NHS and others experience a sense of despair that because of their illness their concerns have no validity. Those providing care and treatment generally do the best they can to attain high professional standards but delivery does not always match expectations and the outcome can be a complaint. Services for the mentally ill are not immune from shortcomings and, if local management fails to satisfy the complainant, the Ombudsman can step in.

I am not a brave person. I have never been tempted to sign up for the armed forces, go parachuting or enrol on an Outward Bound course. It was therefore as much a surprise to me as anyone to find myself in January, travelling through central Bosnia, in flak jacket and helmet in an armoured personnel carrier. Together with my three female companions we had been despatched by the EC to investigate allegations of systematic rape and sexual abuse of Muslim women.