In successfully recruiting patients for drug trials in dementia the Therapeutic Research Unit for the Elderly (TRUE) had referrals from various sources. The local Memory Clinic (MC) provided 38 patients for screening of which 31 (81%) were recruited, 75% of the overall number recruited. This number was small (n=41) despite various efforts and does not reflect the time invested and amount of contact work with GPs, out-patient departments and other psychiatric services.

The memory clinic provides a source of recruitment of patients for drug trials as well as services for those who do not qualify for such trials. But recruiting without the aid of a memory clinic is difficult and time-consuming and new approaches must be found.

The use of mental health legislation in a Regional Adolescent Unit over a 10 year period was reviewed. There was a trend of increasing use over time. This was thought to reflect changes in attitude and professional practice subsequent to the introduction of the Children Act 1989. Conversion rates of Section 5(2) were high and practitioners with appropriate training were involved in the majority of sections, indicating good practice.

A questionnaire was sent to a random sample of 339 psychiatrists on the Royal College mailing list, enquiring about their practice of screening and risk disclosure in patients at risk of tardive dyskinesia. The response rate was 70%. There was wide variation in the rate of informing patients of the risk. Over half of the respondents felt that knowledge about tardive dyskinesia would reduce compliance, a view which predicted a low rate of informing patients. There was support for the issuing of clinical practice guidelines by the College. Psychiatrists need further education about tardive dyskinesia.

Non-attendance rates are high in child psychiatry clinics. This potential waste of resources is coming under increasing scrutiny within the NHS. This study shows that therapists themselves are good at predicting who will attend and who will not. The family's previous attendance rate is the most reliable predictor. Why then is not more use made of this information when organising clinics? Ways are suggested how attendance rates might be improved.

Lay involvement in clinical audit has been advocated but rarely reported. Since early 1994 in the mental health unit at Airedale, Yorkshire, lay representatives have participated in all stages of clinical audit, Including selection of topics and methods, data collection and standard setting. After 8 months of lay involvement, all respondents to a brief questionnaire saw lay involvement as important, although none identified specific benefits that had already occurred. The paper outlines themes in respondents' perceptions of the benefits and problems of lay involvement and in their suggestions for minimising difficulties.

Learning medicine and psychiatry is a moral as well as an intellectual challenge. Successful training in psychiatry can lead to significant personality maturation. Using poetic examples, the paper explores aspects of emotional development relevant to the traditional values of dynamic psychiatry. Such values are contrasted with those of the prevailing bureaucracy.

Detention of general hospital in-patients under Section 5(2) is a rare occurrence. This study of the use of Section 5(2) in general hospitals uncovered a frequent neglect in following the guidelines of The Mental Health Act and The Code of Practice. Surprisingly the conversion rate of Section 5(2) to Section 2 or 3 was similar to that seen in a number of other studies conducted in the quite different setting of large psychiatric hospitals. A number of patient characteristics were identified that appeared to influence whether 5(2)s were converted to an admission Section. Each general hospital needs to develop guidelines to be followed when staff feel that a patient should be detained under Section 5(2) – an example of such a policy is included.

Liaison psychiatry is a relatively new and expanding speciality in the UK. A survey conducted in 1990 revealed widespread inadequacies in the training opportunities and resources in consultation liaison services (Mayou et al, 1990). In spite of a growing recognition of the need for more consultants with designated responsibility for general hospital patients, there is currently no formal training programme and many psychiatric schemes fail to provide satisfactory supervision and training opportunities in liaison psychiatry (House & Creed, 1993). The Manchester University liaison psychiatry course was developed in 1993 and is currently the only advanced liaison training course in the UK. Lasting five days, it provides an opportunity for senior psychiatric trainees to improve their specialist knowledge and to develop clinical, research and management skills in liaison psychiatry. The course does not give a comprehensive review of all aspects of liaison psychiatry but aims to generate ideas and discussion through skills based seminars, case discussion and workshop exercises.

Over the last 20 years the Spanish system for postgraduate education has been channelled, for all specialities including psychiatry, through the MIR Exam (Medico Interno Residente). This is an exam that all Licenciates in medicine and surgery (the Spanish equivalent for the British MBBS degree) can take after finishing their medical school training.

The APA is concerned about its declining membership. Only 16 700 psychiatrists were able to attend this year's meeting in New York and many of them came mainly to consult the job bureau in search of employment. For the first time unemployment is a real issue for psychiatrists as health care providers restrict services and seek alternative and cheaper patterns of care. Most health care organisations have lists of approved psychiatrists and anyone not on that list is not able to claim reimbursement for their services. Exclusion may be because of unreported and unchallenged complaints about care or conduct or a penchant for expensive drugs or high risk therapies. In this context a high risk therapy is one which exposes the insurers to a high risk of litigation, such as ‘recovered memory therapy’. The buzz in the corridors, which used to be of art collections, the new home by the lake or the costs of putting the kids through college, is now of managed care. These dread words reduce the most ebullient colleagues to anger or tears. Some time ago I reported in amazement the discussions at an earlier meeting on alien abduction, ritual abuse, multiple personality disorder (110 different individuals in one body was then the record) and the false memory syndrome.

On 1 April the mental health section of the Home Office's C3 Division was renamed “Mental Health Unit”, as part of a wider initiative to streamline the Department and give more meaningful titles to the various different areas of work. The responsibilities of our Unit remain the same, however. First, we deal with the cases of restricted patients under mental health legislation. As well as advising Ministers or taking decisions on their behalf about leave, transfers and discharge, the Unit also authorises the transfer of mentally disordered prisoners to hospital. This prison transfer work is focused in a separate section of the Unit which is able to provide a very rapid response to urgent requests for transfer warrants. The number of transfers has gone up from 337 in 1990 to over 700 in each of the last three years.

The story of ‘mad-cow’ disease has been closely followed by the media in Brazil with a nagging concern that it could happen here. Beef is big business in Brazil, there are 169 million head of cattle, a high beef consumption (35 kg per person per year) and a thriving export trade; indeed Brazil is one of the main providers of corned beef to the UK. If BSE were to be found in Brazilian cattle it would be a massive problem. However, before the investigative journalists had a chance to dirty their boots on the nearest cattle ranch, a respected authority was quoted as saying that there had been no reported cases of BSE in Brazil and since cattle were not fed protein that came from other animals, the risk of it developing was extremely low.

During my years in rehabilitation and community psychiatry I have picked up a number of aphorisms which I believe enshrine some of the lasting truths in this field. I have always liked Albert Kushlik's remarks about doctors as the “hit and run” staff in terms of the duration of their contact with patients. But over the years other aphorisms have been brought to my attention by colleagues or students, although I can claim to have coined a couple myself.

Academic psychiatry at Keele University reached its 10th birthday in 1996. In 1986 John Cox was appointed to the foundation Chair of Psychiatry in what was then the Department of Postgraduate Medicine (Cox, 1990; Barrett, 1991). The School of Postgraduate Medicine was established in 1989 and along with it a formal Department of Psychiatry. There is no undergraduate medical school at Keele and the School of Postgraduate Medicine, with 14 full Professorships, is now the largest in the United Kingdom, outside of London. The Department of Psychiatry has expanded in size since 1989 and has one Professor of Psychiatry, four Senior Lecturers and two Lecturers. With its busy MRCPsych teaching programme, a Diploma and MSc in General Psychiatry and research activity it has made a significant contribution to the raising of the standards of North Staffordshire psychiatry. From its small beginnings it has now attained a national and international profile.

The West Suffolk Strategy to Combat Alcohol Misuse and the first edition of the Good Beer Guide to Belgium and Holland hit the streets on the same day. More importantly the press releases hit the newsdesks of the regional media by the same post. Fortunately, alcohol is entertainment and alcoholism is public affairs so none of the news editors twigged that the two publications had the same author.