Old age psychiatrists and their teams have a particular responsibility in the identification and prevention of elder abuse and in carefully examining the factors that foster ‘the corruption of care (Wardhaugh & Wilding, 1993).

There are a number of different clinical circumstances in which the issue of incoming and outgoing mail to or from a patient in a psychiatric hospital, whether detained or not, may present particular difficulties. Under current mental health legislation there is provision for post to be stopped or inspected on clinical and legal grounds (Jones, 1999), but these are fairly limited and concern only outgoing mail in specific circumstances, other than for patients detained in special hospitals (Mental Health Act (MHA) 1983). The issue of patients' mail may lead to problems in day-to-day practice where patients' desire to send or receive correspondence is linked to their abnormal mental state, is a direct result of symptoms of their illness or when it might constitute a potential or actual criminal offence. This paper reviews the relevant part of the MHA 1983 and describes three case vignettes that illustrate some of the difficulties and potential solutions to problems associated with patients' correspondence.

Establishment of boundaries, limit setting and safety of patients and staff are important aspects of mental health care delivery, but some psychiatric patients appear unwilling to cooperate when faced with appropriate limits. They may become involved in violence, criminal damage or public order offences. Rates of assault by in-patients against staff are increasing (Schneiden, 1993). In NHS hospitals this has been found to range from 0.15 incidents per patient per year in rural settings to 0.60 incidents per patient per year in urban hospital settings (Drinkwater & Gudjonsson, 1989). A high rate has been confirmed recently among psychiatrists (Davies, 2001).

Given the marginal nature of psychiatry in terms of Western health priorities, it is always worth reviewing how countries with clearly different political systems treat their mentally ill. The 40-year economic embargo imposed by the USA on Cuba, the effects of which have been compounded by the hardships suffered during the ‘Special Period’ from 1989 onwards when the collapse of the Soviet Union left the island's economy in ruins (Pilling, 2001), is one of the most stringent of its kind. It prohibits the sale of food, and sharply restricts the sale of medicines and medical equipment, which, given the USA's pre-eminence in the pharmaceutical industry, effectively bars Cuba from purchasing nearly half of the new world class drugs on the market (Rojas Ochoa, 1997). Between 1989 and 1993, Cuba's gross domestic product fell by 35% and exports declined by 75% (Pan American Health Organisation, 1999). This has reduced the availability of resources and has adversely affected some health determinants and certain aspects of the population's health status. Despite this, however, Cuba has developed a system prioritised to primary and preventive care, with an infant mortality rate half that of the city of Washington, DC (World Health Organization & Pan American Health Organization, 1997; Casas et al, 2001). Furthermore, biotechnology and family medicine are being developed by Cuba as a human resource for other developing countries. Cuban medical schools also train physicians specifically for many developing countries around the world (Waitzkin et al, 1997).

‘Doctor, would it be alright to take mum to Cyprus for a family wedding?’ In a cosmopolitan city such as London hardly a month goes by without hearing a similar sort of query. If ‘mum’ has dementia I tend to advise the family against flying. This advice is based on anecdotal observations from past clinical practice. I have witnessed a number of patients experience significant deterioration in cognition following flying. While disorientation in unfamiliar environments may explain some of the difficulties in travelling for a person with dementia, as illustrated by John Bayley in Iris (1998), this may not be the only explanation. On this occasion, I decided to use evidence-based practice to review the situation.

In psychiatric care, where patients experience a wide range of difficulties – emotional, physical, mental, social and spiritual – care must be given to the patient as a whole person. This article is about the significance of the presence of the chaplain within the mental health care team as it seeks to offer this holistic care.

New Zealand, an outstandingly beautiful country, offers an opportunity for the psychiatrist from the UK to work in an alternative environment. There is currently a shortage of trained psychiatrists to fill the available posts. The experience of a locum consultant post in adult mental health in the Nelson Marlborough Mental Health Service at the top of the South Island, at the beginning of the new millennium, forms the basis of observations made in this article, the purpose of which is to describe points of interest in the similarities and differences in psychiatric practice between the UK and New Zealand.

Uganda has a rich history of medical education (Odonga, 1989) that was severely harmed by the rise of Idi Amin and the years of internal strife. It is only over recent years that the country has begun to rebuild itself (Boardman & Ovuga, 1997).