Mental Illness Specific Grant was made available to local authorities for the care of people with severe mental illness, as part of care in the community. Although only a small sum of money it has had the effect of giving the newly created community care planning system a boost start. It has enabled professionals from all agencies to see tangible benefits from collaborative working. MISG is time limited but has already shown that health and social services can work together to make a reality of community care.

In a retrospective study, referrals to a community old age psychiatry service were obtained for local practices a year before and a year subsequent to the introduction of prospective general practitioner (GP) fund-holding. Although overall patterns of referral were the same, there was a significant reduction in domiciliary consultations requested by fund-holding GPs which was not balanced by a rise in other referrals. The findings suggest a shortfall in the number of referrals to old age psychiatry services in the light of GP fund-holding, prompting speculation as to the fate of those who would otherwise have been referred.

Learning disability services care for the needs of patients whose autonomy of thought and action is impaired by processes that often cannot be reversed. Their autonomy may also be limited by external influences such as carers' attitudes, both positive and negative. Others may therefore find themselves making decisions for such patients. The case presented in this paper illustrates how these factors can condemn a wealthy woman to a life of relative poverty, lacking in pleasures she could so easily afford, because she lacks competence in some areas of decision making. A possible solution is proposed.

The law in England and Wales regarding consent to treatment is of some complexity, but it remains true that hospital patients have two basic rights: to refuse treatment of any kind, and to leave hospital. Two hundred and seven teaching hospital in-patients were asked about their care, and what would happen if they exercised these rights. Informal psychiatric patients were the most likely to disagree with their treatment in hospital, while almost half of all patients did not know that they had the right to refuse it. Many anticipated coercive responses from staff. Patients in hospital should be better informed of their rights.

Attempts to deliver quality service outside the traditional mental hospital to those with chronic mental illness have resulted in several new models of care. We describe one such model of alternative care and asylum. Considerable improvements in quality of life, quality of care and clinical state occurred.

There has been a substantial increase in the number of Mental Health Review Tribunals (MHRTs) and hence the cost of administering the tribunal system. We report an estimate of the cost of MHRTs taking account, for the first time, of both direct and indirect costs to the various government departments. We estimate that the total cost is currently £12,274,380 per annum.

The use of electroencephalography over a three year period in a large mental handicap hospital was studied. There were no significant differences in its use according to sex or intelligence. The majority of requests were made following seizures and in the investigation of behavioural abnormality. In over a quarter of cases the EEG requests appeared to be inappropriate. It is suggested that a more cost-effective use would result if EEGs were requested only in those cases in which the result will lead to a change in the management of the patient.

All staff based in a newly built acute psychiatric unit for more than six months were asked about the difficulties they encountered in the implementation of their duties and what changes they recommended. The problem areas identified included poor design and location of nursing observation station, lack of proper seclusion facilities, insufficient ventilation, unsafe position of the roof garden, exposed beams and supports, proximity to the lake and inadequate interview facilities for all staff. The urgent recommendations included alteration in the design and positioning of observation station, improving ventilation, making the roof garden safe, and covering all exposed beams and supports. The desirable changes included extra interviewing facilities and a spacious observable television room. Consultation by mental health professionals during the initial stage of designing of psychiatric units is essential.

Circumstances surrounding emergency detention under the Mental Health (Scotland) Act were examined, with particular regard to whether consent was obtained from a third party. Twenty-eight ot 100 consecutive detentions occurred without consent. These patients were more likely to exhibit aggressive behaviour and be detained by a psychiatric registrar or senior registrar. Mental disorder was doubted more often and detention was less often continued. Reasons given for failing to obtain consent were frequently inadequate and possible explanations are discussed. Increased education and supervision of trainees resulted in a substantial fall in cases of non-consent in a follow-up sample.

The idea for this committee of Council came from Professor Andrew Sims when President of the College. A Working Group of the Education Committee produced a report on continuing medical education (CME) and the first meeting was held in February 1992 under the chairmanship of Dr Fiona Caldicott, then Dean. Following her election to the Presidency in 1993 Professor Sims took on the chairmanship and the committee has now met ten times to date.

Eighteen psychiatric trainees from St George's Hospital were placed in three local general practices for periods of six months each. The aim was to broaden their postgraduate education by an experience of primary care and to test the feasibility of such a scheme. Their assessments of the placement were canvassed by postal questionnaire. All considered the experiment a success but there were a number of problems. Resistance among the trainees was much greater than expected. Some of the relationships in practice posed problems for them and the ongoing demands of their psychiatric training exceeded the practices' expectations. Supervision by the GP trainers was rated very highly and old knowledge returned rapidly.

Sleep disorders are common in psychiatric and non psychiatric consultations. Yet there is very little education and training available to medical trainees in the UK. In this paper we describe our experience in a sleep laboratory during a part time six months attachment. We feel that a basic knowledge and experience in assessment, investigations and treatment of sleep disorders and involvement in academic and research activities in this field should be considered to be a part of the psychiatric training schemes.

We have written this paper trom the perspective of a trainer and a trainee who have each participated in the psychological treatments course run for senior registrars training in child psychiatry on the North West Thames Rotation. The course aims to provide senior registrars with an integrated training in the three major psychological therapies: systemic family therapy, cognitive-behavioural and psychodynamic therapy. It was hoped that, by the end of the course, trainees would have a good theoretical and clinical grounding in each model at a medium level of expertise.

Professor Patricia Casey of University College, Dublin explains why it is worth risking the microphones and phone-ins