Hospital visiting teams, review bodies, and inquiries have become a fact of life in psychiatric settings in the Health Service. In the last 20 years or so there has been an intensification of efforts aimed at examining and evaluating psychiatric services. There can be no doubt that the purpose of the visits—to monitor and improve standards of care and to facilitate changes in service delivery—is a worthy and important one. Clearly, too, a great deal of expertise and energy goes into the visits. Descriptions of the range of visits and the arrangements involved, as reflected in the HAS Annual Report (1985–1986), are impressive.

The Marlborough Family Day Unit has been in existence for 10 years. It is part of the Marlborough Family Service, a community-based psychiatric service for patients of all ages. Its location is the site of the former Marlborough Day Hospital in London NW8. The Day Unit was created in 1977 by Dr Alan Cooklin who is still the consultant in charge of the whole service. The reason for setting up such a unit was to experiment with new ways of dealing with what is now so fashionably termed ‘multi-problem families’. These are families where one or more members have been in extensive contact with psychiatric and social services. Multiple hospitalisations, removal of children into care, and general chaotic behaviour are the presenting ‘symptoms’. Such families have unrivalled skills in collecting agencies and professionals like flypaper and making it very difficult for anyone to leave the field given the enormous anxiety created all round.

Over the past 20 years the Department of Psychological Medicine at King's College Hospital has gradually taken responsibility for the provision of psychiatric services to the East Lambeth sector of the Camberwell Health District. A small District General Hospital (DGH) in-patient unit was opened in 1972, and since then it has been the aim of the Department to provide a comprehensive locally based psychiatric service. Slow progress has been made compared with the developments that have taken place in the South Southwark sector of the District, which have been fostered by the Maudsley Hospital. With the impending closure of Cane Hill Hospital, on which the District has historically relied, the object of a completely local service is rapidly becoming a reality. Releasing the resources hitherto tied to the large institution presents an unparallelled opportunity for change.

In July 1986 we went to Moscow and Leningrad to visit refusenik physicians and to learn about the medical and psychiatric problems of this community. Refuseniks, the several thousand Soviet Jews who have applied for—and been refused—permission to go to Israel, suffer considerable official and unofficial punishment. We were interested in the effects of this treatment on physical and mental health as well as in the experiences of Soviet Jewish physicians who apply for emigration. Our information comes from discussions with a number of doctors in both Moscow and Leningrad who gave us examples from their own experiences and those of their patients.

The South Camden Schizophrenia Survey was started in 1985 with Regional Funding through the Locally Organised Research Scheme. Its overall aim is to explore the disabilities and needs of those individuals recognised by the services within an inner-city area as suffering from schizophrenia. The survey has also been the first step towards setting up a computerised case monitoring system, named ‘Safety Net’, which is being developed as a means of keeping track of the needs and progress of these vulnerable individuals. This enterprise will develop a community-wide perspective directed at targetting the deployment of services to those most in need. This article gives a preliminary account of the progress so far and highlights our experience of carrying out research within the community.