Dr McGrath was born in Liverpool in 1922. He was Medical Director of St John of God Hospital from January 1955 until December 1991 and Consultant Psychiatrist, St Laurence's (Richmond) Hospital (Beaumont Hospital from 1987), Dublin from 1956 until 1988. He was a Foundation Fellow of the Royal College of Psychiatrists and was a member of Council from 1974 to 1979, a member of the Court of Electors from 1979 to 1982 and Chairman of the Irish Division from 1974 to 1977. He was a member of Council and Censor of the Royal College of Physicians of Ireland from 1980 to 1982 and Chairman of the Section of Psychiatry of the Royal Academy of Medicine in Ireland from 1973 to 1975. He was President of the Medico-Legal Society of Ireland from 1966 to 1968 and has served on the Fitness to Practice Committee of the Medical Council of Ireland since 1989 and the Mental Health & Neurology Committee of the Medical Research Council of Ireland from 1969 to 1991.

Although the work of general practitioners (GPs) with mental illness generally, particularly in relation to minor mental illness, has been extensively examined, there has been practically no work devoted to the role of GPs in assessment for compulsory admission, either under the 1959 or 1983 Acts. The notable exception is the work of Bean (1980), who is, in some respects, highly critical, accusing them of showing little interest in patients, referring at times inappropriately, committed to the rhetoric rather than reality of care and of knowing little or nothing of the law they were supposed to be using. Bean's work is, however, a study of the 1959 Act, and no research exists on the 1983 Act which now governs section assessments. This neglect of GPs is surprising, in view of the severe consequences of compulsory admissions (sections) and research on the use of the 1983 Act already available on other participating professionals (Sheppard, 1990; Rogers, 1989). GPs are likely to be professional instigators of section assessments as well as involved in the assessment itself.

This is the second of two articles on GP referrals for compulsory admission, and seeks to examine the process and outcome of assessment by (a) comparing GP with other section assessment referrals and (b) comparing GP referrals who were compulsorily admitted to hospital with those not compulsorily admitted or voluntarily admitted. In relation to the law the main relevant sections for this article are sections 2, 3 and 4. There are two basic grounds for admission: that the patient is suffering from a mental disorder and that admission is in the interests of his/her own health or safety or for the protection of others. Section 4 requires one and sections 2 and 3, two medical recommendations, as well as an application by an approved social worker (ASW) or nearest relative. Section 2, admission for assessment, involves admission for up to 28 days; section 4, emergency admission for assessment, involves admission for up to 72 hours; and section 3, admission for treatment, allows admission for up to six months, and is renewable.

Threats made by patients to harm, or even kill, their psychiatrists, may cause great stress to both the doctor and his or her family. This potential source of anxiety is seldom discussed by the profession and is a neglected area in the literature, perhaps indicating that denial is a common mechanism used to cope with any fear engendered by such threats.

Aggression directed towards health care workers has been widely discussed (Health Services Advisory Committee, 1987), but information relating to British psychiatry has been anecdotal. The Collegiate Trainees' Committee (CTC) has recently expressed concern about the apparent dearth of training opportunities in the recognition and management of aggression, and the difficulty in obtaining post-incident counselling (1991).

The new general practitioners' contract requires the primary health care team to perform a yearly assessment of their patients of 75 and over. This includes an assessment of the ‘mental condition’. In a list size of 2,000, typically 130 fall within this age group. Screening does not have to be carried out by the doctor and as 90% are already seen at least once a year, there is scope for opportunistic screening. Nonetheless, screening increases the general practitioner's workload and while it improves the morale of elderly people, it may have little impact on medical and functional problems.

In recent years there has been increasing interest in long-stay psychogeriatric patients. Hilton et al (1989) and Anderson (1990) have described the profile and characteristics of this population, confirming clinical impressions of the severe degree of cognitive impairment and high dependency levels among such patients. At the same time, there has been a trend towards more active intervention in the type of care provided, moving away from the traditional custodial approach and towards more supportive continuing care models.

This paper describes the development of a community orientated mental health service including the introduction of a community-based admission unit. The catchment area is a compact conurbation with a population of 56,000 in a deprived part of North Tyneside. Most people come from social classes IV and V and less than 1 % are from ethnic minorities. The male unemployment rate varies from 16–24% and the area is ranked 58th (out of 192) on the Jarman deprivation indices. The primary health care services suffer from many of the problems of inner-city general practices, with the Family Practitioners Committee being the highest prescriber in the country.

The aim of this paper is to continue a dialogue regarding the possible future use of log-books during training. The Royal College of Psychiatrists has been considering their use at various stages of training in psychiatry. Cole & Scott (1991) rejected log-books as a tool for self-audit during registrar training because they were often not kept up to date. The situation in higher professional training is more complex; there is not the clear focus of studying for the Membership examination and there are many more training components to cover during a four year period. Thus, we feel that a system for self-audit and monitoring could well prove valuable at the senior registrar level. There is a tension for senior registrars with whom we discussed this issue at the last Annual Meeting of the Section and among colleagues on our rotation.

In 1987 and 1989 surveys of junior doctors' experience of behavioural and cognitive psychotherapy in the South West Thames Region were published (Drummond & Bhat, 1987; Drummond & Bhat, 1989). These surveys demonstrated that a marked increase in the numbers of trainees gaining cognitive and behavioural experience was shown following monthly visits by the peripatetic Senior Lecturer in Behavioural Psychotherapy. The number of trainees gaining experience of treating at least one case under supervision increased from 17% to42% over this period. However, this still fell short of the College recommendations that every trainee should receive this experience and treat at least two cases under supervision.

Many admissions to general adult psychiatric beds occur as emergencies, either due to social crisis or relapse of psychiatric illness. Other admissions are planned to arrest or reverse deterioration in mental state. Length of stay varies from days to months depending on reason for admission and adequacy of support in the community. Rapid readmission or failed discharge, defined as readmission within three months, has been linked with multiple previous admissions and personality factors (Jones, 1991).

From time to time I am asked to help colleagues from other disciplines with interprofessional issues. Here is an example. To avoid identifying the workers concerned, names have been changed and some details omitted.

Physicians for Human Rights (PHR UK) is an independent group of doctors and health professionals launched two years ago by Drs Ian Munroe, former editor of the Lancet and Peter Kandela, a Middlesex GP. The group's aim is to direct the influence of the medical profession towards the defence of human rights, most immediately by bringing the skills of the medical profession to the aid of victims of human rights abuses (Hall, 1991).

In 1987–88 I undertook a research project, to look at parental views on sterilisation for their mentally handicapped offspring. This project was prompted by the then recent decision of the High Court in the UK, which authorised the sterilisation of a 17-year-old girl with mental handicap, and created much controversy and debate at the time. Very little was known about the views of parents as a group in the UK on this issue, and hence the decision of our Department of Mental Handicap in Nottingham to explore this area (Bambrick & Roberts, in press).

About five years ago I was seized by the idea of working in Africa. Now, nearing the end of a two year contract at the Department of Psychiatry, University of Zimbabwe, it is time to reflect.

The Jubilee Room at the House of Commons on November 5th would seem a suitably explosive venue to launch a campaign to obtain organised funding for trainee child psychotherapy posts. A working lunch was sponsored by the Child Psychotherapy Trust and the Association of Child Psychotherapists, and hosted by Emma Nicholson, MP, a Vice-Patron of the Trust.

There can be no doubt that schizophrenia is associated with a variety of neurophysiological disturbances and disordered cognitive functioning. But we are only beginning to identify which brain areas are involved and to discover how abnormalities in these areas are related to abnormal psychological processes. This symposium, organised by Drs David and Cutting, offered an opportunity to learn about the work of both psychologists and psychiatrists in this field. Diverse research presented ranged from PET studies to the analysis of home videos, from epidemiological work to studies of cognitive performance.