Confidentiality and psychiatric practice

The environment in his district sounds very different to that in our own. The question remains about the difference between a psychogeriatric service and a social service. It is our opinion that caring for most dementia sufferers requires special skills. Given that much care will be provided by staff who do not have the benefit of a lengthy professional training, it seems to make sense to employ these people as part of a NHS psychogeriatric service. Within this service it is possible to arrange some basic training from doctors, nurses, OTs, physios, psychologists and even social workers. Furthermore, it enables the nursing assistants to have quick and easy access to the pool of expertise about dementia from these professionals. We also do aim to offer our services to all clients with dementia. None of this is to say that we do not work closely with social services, nor that we may not change in the future. PAULWHITBY JOANRULE GILLJOOMRATY Tonini Hospital Tonna, Nealh West Glamorgan SAH 3LX


Support and stay
DEARSIRS Dr Macdonald is quite right that there are "marked differences in the balance between health and social services provision for the elderly demented across the country" (Psychiatric Bulletin, April 1991, 15, 224).
The environment in his district sounds very different to that in our own.
The question remains about the difference between a psychogeriatric service and a social service. It is our opinion that caring for most dementia sufferers requires special skills. Given that much care will be provided by staff who do not have the benefit of a lengthy professional training, it seems to make sense to employ these people as part of a NHS psychogeriatric service. Within this service it is possible to arrange some basic training from doctors, nurses, OTs, physios, psychologists and even social workers. Furthermore, it enables the nursing assistants to have quick and easy access to the pool of expertise about dementia from these professionals.
We also do aim to offer our services to all clients with dementia.
None of this is to say that we do not work closely with social services, nor that we may not change in the future.
PAULWHITBY JOANRULE GILLJOOMRATY Tonini Hospital Tonna, Nealh West Glamorgan SAH 3LX Confidentiality and psychiatric practice DHARSIRS J. V. McHale raises important forensic issues in her note (Psychiatric Bulletin, March 1991, 15, 60) Recent legal decisions in the North Americas could well soon find their way to these shores. In those parts, it has been decided, in Tarasoff and other cases that mental health professionals can be held liable for failing to warn third parties of possible dangers to themselves (Mackay, 1990).
In a comparable field of activity, probation and parole officers in the USA have, in some instances, been held to be similarly so liable (though there have been conflicting judgments) (Sluder & Del Carmen, 1990). It is to be hoped that those in the indemnity business are busy exploring the implications of Egdell and the North American cases. Forewarned may well prove to be forearmed. Yes, I mean throughout patient and staff areas excluding only bathrooms and lavatories. Our patients have complete freedom of movement and are not required to wear catheters. They are regularly taken to the lavatory by nursing staffand it is the high quality of nursing care which underpins the success we have in keeping our patients continent and our carpets odour-free.

HERSCHEL PRINS
The addition of carpets to an environment, already considered quite homely by virtue of other furnish ings, completes the picture by changing the 'feel' and greatly reducing the rather bright, noisy quality so typical of many other uncarpetcd institutions. The excellent domestic service does indeed play a vital role in maintaining the carpets in their present con dition but I can assure Dr Jolley that this is not at the expense of the secretarial delays described by him.
Dr Jolley has visited a number of units which he feels support his anti-carpet philosophy. I urge him to widen his horizons, remove his noscplug and make haste to my service to be enlightened.

DEARSIRS
The recent publication of four articles on MCQs in the MRCPsych (Psychiatric Bulletin, February 1991. 15, 87, 88, 90 and 108) is to be applauded for provid ing some helpful guidelines on how to approach them and should be welcomed by trainees as the uncer tainty of what awaits and is expected of them is a source of considerable anxiety. Such strategies as those suggested may help reduce the anxieties induced by this particular part of the exam and im prove candidates' performance. The fact that candi dates are obliged to pass the clinical examination and