“There they stand, isolated, majestic, imperious, brooded over by the gigantic water tower … the asylums which our forefathers built with such immense solidity to express the notions of their day. Do not for a moment underestimate their powers of resistance to our assault” (Enoch Powell, 1961).

Smoking accounts for 15–20% of all British deaths (Royal College of Physicians, 1983). Smoking-related diseases incur considerable cost to the NHS and smokers' materials cause 39% of accidental hospital fires (Batten, 1988).

Many admissions to general adult psychiatric beds occur as emergencies due to social crisis or relapse of psychiatric illness. Other admissions are planned to arrest or reverse deterioration. Length of stay varies 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).

The number and diversity of rating scales and tests of psychiatric status has increased dramatically in the last 20 to 30 years. Tests are in screening, e.g. for dementia the Mini Mental State Examination and the Abbreviated Mental Test; to aid clarification of the diagnosis in difficult cases, e.g. Walton-Black New Word Learning Test, to differentiate between depression and dementia; and in assessing severity of symptoms, e.g. Hamilton Depression Rating Scale.

Stones of mishap and disaster have a grisly if reluctantly acknowledged appeal. Who can resist flicking through the annual reports of the medical defence organisations or reading the epitomes of the Health Ombudsman? What newspaper editor with an eye for the circulation figures omits tales of human misfortune?

Studies have shown that significant physical morbidity exist within psychiatric units (Honig et al, 1989), yet general medical care is often left in the hands of psychiatrists who may not always be the most appropriate people to deliver it (Colenda et al, 1988). The new general practice contract places certain obligations on the general practitioner (GP) with regard to his or her patients, especially the elderly, yet these provisions do not extend to many of our patients. Our study looks at four areas of health care and examines how they are delivered to long-stay patients in a district pyschiatric unit with no GP input.

When any organisation is exposed to pressure to change, this not only mobilises considerable anxieties within the organisation but calls a variety of defensive operations into play. The work of Jaques (1955) and Menzies Lyth (1959, 1988) has demonstrated that this can result in the central problem ceasing to be the focus of attention, with primitive defensive mechanisms (often of an obssesional or paranoid kind) being mobilised. This process may either lead to energy being devoted to isolated elements of the situation, or staff withdrawing into a state of passivity and hopelessness. Indeed, Jaques has observed that when changes are imposed on an institution in a way which fails to take account of the functions that existing structures serve in relation to the deeper needs and anxieties of those working within the institution, such changes are likely to be resisted, and may even fail.

This audit examined 65 consecutive admissions to a psychiatric hospital in the Irish Midlands over six months. The admissions came from a defined sector with a total population of 39,000. In the year prior to the study major changes in the delivery of psychiatric care in the sector were instituted. These changes included the introduction of admission guidelines and extra resources in the community. The general practitioners who see mental illness at first contact were informed of these changes. Attempts were made by the sector psychiatrist team to screen for appropriateness of admission with regard to the special groups such as alcoholics, the aged and the mentally handicapped.

We report on the first two years of a novel, controversial approach in East Dorset where consultants in old age psychiatry have taken on the consultant responsibility for patients who have mental handicap. We discuss our experience as it may be of interest to others where there are problems recruiting consultants in the psychiatry of mental handicap.

For more than a decade there has been no opportunity for formal post-graduate training in psychiatry in Romania. In February 1992, as part of a World Health Organization (Regional Office for Europe) initiative, we travelled to Romania as WHO temporary advisers to give seminars on: (i) the role of primary health care services in providing mental health care; and (ii) the development of community-based services for the mentally ill and disabled. Our seminars were designed to complement the biological and clinical elements of a developing psychiatric training programme.

Academic medicine in South Africa was created largely by talented graduates who, having travelled overseas (especially to Britain) for postgraduate training, returned to teach in the newly established medical schools and teaching hospitals. However, over the past three decades fewer have decided to return. Consequently academic medicine generally is in decline. Hospital specialists are demoralised, and about 80% of those recently surveyed indicated that they intended leaving the public health service if the present imbalance between service commitments, research opportunities, and poor pay persists (Curtin, 1991). About 40% of graduating medical students emigrate, usually to avoid conscription. The continuing violence and political uncertainty within the country probably ensure that few will ever return.

This series of articles is based on a course of five seminars which formed part of the Postgraduate Teaching Programme at the Crichton Royal Hospital. It aims to provide an introduction to computer terminology and to the most commonly used software applications for those with little or no previous knowledge of computers. The emphasis throughout is on what the personal computer can do rather than how to use specific applications. The articles refer mainly to the more common ‘IBM-Compatible’ computers.

Disability Living Allowance (DLA) is a new benefit which was introduced from April 1992. Note, however, that claims for DLA have been accepted from 3 February 1992 with payment starting from April.

Developments on the world political scene over the last year have had far-reaching effects on the lives of ordinary people in areas such as the Middle East and Eastern Europe. For the International Rehabilitation and Research Centre for Torture Victims (RCT) in Copenhagen these changes have led to a huge increase in calls on its service. In 1991, the continuing opening up of Eastern Europe made it possible to reach out to new countries where support is needed to establish centres offering training in RCT's treatment methods and information about torture, while the Gulf War created more urgent demands on its resources.

How relevant is the training which postgraduate psychiatrists from the developing world receive in the West? Are the investigations, treatment, and clinical practices taught in the UK transferable across widely disparate cultures? Should trainees be taught basic psychiatry or only sub-specialities? Should they come at all?

Careers in psychiatry which commence straight after house jobs are now commonplace and an informal tradition by which future child psychiatrists worked in paediatrics before training in psychiatry is nowadays less rehearsed. Recently, one of the St George's psychiatric registrar rotations arranged a six month post as a community child health doctor (community clinical medical officer) for a psychiatric registrar (JD) who had expressed an interest in child psychiatry as a career but lacked experience in paediatrics.

The organisation of psychiatric emergency services varies widely in the UK. These can usefully be viewed as a spectrum. At one end are traditional services where the GP acts as the primary filter to admissions. At the other extreme are crisis intervention teams aimed at managing the patient in the community. Somewhere along this spectrum of service provision lie the emergency walk-in clinics. There have been few studies on how effective these different arrangements are.

Our countrymen, including ourselves, share numerous prejudices.

We are sexist, racist, ageist, chauvinist (an un reasonable patriotism), and classisi (by birth, wealth or education). We also share that fear, dislike and rejection of the mentally disordered, which I would like to call the prejudice of ‘psychiatrism’. Not only those who suffer are stigmatised – but so are their carers.

In recent years registrars on psychiatric training rotations have been encouraged to begin their research careers early. Most of them are in such (training posts) for three and a half years. A few with extensive previous experience in other areas of medicine will be in post for less than this. The usual pattern of work with such schemes is to change both posts and accompanying routine every six months. At no point during this time will they have time allocated for research per se unless they are a fortunate member of some of the training rotations which include this in the weekly timetable. Such time has to be begged, stolen or borrowed from the hapless consultant who is all too aware of the service shortfall in his or her own area. If the registrar is fortunate enough to find an accommodating senior, this may not be the situation in his or her next post, which renders long term research well nigh impossible.

In his memorial speech given on the 30th anniversary of the Chinese Society of Psychiatry in Taiwan, the founder of the Society, Professor T. Lin, spoke on the evolution of psychiatry in Taiwan. He stressed that the “building up of psychiatry from almost nothing against all odds” just after World War II in an area where “the general attitude of the medical profession as well as the lay public to psychiatry was characterised by indifference and contempt arising from their ignorance and also prejudice against mental illness” (Lin, 1961) is like Robinson Crusoe surviving on his desert island. Today, the Society with its 518 members has had considerable success in the development of psychiatry in Taiwan.