European Integration confronts both Individual psychiatrists and psychiatric service planners with ethical dilemmas that should best be dealt with proactively by medical and psychiatric organisations. Selected examples are presented of ethical Issues arising out of differences In psychiatric practice across Europe. Some of the ethical implications may seem relatively minor, but still require a major adjustment effort on the part of psychiatrists who are exposed to transcultural practice In the European Union. Other examples have been selected, not because they are common, but because of their massive ethical ramifications.

One hundred and nine consultant psychiatrists completed an anonymous questionnaire on the suicide of patients In their care. A patient suicide was reported by 82%, of whom 47% had experienced their first patient suicide within five years of entering psychiatric practice. A formal review of the suicide had occurred in 24% of cases. The study examines the perceived effects of their first patient suicide on the professional practice of the respondents, and measures the personal stress related to it, using the Impact of Event Scale. We discuss the implications of this common experience for psychiatric training programmes.

We surveyed 119 psychiatrists to see how they would act with a patient who has taken a potentially lethal overdose, has no mental illness, and is refusing treatment. There was substantial disagreement. There may be a risk of action under civil law whether the psychiatrist decides to treat the patient without his or her consent or not. The Law Commission are examining whether mental disorder, as defined in the Mental Health Act 1983, should be used as a test of Incapacity to give consent to medical treatment. Such legislation would help doctors but may encourage a wide interpretation of the definition of mental disorder.

There are good reasons for Improving liaison between child psychiatrists and general practitioners. This study examined whether characteristics of the GP, patient or service influenced the referral of patients from primary care to the local child psychiatry service. Data collected by semi-structured interview from two samples of general practitioners who had either referred frequently or not at all over a two year period failed to show many of the associations found in other studies. Referral behaviour appears to be a complex phenomenon which may be influenced by increasing personal contact between professionals.

In this article we give an alternative view of service provision for adolescents with emotional difficulties centred around four high schools. We believe that the service we offer differs in a number of ways and has a number of benefits for clients and other pupils and staff at the schools. We present this view of our service with some information about its historical context and as a snapshot of the current state of the service in the expectation that there will be further developments.

A pharmacy-run lithium clinic was set up In a district general hospital in order to save medical staff time, utilise pharmacist skills and provide an efficient lithium monitoring service. After one year the clinic was evaluated in terms of the control of serum lithium levels, the acceptability of the arrangements to the patients and the patients' knowledge of and attitude towards lithium therapy. We suggest this model of a lithium clinic could be usefully adopted In other psychiatric departments.

We describe the operation of a psychotherapy clinic where a one-way screen is used in the assessment of adults for a range of dynamic therapies. While observation of psychotherapeutic encounters remains contentious as an activity in its own right, we attempt to illustrate how such a way of working can be helpful to patients and staff. The potential drawbacks of this approach are discussed and ways of minimising these are explored.

The adult psychotherapist model of staffing is considerably strengthened by a clinical directorate management structure with a specific local pay scale for psychotherapists. When such arrangements exist they are usually welcomed by clinicians and managers. One reason for this is that they make it possible to ensure that services maintain good clinical standards while meeting the managerial objectives of the unit or trust. Underlying the success of these arrangements is the fact that by promoting separation and individuation they give services a firm identity. This is good for the service itself and also for the unit or trust as a whole, because separation and individuation are the basis of co-operation and integration.

As mental health care services move increasingly into the community with staff working in more isolated settings, violence against staff is becoming an increasing health and safety issue. Education and training of staff to cope with potentially violent situations is a priority, equally important is the design and physical layout of the room in which potentially violent patients are seen. This audit looked at the safety features present in consulting rooms used daily, for interviewing patients, by mental health professionals. The study identified rooms which were judged unsuitable for interviewing potentially aggressive patients in, and as a result, several recommendations for safety improvements to these rooms were made.

While conducting a study on the nature and extent of compulsory admissions to mental hospitals within the four London regional health authorities, discrepancies and inaccuracies were revealed in many of those mental hospital in-patient statistics. The nature and extent of some of these are examined. It is suggested that the value of such statistics for government planning must be questioned as is their value for research. It is recommended that a centralised system of collecting and collating such data be introduced as a matter of priority and that such a system be operated by the Mental Health Act Commission.

This article offers suggestions to psychiatric trainees who might be interested in spending a period of training in the USA, including ideas about employment, qualifications, differences in practice, and useful addresses and sources of information.

The New South Wales Mental Health Act (1990) heralded a number of important changes to mental health legislation in the state. One of these was the option to give compulsory treatment to mentally ill clients living in the community. This article briefly explains community treatment under the Act, and the perceived benefits and the limitations of such legislation. A case example is used to illustrate some of these points. Involuntary community treatment is seen as a less restrictive alternative to hospitalisation for a number of mentally ill clients, but the use of such provisions demands significant resources from the supervising agency.

Libya occupies an approximate area of 1.8 million sq. km in the northern part of Africa, with a population of 4.5 million. of the population, 97% are Muslims, 46.5% are under 15 years and only 2.3% are over 65 years of age. Sixty-four per cent of the population live in urban areas and the literacy rate is 60%. Tripoli, situated in the west, is the capital city of Libya and Benghazi, the second biggest city, is situated in the east of the country and the distance between the two cities is about 1000 km. The population of Benghazi and eastern Libya is about 2 million.

In February 1994 the Sainsbury Mental Health Initiative was launched by the Sainsbury Centre for Mental Health (formerly Research and Development for Psychiatry) in conjunction with the Department of Health and the Welsh Office to make available £3 million for selected community based mental health services. On 10 October 1994, as part of the World Mental Health Day, the eight winners were announced and invited to receive their awards at a prestigious ceremony attended by the Secretary of State for Health and many of the great and good from the British mental health scene.