I am grateful of the honour the President and the College has bestowed on me in accepting the presentation by Lundbeck Pharmaceuticals of my bronzes of Henry Maudsley and Erwin Stengel, as part of the 150th Anniversary Celebrations. Special thanks are due to Professor Hugh Freeman for his assistance in this regard.

The co-ordination of services for the long-term mentally ill in the community poses difficulties of organisation. Each country has its own health and social service structure which influences the development of such services. This paper outlines an approach to co-ordinating care in Portsmouth. The mental health services were well known in the ‘30s because of their community orientation due to the leadership of Thomas Beaton, the superintendent of St James' Hospital (Freeman, 1962). The city has a population of 210,000. Previous seaside holiday accommodation is now utilised for residential care homes for the elderly and the mentally ill.

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.

If high quality services are to be provided for the elderly mentally ill throughout the country it is now recognised that specialist teams are needed, led by adequately trained old age psychiatrists (Wattis et al, 1981).

Section 48 of the Mental Health Act, 1983 (MHA) permits the Secretary of State to authorise the removal to hospital of an unsentenced prisoner who is ‘suffering from mental illness or severe mental impairment of a nature or degree which makes it appropriate for him to be detained in a hospital for medical treatment and that he is in urgent need of such treatment’. (Mental Health Act, 1983). Its common usage in the past has been in transfers of unsentenced prisoners from prison to hospital.

Skill in physical medicine is an often neglected area in psychiatric training. It is nonetheless very important, particularly in the care of the elderly. The need for reciprocal training in geriatric medicine and old age psychiatry was highlighted in Care of Elderly People with Mental Illness (1989), the Joint Report of the Royal College of Physicians and the Royal College of Psychiatrists on services for the elderly and medical training. It recommends that, “Higher professional training for specialisation in the psychiatry of old age should include at least two months experience in geriatric medicine”, and suggests that this previously optional experience should become an obligatory part of specialist training. It indicates the alternative ways of gaining such experience: a short secondment, a weekly sessional commitment or a direct exchange of posts.

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.

The Royal College of Psychiatrists' Guidelines for Training in Liaison Psychiatry (1988) recommend that trainee psychiatrists have the opportunity of working closely with an individual ward or department. Such an attachment may involve the trainee psychiatrist in staff support. This paper describes the involvement of a psychiatric trainee in the development of support structures in a hospice during a liaison attachment. The project not only shed light on the causes of staff strain in palliative care settings, but also provided an opportunity to participate in management.

When Britain committed an armoured division to the Gulf in the autumn of 1990, it was inevitable that psychiatrists and other mental health personnel would be required. Battleshock, or combat stress, is important to the Army – it not only accounts for significant numbers of casualties in any land war, but, unlike other casualties, represents a potentially avoidable loss of manpower and important source of reinforcement. Based largely on the experience of Arab-Israeli conflicts it is believed that, with appropriate management, up to 90% of battleshock cases can be returned to duty within seven days. Moreover, it is thought that early recognition and intervention may reduce the incidence of PTSD and other long-term psychiatric sequelae (Foy et al 1987; Solomon & Benbenishty, 1986). Fortunately, Battleshock claimed few victims in the Gulf, due mainly to the brevity of the land war and the high state of motivation and morale of the allied force. The effectiveness of the Army's policy of early recognition of battleshock cases with minimal medical intervention on the battlefield and rapid return to duty remains uncertain and untested (Dunning, 1990).

This article addresses Jadresic's quandary (1992) on management training. Learning about management requires the same process as learning about medicine; it is not just another topic or qualification to add to a CV. Doctors need to incorporate management skills into their everyday working lives to ensure the effective delivery of care to their patients. All trainees manage. They organise duty rotas by negotiating with colleagues, they prioritise their clinical workload etc., so they have a sound management base.

How would one find out the following information? Where to find a needle exchange in North Shields, residential rehabilitation for a drug user in Gwent, advice for a solvent misuser in Bradford, an urgent detoxification for a heroin user in London or alcohol counselling in Fife? One could contact the duty psychiatrist at the local hospital or even the duty social worker in the relevant social services district. However, if they did not know the Regional Drug and Alcohol Unit should be able to help. But if they were unable to, where else could one turn?

On Saturday, 9 March 1991, I had a great fall. I think I'd been heading for it for a year or two – rushing endlessly and never quite catching up. I was just back home from the Section for the Psychiatry of Old Age's meeting in Chester. I hurried downstairs and lost my footing. My right leg shot suddenly down seven or eight stairs, leaving the left behind; I didn't even make the bottom of the staircase. The pain, swelling and distortion clearly indicated something more than a sprain. My first thought was of my appointments diary, crammed for the next two months. My second was “I hope I don't get a DVT!”

Violence is an important consideration in the management of psychiatric patients. Probably one in ten psychiatric patients assault staff (DHSS, 1988), although this may be an underestimate (Lion et al, 1981). Fellow patients are assaulted less frequently (Nobel & Rodger, 1989). Several factors have been associated with violent behaviour in patients: suffering from schizophrenia, delusions, hallucinations (Noble & Rodger, 1989); being young, compulsorily detained and an increased use of temporary nursing staff (James et al, 1990).

Higher professional training is designed to produce consultants and in general this aim is achieved by combining the increasing practice of consultant-like activities (clinical, teaching, administration) with the opportunity to consolidate basic skills and knowledge and to undertake research. This combination of the practical and the intellectual is regulated by clinically and academically responsible professional bodies. While the same principles apply in psychotherapy, there are a number of special features.

Single issue political movements (such as feminism, anti-racism, Marxism, homosexual liberation, animal rights etc) have been a major characteristic of the post-1960s radical scene in the United States and Western Europe. While such movements typically start out doing a good job, it is my assertion that they have now reached the point of posing a serious threat to medicine at large, and to psychiatry in particular.

Since the 1970s there has been a growing trend for psychiatrists to establish formal attachments to primary care and these now form an important component of community psychiatry (Strathdee & Williams, 1984). In this paper a six stage plan for the establishment of a psychiatric attachment is proposed. The framework outlined may be modified in the light of local service, training and research needs.

The multidisciplinary team and its functioning have been much debated. Such teams have been encouraged as a basis for good clinical practice. However, exactly how these teams should function has gone through various phases. With the advent of family therapy, some teams have experienced a process of crisis and the dismantling of more traditional ways of working. This has brought about a lot of disillusionment within teams and also a challenge to medical authority in the team. Unfortunately, it seems that family therapy as a treatment approach has been confused with the organisation of a multidisciplinary team. Considerable stress has been produced in the process as each professional has vied for a position and role in the team.

The Audit Commission has drawn attention to local champions of change in mental health services. Good Practices in Mental Health (GPMH) (1985) has highlighted a district which has overcome some of the myths about the impossibility of transforming the service, and recently the Institute of Health Services Management (IHSM) Working Group (1991) has entered the debate with “good psychiatric services can be developed in areas where managers are determined to introduce improved services”. The Audit Commission singled out Torbay Health Authority, GPMH highlighted Exeter Health Authority, and the IHSM Working Group have listed 12 exemplary health authorities (including Torbay and Exeter) where good local services have been developed.