This is a retrospective study of 173 consecutive admissions to a general psychiatric hospital. The aim was to establish the frequency and adequacy with which alcohol and tobacco use were recorded. Regarding alcohol, in 41% of the notes there was no adequate quantitative history, in 29.5% there was a descriptive mention and in 29.5% no history was recorded. Female patients were less likely to have an alcohol history taken than male patients. With tobacco, in 64% of the notes there was an adequate quantitative history, in 6.4% there was a descriptive comment and in 28.9% no history was recorded. It is to be stressed to all doctors that an assessment of alcohol and tobacco use should be made for every patient, whatever their age, gender or ethnic origin.

This paper reflects on a special edition of the journal History of Psychiatry and a related symposium held at Somerville College, Oxford, exploring the innovations in mental healthcare in Oxfordshire led by Dr Bertram Mandelbrote between 1959 and 1988. I draw on clinical culture, biography, mental health policy and my lived experience to understand Mandelbrote's life and work, and his legacy and lessons for contemporary psychiatrists. I explore the ecological niche that Mandelbrote created and conclude with the probable importance of his relationship with Professor Michael Gelder, who led the University of Oxford Department of Psychiatry at the time.

Freeman (1992) advocated the setting up of a network of College Research Training Coordinators to provide practical assistance and supervision for trainees engaging in research for the first time. A recent debate held at a College Research Training Coordinators meeting in York under the Chairmanship of Dr Chris Freeman debated the motion “All trainees should undertake research”. This has stimulated us to think again about our own attitudes towards this question.

Health inequalities in psychiatry are well established, with people living in poverty and those from minoritised groups receiving different care and experiencing worse health outcomes. Psychiatric patients experience significant differences in life expectancy compared with the general population. This article explores changes within psychiatric services and public health interventions that could address health inequalities and asks why this has not happened yet.

The number of psychiatric beds in Friern Hospital in North London was steadily reduced in line with plans to close the hospital in 1993. Meanwhile some discharged patients deteriorate, most of whom have schizophrenia, with significant and multiple disabilities of a chronic nature and are service dependent as described in the recent report of the Royal College of Psychiatrists (1993). Return to their accommodation may be prejudiced by their relapse and the attendant disturbed behaviour. The poor employment prospects too are unhelpful in rehabilitation, particularly since we are running down and closing probably one of the best industrial rehabilitation facilities in the world. The combined effects generate great pressures on the remaining beds and there are increasing numbers in prison.

It is a common belief among staff in Nottingham's acute psychiatric services that the Rehabilitation and Community Care Services (RCCS) are slow to respond to referrals leading to blocking of acute beds. In response to this the authors examined ‘bedblocking’ while RCCS responded to referrals of acute in-patients and long stays of existing RCCS patients admitted to acute wards during exacerbations of their illness.

In 1979, I wrote a personal paper on psychiatry viewed from retirement (Jones, 1979). Six years later Wounded Healers included a chapter by me (Phoenix, 1985). In the first I was coy about the nature of my ‘personal crisis’; in the second, I could pseudonymously be frank. Now, at 76, my further account appears above my own name.

Serenity Integrated Mentoring (SIM) involved the police and mental health crisis services working in a single team, developing case management plans that allowed a seamless move from offers of therapeutic engagement (by the mental health team) to use of coercive measures (by the police) with those who persisted with frequent crisis presentations. Withdrawn after widespread criticism, the scheme raises important questions – about the practice of mental health professionals who are involved in decisions about using criminal sanctions for people presenting in crisis, about the ethical and legal status of the sharing of confidential clinical information with the police, and about the processes that professional bodies use in promoting, monitoring and responding to controversial service developments.

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.

Earlier research reported that female undergraduates performed significantly better than their male counterparts in medical school examinations. Such findings were partly explained by biases in admission policies with women (who formed only 25% of the student body) being higher achievers than men prior to entry to medical school. While some recent studies provide evidence of higher achievement levels by women (Norcini et al, 1985), it is increasingly recognised that these differences do not apply to all specialities within medicine (unpublished observation, Ferrier & Scott, 1987).

A previous article in the Bulletin describes the ‘BTC’ (Been to Canada) scheme sponsored by the Nova Scotia Department of Health to bring psychiatric trainees to Canada in order to undertake a year's clinical work in addition to ongoing medical education under the auspices of the Department of Psychiatry at Dalhousie University. Over the years the scheme has attracted a number of graduates, some of whom have been prompted to stay on and develop rewarding careers. The original article by Munro and colleagues (1987) describes the programme from the sponsor's perspective and might well be complemented by this account from a BTC graduate who has now returned to the National Health Service.