It was in 1961 at the Annual Conference of MIND that Enoch Powell first announced that the traditional mental hospitals were to be run down. Since then it has been government policy to emphasise the value of a transfer of care from hospital to the community. Concern was soon being widely expressed at the growing gap between statements of proposed government policy and their realisation. It has long been the intention to close Knowle Hospital, which originally served the city of Southampton, and over the last ten years there has been a gradual transfer of some of the services away from the main hospital site. A major problem in successfully implementing the closure of any mental hospital is the appropriate relocation of the long-stay population. The problems this involves have been much debated recently.

I have recently addressed myself to the problems of teaching medical students. In my case it is that of teaching the principles of psychotherapy. It is difficult to teach about the doctor–patient relationship in the normally accepted lecture form. Definitions of transference, psychological defence mechanisms or empathy can be given, but this gives no impression of what is meant at an experiential level.

This tape deals with the transition from pre-clinical to clinical medicine as seen through the eyes of two medical students. They embark on their clinical training at Sutton Hospital where an apparently inhumane and thoughtless surgeon talks literally over the head of a recently admitted emergency. He and his entourage walk away leaving the patient unable to answer the questions of her neighbour, and presumably of herself, as to what is wrong and what is going to happen to her.

At an important interview, a candidate was asked about his experience in teaching medical students. He replied with an enthusiastic and detailed account of his seemingly extensive experience in this field. However, when asked to name one psychiatric textbook suitable for medical students there followed a fumbling and paradoxical silence. When asked the same question, although able to name a small number of such books, embarrassingly I had to admit that as a student I had never possessed any one of them. I subsequently put the question to some of my colleagues and was reassured to find that my own omission was commonly shared.

The Royal College of Psychiatrists has always been keen to promote research by psychiatric trainees. Trainees are becoming increasingly aware of the need to produce research in order to enhance their promotion prospects and to widen their own knowledge and experience. At the University Department of Psychiatry in Liverpool we have taken an active role in its promotion within the region and in the spring of 1986 we decided to conduct a survey into research activity by psychiatric trainees in Mersey Region.

‘Community Care’ has become the psychiatric catch phrase of the eighties. With this burgeoning interest go the difficulties of working not just with a multi-disciplinary team but with Social Services and voluntary agencies, a move from our ‘ivory towers’ which not all psychiatrists will view with relish. Despite initial antipathy more psychiatrists are coming to accept the fact that moving patients out of long-stay facilities is a reality and new ways of working have to be found for these patients as well as acute patients.

The relatively rigid structures of the medical and nursing professions hamper the development of an adequate mutual understanding of the experiences and contributions of each in the care of patients. It is not uncommon for medical staff in psychiatric institutions to be patronising in their attitudes to work done by nurses; and vice versa. McGuire, in her submission to the Report of the Royal Commission on the NHS (1979) commented that “decisions made by nurses may go unrecognised by doctors and even by nurses themselves”.1 Such failure to recognise decisions is symptomatic of an underestimation of the role of nurses in general.

Child and adolescent psychiatry is a relatively new sub-speciality and it is only recently that its practitioners have started to examine the problems of teaching it on the undergraduate curriculum. Questions about when it is best taught during the undergraduate years and what constitutes a core curriculum are still contentious. Indeed some psychiatrists have yet to be convinced that it should be taught at all at an undergraduate level.

Sexual abuse in children is a common problem. The Department of Psychological Medicine at Great Ormond Street Hospital, London, have developed a treatment approach based on six sessions of small group work with sexually abused young children. It is evident that they have considerable experience and have produced a training package to help other professionals working in this field. The package consists of a video, detailed manual and flash-cards. The video begins with a brief introduction to the whole subject. The major portion of the tape is given over to clinical illustrations from sessions and these are briefly commented on. The tape shows the children progressing and the staff coping with problems such as shyness. At the end of the tape there is a discussion between the presenter (Dr E. Vizard) and Dr A. Bentovim about the project and its successes, failures and limitations. They also discuss how the group work fits in with other treatment strategies.

Chance meetings in public between psychiatrists and their clients are not usually relished by either. At its least embarrassing, the encounter can pose to both parties the dilemma: Should we greet each other and risk revealing to the public our special, but stigmatised, relationship? Or, should we ignore one another and risk one (or both) of us feeling rejected? The more embarrassing encounters are well known in psychiatric covens and sometimes even revealed to outsiders in the course of ethanolic abreaction at intimate dinner parties. However, hitherto they have not found a place in conventional psychiatric literature, with its scientific emphasis and basic assumptions in the journals of smoothly flowing professionalism and the normality of the psychiatrist.