A psychogeriatrician was recently given the opportunity of five sessions of speech therapy for his service. His response was that he had no need of a speech therapist as he was perfectly well able to do his own assessment of dysphasia. This attitude is perhaps understandable since there has been so little exposure to the skills of speech therapists within this clinical field. In 1985 a full-time speech therapist was appointed by Central Manchester Health Authority to be part of the multidisciplinary team working in old age psychiatry. At the time this was, to our knowledge, the first full-time position of its kind. This article reviews progress thus far and outlines the contribution of speech therapy skills to the management of the elderly mentally ill.

Group therapy in an out-patient setting has been well established for over 40 years. Today, most acute wards offer some in-patient group therapy experience. Duration of in-patient stay (Yalom, 1983), the type of group therapy offered (Cox, 1976; Kanas, 1980) and patient psychopathology, can all alter efficacy of in-patient group therapy. However, in-patient units do appear to benefit from group therapy programmes, although some approaches are more effective than others and psychotic patients may suffer from the traditional group therapy approach (Cox, 1983).

The dichotomy caused by the National Health Service Act, Section 28, which split the responsibility for the mentally disordered between the Minister of Health and local authorities has remained with us. Along with a separate GP service this dichotomy has caused inconsistencies, confusion and overlap in day care facilities. Although psychiatric day care has now become accepted as an essential element in the comprehensive psychiatric care of the mentally ill, its development has been unplanned and there is a great regional variation (Vaughan, 1983).

The issue of the relationship between physical illness and psychological disorder has a long and chequered history. It is therefore difficult to derive practice implications. However, there are associations between methods of patient care and long-term psychological and physical functioning which have provided some guiding principles (Nichols, 1984). This paper describes how these principles have been applied in a regional burns unit.

There are two medical schools in Hong Kong, that of the University of Hong Kong and that of the Chinese University of Hong Kong. The former has a history of more than 100 years whereas the latter admitted its first batch of students only in 1981. Both use English as the teaching medium and both are recognised by the GMC. I received my undergraduate medical education in the former but have been teaching in the latter for seven years.

As a relative newcomer to the medical undergraduate curriculum, child psychiatry is still looking for ways in which to best convey its message to students. There is fairly general agreement that this should combine opportunities to assess children or at least to observe the psychiatric assessment of problems and to impart basic information on child development and psychopathology.

The Alma Ata Primary Health Care Conference in 1978 marked a watershed in global health care policy and specifically a fundamental milestone for mental health. Not only was mental health defined as a right and an integral part of health generally, but also its promotion was a major recommendation of the conference.

In November 1987, I wrote to the ‘Planning Officer (Mental Health)’ of the 192 English Health Authorities requesting a copy of the section of their 1984 Strategic Plan dealing with mental health and any recent update. A checklist of information to be analysed was drawn up on the basis of an initial reading of the plans. This contained a substantial proportion of the elements for a comprehensive service listed by Hirsch (1988) and by MIND (1983). Replies were received from 137 (71%) of the health authorities. Of these, 127 (67%) sent planning documents, ten wrote saying that their plans were under review and therefore unavailable, or “meaningless”. Strategies were sent dated 1983 (2), 1984/5 (63), 1986 (11) and 1987/8 (45). Planning reports and Short Term Programmes were also sent which meant that four (3%) provided information updated to 1988, 74 (58%) to 1987, 16 (13%) to 1986, 17 (13%) to 1985, 15 (12%) to 1984, with one giving details relating to 1983 only.

The 1984 Scottish Mental Health Act (and its counterpart in England and Wales) invoked unique restrictions in medical practice in this country. For the first time certain standard treatments could not be given to particular patients unless an independent second opinion doctor authorised that treatment. Fortunately, in respect of drug treatment and ECT the second opinion doctors are themselves practising clinicians. Second opinion doctors are asked to give their opinion about the suitability of a proposed treatment using the following guidelines: “the appointed doctor will have in mind his/her understanding of practice accepted as proper by a responsible body of medical men skilled in this particular art in Scotland at this time and should avoid any idiosyncratic view of treatment however firmly held”.

Consent to a transaction has three basic components. These are: the transaction – its nature; understanding; and response, i.e. the consent itself.

There appears to be a growing public interest in “holistic” and alternative medicine which can be seen as a reaction to the scientific–medical role (Mechanic, 1978) of a conventional medicine which often fails when confronted by emotional or psychosomatic problems, and to fears, by the public, about the side-effects of therapeutic drugs.