Although the principles behind the care programme approach have generally been welcomed, its implementation has at best been patchy and at worst a complete failure. The principles behind supervision registers have not been welcomed by most psychiatrists. This paper presents a practical solution to the major problems associated with the implementation of the care programme approach and supervision registers by defining pragmatic criteria for inclusion on these registers and the services which should be provided to registered patients. This solution was agreed between purchasers and providers following a series of consultative meetings and this is a process which must be recommended.

We describe the problems encountered in dealing with a ‘discharge refuser’ in the context of recent government guidelines on good practice in the discharge of mentally disordered people.

Psychiatrists are becoming increasingly involved in the assessment of candidates for genetic testing for Huntington's disease (HD) in which their role ranges from diagnosing conventional psychiatric disorder to identifying ‘new odd behaviours'. They are also expected to predict dysfunctional response to test results (e.g. self-harm). This paper describes the psychiatric component of the Cambridge HD Clinic and its assessment protocols. Practical concepts, useful to the understanding of the clinical problems that may be encountered, are also discussed.

Dose titration is the new colloquialism in ECT circles. The technique, as generally applied, assumes that current and the time for which it is passed, are equally important in the depolarisation of nerve cells. The units used to quantify its measurement, namely the milliCoulomb (mC) reflect this. We think this is misleading and suggest it ought not to be used as a parameter to describe a treatment regime. It is the aim of this communication to explain, in general terms, the physical parameters that control the current flowing in the patient's head, to suggest a more appropriate method to describe the treatment administered and outline the requirements of a good ECT machine.

A model psychotherapy service is proposed, integrated in the double sense of combining different psychotherapeutic modalities in a single psychological treatment service, and forging close links with general psychiatry. The four limbs of the service extend into supporting counsellors in general practice, providing psychotherapeutic input into the treatment of the severely mentally ill, managing patients with personality disorders, and supplying psychotherapeutic aspects of a liaison service. The advantages of this model in the current managerial climate are discussed.

This paper examines the concept of the person as distinct from the concept of the human being. It argues that the criteria which some contemporary philosophers propose for making this distinction are likely to have adverse effects for the moral status of people with learning disability and psychiatric disorders respectively.

The recent review of mental health nursing recommended that nurses refocus their attention on people with serious mental illness. There are some encouraging trends in the training of nurses in problem-oriented case management. However, mental health nursing needs to face various problems. These include the need for the large-scale retraining of nurses currently working in traditional psychiatric hospitals and difficulties in the new Project 2000 programmes. In addition, there is a clear lack of leadership in the profession, largely because of the recent emphasis on management rather than clinical and academic attributes. Finally, nursing needs people who care what happens to the seriously mentally ill.

As mental health professionals move increasingly towards providing community-based services, a good working relationship with general practitioners becomes central to patient care. This relationship depends on good liaison and communication as well as shared goals. This study examines the relationship between a community psychiatric rehabilitation team (CPRT) and GPs by means of a postal questionnaire to local principals in general practice. Although the awareness of the service was less than optimum, clear indications were made of ways of improving communication. The GPs overwhelmingly supported the priorities of the CPRT in the care of those with major mental illness.

This article describes the process of setting up a community support team for the severely mentally ill, and the challenges this posed. As this method of service delivery has been infrequently described, it is hoped our experience may be instructive to others.

Unrecognised and untreated depression is common, particularly in the elderly. This paper describes an attempt to offer screening for depression to 4,500 people over the age of 60. Only two people attended and both were depressed. This may have related to the arrangements for screening, to the symptoms of depression, to inadequate publicity or to characteristics of the elderly population. Others contemplating screening for depression in elderly populations are advised to adopt a different methodology.

Concerns about the use of high doses of neuroleptic medication prompted an audit of prescriptions of these drugs in a large psychiatric hospital. Following an initial audit in 1991 of 196 patients, a follow-up of 192 patients was undertaken in 1993. A significant reduction in levels of neuroleptic medication was found, although doses still tended to remain high.

The efficacy of training in dynamic psychotherapy was assessed by sending a questionnaire to all visiting therapists (trainees) in the Leicester Psychotherapy Department. Questions were directed towards the effect of training on trainees' work in non-psychotherapy settings. Trainees noted improvements in communication skills, assessment/referral skills, anxiety and boundary management and overall management of the therapeutic relationship. Improvement was also noted in job satisfaction and motivation at work. These improvements were more prominent in trainees who had had more than two years' training.

This article describes a part-time attachment to the public health department of a purchasing authority, during my senior registrar training in child psychiatry. This London purchasing authority was responsible for researching needs and priorities, planning services and drawing up and administering contracts for an area previously administered by several separate health authorities. In carrying out these tasks it worked in close collaboration with its local public health department, but was not directly linked to a Family Health Services Authority.

Where human relationships are concerned, issues of trust and control go together. Where professional relationships are concerned, these issues require special attention.

Extraterrestrial kidnapping is in vogue. A dozen books are available that detail accounts by alleged victims. A telephone survey of almost 6000 Americans revealed that many reported ‘abduction by an alien’. BBC's Horizon programme sent Dr Susan Blackmore, psychologist and TV-troubleshooter for the paranormal, to investigate.

Concern is growing over the decline of services for disturbed young people, expressed in the correspondence columns of the British Medical Journal, in professional journals (Vanstraelen & Cottrell, 1994; Saunders, 1993), and in literature from the Royal College of Psychiatrists (Pearce, 1994) among others. There has been a gradual loss of beds in adolescent psychiatric units, amounting in one survey of 60 units to nearly 20%. At least seven units have closed all their beds, and others are threatened with closure.

The Mental Health Task Force was set up by the Secretary of State for Health under the leadership of David King to assist in the process of the closure of the large mental hospitals and to ensure adequate provision was made to replace their services. Its strategic objectives, to be accomplished by the end of 1994, were to map the replacement of the remaining large institutions by good quality services, ensuring that this happened effectively; to identify what makes a service good and find ways of ensuring that services possessed these qualities; and to develop a vision of the shape of the mental health market in years to come. To assist in this a wide support group of about 20 people was set up. This included representatives of the Department of Health, Research and Development in Psychiatry, carer organisations, users, social services, general practice, nursing and the Royal College of Psychiatrists. The authors represented the College.

I would like to raise Issues about tape-recorded interviews by way of describing the recent admission to hospital of a man who began recording staff and patients.