Questionnaire data are presented from a national multi-professional survey. Only 12% of respondents had local quantitative data on adults with learning disabilties (LD) and mental health needs (MHN). More described local provision as part of specialist LD services than integrated with generic mental health services. LD services were rated as more accessible and more available than generic mental health services. Clinicians agreed about the important elements of psychiatric assessment, treatment and their preference for using the ICD–9 and ICD–10 diagnostic classifications. The planning, delivery and evaluation implications for psychiatric services for adults with LD are outlined.

The legal and moral status of the concept of consent are examined. The notion of informed consent as the sole basis for acceptable treatment is found to raise moral difficulties and to have potentially damaging side-effects on the relationship between doctors and patients. It is argued that developing trust between doctor and patient is crucial to obtaining valid consent.

The loss of psychiatric beds associated with the closure of large psychiatric institutions creates problems for the community care of those with severe mental Illness. This paper describes the use and possible advantages of a non-acute in-patient unit attached to a Community Menial Hearth Centre in North Staffordshire which has prioritised Individuals with severe mental Illness.

A survey of 92 in-patient alcohol detoxification services revealed that they varied in their goals, organisation and treatment approaches. We argue that detoxification units and alcohol treatment units should increasingly take on the assessment and treatment role hitherto played by general psychiatric wards in the management of the problem drinker. However, we also suggest that the general psychiatric wards should work closely with community alcohol teams and more specialist services in order to provide a comprehensive service for these patients.

We evaluated clinical Information gained directly from 10 English-speaking and from 10 non-English-speaking subjects both directly and through interpreter-mediated Interviews. High levels of agreement between raters, when assessing both cohorts, were found for all data with a non-significant tendency towards better agreement in the Asian than the English-speaking sample for family history data. Analysis of the interview contents showed a number of errors of interpretation which were similar to those noted in previous studies. The addition of quantitative data represents a significant advantage over previous studies, allowing the qualitative results to be placed into perspective. Recommendations are made for optimising and avoiding the pitfalls of interpreter-mediated interviews.

The risk of suicide pervades much of day-to-day clinical practice. Effective management encompasses its recognition, evaluation of severity, and the use of techniques which reduce it to an acceptable level during treatment of the condition which it complicates.

There has been increasing concern in recent years that trainee psychiatrists are not receiving adequate training and are not fully competent in the administration of electroconvulsive therapy (ECT). This has led to the publication of guidelines by the Royal College of Psychiatrists recommending measures to improve supervision and tuition. This study compares the results of two surveys, five years apart, exploring levels of supervision, satisfaction with training and confidence in the procedure among trainee psychiatrists on the Royal Free Hospital scheme. The findings are discussed in the light of Improvements to teaching of ECT in the interim. Continuing problems with supervision are highlighted, and the need for organised training is emphasised.

Carbamazepine and valproate are now well established treatments for bipolar affective disorder (BAD). Both drugs are used in the acute treatment of mania and, more frequently, as longer-term mood stabilisers. The British National Formulary (BNF, Vol. 32, 1996) provides information on the use of carbamazepine in the ‘prophylaxis of manic depressive illness' and suggests that the ‘usual range’ of doses is between 400 mg and 600 mg daily. No guidance on the use of valproate in BAD is given in the BNF because the drug is not licensed for this indication in the UK.

A consensus of available information is used to produce a working table of conversion for the most commonly used drugs to chlorpromazine equivalents. A user-friendly computer program has also been developed from this information. The use of the concept In the clinical setting and for research purposes is briefly discussed.

The seclusion of general adult psychiatric patients is still a common nursing Intervention of questionable therapeutic benefit. It is often initiated as a last resort to maintain safety where there are staff shortages. Historically concerns over the abuse of this procedure led to the Involvement of medical staff to oversee or monitor the procedure and this practice has become fossilised in the seclusion policies of many trusts. This paper argues that the routine involvement of trainee psychiatrists in this procedure, for which they are rarely trained, is archaic, impairs inter-professional relationships and should be regarded as an inappropriate duty.

The recent reforms to the MHS have resulted in a need for management training to be a part of higher professional training. The trend towards competition within internal markets requires that all doctors become managerially accountable for the quality and efficiency of their service (Waters, 1985). The beed for management training has been recognised by the Collegiate Trainees' Committee (CTC, 1990, 1995). Some training schemes offer no organised management training, and some provide training as a short course (Reder, 1996). Many residential management courses are available, providing one or two weeks of ‘Intensive training’. Inevitably, the amount of management theory and techniques which can be learned on such courses Is limited.

Holloway Sanatorium, named after the benefactor, Thomas Holloway, stands in beautiful grounds opposite Virginia Water railway station, Surrey.

The 1996 Conference of the Team for the Assessment of Psychiatric Services attracted a larger audience than ever, including many from overseas. Dr Douglas Bennett looked at the historical evolution of community services over a 50-year period, in which no grand plan can be found. It has been a step-by-step process in which each step has followed either a successful innovation by pioneering psychiatrists, some advance in medical treatment, or a political or social change in our society. In his own experience of working with Dr Maxwell Jones at Belmont Hospital, he had not realised at first how revolutionary it was then for the staff to meet in groups. Wartime experience, when some of the traditional restrictions had to be given up, influenced some medical superintendents to open the doors of their hospitals in the 1950s. When industrial therapy introduced paid work, it provided an adult social role to those from whom nothing had been expected up to then. For chronic patients, social changes were the most important ones; in the 1950s, these started to release both patients and staff from the separate world they had inhabited up to then. The mental hospital ceased to be seen as the centre of psychiatric care; it was replaced by the comprehensive mental health service for a district.

Preservation of the world's rainforests and other natural habitats can be argued for from several points of view. Maintaining biodiversity and preventing the ‘greenhouse effect’ are two commonly stated objectives. A less altruistic reason is that many of the floral species in such habitats remain unstudied and could yield new and important drugs to treat human diseases. Many of the drugs we use today are derived from plants or are their synthetic derivatives.

This study explores the rationale and need for a short-stay psychiatric unit at Al Ain (United Arab Emirates) district hospital. The paper describes the demographic and diagnostic characteristics of patients with brief admissions over 40% – of all psychiatric admissions – most of whom have neurotic, stress-related and adjustment disorders. Only 12% of patients were severely disabled and in about half the patients, anxiolytic or no medications were prescribed. Significant reduction of distress was achieved by brief admission. In current circumstances, we believe that the short-stay unit might be the best available and least costly option.