The referral rate to the Psychotherapy Department at the Warneford Hospital, Oxford, has increased by 84% in the last three years, creating a bottleneck at the assessment stage. As part of the response to this we carried out the audit reported here. Assessment for psychotherapy is costly in professional time. If any group of referrers is significantly better at referring patients who need, and make use of psychotherapy, we would have to consider selectively accepting referrals from these sources. We thus asked whether different referrer groups, and different “levels” of referral (secondary or tertiary), were more or less likely to provide patients who ultimately entered treatment.

In April 1991, the government announced the development of a new research and development programme for the NHS. Professor Michael Peckham was duly appointed Director and the first strategy document appeared in September of the same year (DOH, 1991). The suitably broad objective of the strategy is to “ensure that the content and delivery of care in the NHS is based on high quality research relevant to improving the health of the nation”.

It is generally agreed that training in liaison psychiatry should be available at SHO/registrar grade, but the College's guidelines are not specific about what it might entail. As a result it is difficult for approval visitors to decide whether a particular post on a rotational training scheme truly provides liaison experience. At times so-called “liaison experience” amounts to no more than participation in a duty-rota for visiting a general hospital to undertake the assessment of cases of deliberate self-harm.

Recent ministerial statements and health circulars have identified a key role for the NHS in providing services for people with a learning disability who have a mental illness or a severe behaviour disorder (NHS Management Executive, 1992). This is not an insignificant task, given that psychiatric disorders (including both mental illness and/or severe behaviour disorders) occur among approximately 30% of people with a moderate or severe learning disability (Corbett, 1979; Lund, 1985). Patients with psychiatric disorders have proved particularly difficult to resettle from mental handicap hospitals, and form a substantial proportion of the patients who become long-stay residents of mental handicap hospitals despite the development of community-based services. It is therefore essential that each district health authority defines the most appropriate pattern of services for this group of patients, as part of their purchasing strategy for mental health. The type of service required was discussed by the department of Health report Needs and Responses: Services for Adults with Mental Handicap who are Mentally Ill, who have Behaviour Problems, or who Offend. This noted that no consistent pattern of services has yet emerged, and that suitable alternatives included admission to a specialised mental illness unit in a mental handicap hospital, admission to a general psychiatric ward, admission to a small staffed house, or treatment by a community support team.

The frequency with which a given drug is prescribed (the number of doses per day) should be influenced by several factors. First, frequent prescribing is likely to be more expensive and to consume more resources. About a third of the time spent by psychiatric nurses in interaction with patients is devoted to technical activities such as drug administration (Altschul, 1972). Second, it is especially difficult to persuade psychiatric patients to take medication as prescribed whether as in-patients or as out-patients so treatment regimens should be kept as simple as possible. There is evidence that compliance is better with once or twice daily regimens than with a four times daily regimen.

Section 58 is in the part (Part IV) of the Act which is largely concerned with consent to treatment by patients detained on Sections 2, 3, or 37 of the Mental Health Act (1983). It applies to drug treatment if three months or more have elapsed since drugs were first given during the period of detention. It also applies to ECT at any time during the period of detention. Where a patient consents to treatment which comes under Section 58, and which the responsible medical officer (RMO) has proposed and explained to the patient, the RMO is required to certify in writing, on Form 38, that the patient is capable of understanding the nature, purpose and likely effect of the treatment and that the patient has consented (DOH, 1987). The Code of Practice (DOH, 1990) advises that the RMO should indicate on the certificate the drugs proposed, by the classes described in the British National Formulary (BNF), indicating the dosages if they are above BNF advisory maximum limits. The method of administration should also be indicated. This paper will argue that Section 58 in its present form does not strengthen the patient's right to consent to treatment and that the form of words advised in the Code of Practice with respect to Form 38 is faulty in conception.

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).

With changing patterns of care, it is expected that more doctors will have contact with people with mental handicap. This study looks at medical students' evaluation of an aspect of the training they received to prepare them for such contact.

When the idea was first proposed to our practice that we should have a doctor from the York Psychiatry Rotation attached to our practice as a trainee we were all enthusiastic. As the start date approached and it became more obvious that I, as the trainer without a trainee for the six months in question, would be responsible for him I became a little more apprehensive. What if he wore strange clothes? What if he upset all the patients? What if he exposed all my ignorance on matters psychological? When I first spoke to Simon he mentioned that he had not done any acute proper medicine since house jobs, five years previously; I do not know who was more apprehensive – him or me. In the event, of course, I feel the placement was successful and I hope that Simon came away learning a lot about general practice and a significant amount of psychiatry in a different setting.

I've had difficulty in writing this review. I initially caught the last half of Tony Harrison's ‘docudrama’ about Alzheimer's disease shown at the outset of Alzheimer Awareness Week in July and hated it. My heart sank at the Brechtian device of putting the dialogue to the tune of a hymn (in this case the carol ‘In the Bleak Midwinter’), and I found the approach to the three ‘star’ patients chosen for the film from those in Whernside ward, High Royds Hospital, sentimental and patronising.

Electroconvulsive therapy (ECT) is an effective treatment in severe depressive illness (Kendell, 1981). It is unusual in being administered predominantly by junior doctors, although prescribed by consultants. Pippard (1988) has drawn attention to a tendency for practice to depend on established custom rather than research evidence, and to a lack of consultant involvement in ECT teaching.

In December we held the last dance. Shortly after 1 a.m. the ghosts of long dead patients would have heard the strains of Auld Lang Syne drifting down the hospital corridors. Perhaps they should have joined us.

Over recent years there have been a number of articles in the Psychiatric Bulletin considering the vexed question of research and trainees in psychiatry, most recently the suggestion of ‘research troikas’ by Sims (1992). Although this might work well in teaching hospitals with a reasonable number of academic staff, we see problems for the more peripheral areas. This article addresses these problems particularly as they affect people working outside the main centres. We are not concerned here with what trainees need to know about research, but rather how conducting research fits into their clinical job. We will do this by posing a number of basic questions.

The misuse of alcohol causes a range of health, legal, social and employment problems for the individual and the rest of society. Many agencies are involved in dealing with the consequences of alcohol misuse and providing services to those with problems. Sources of funds to finance interventions for drinkers whether from health authorities, social services, probation or other sources are very limited. Without some coordination there will be a tendency for each funder to shift responsibility and costs. These difficulties have been recognised and in 1989 a government health circular was issued emphasising the need for the development of local multi-agency alcohol misuse prevention strategies. Implementing policies such as community care and Health of the Nation also require multi-agency co-operation if they are to fulfil their aims. The survey of the development of local alcohol strategies reported in this paper (Wallace et al, 1993) is therefore of great interest.