Census data from the Danish island of Samsø have provided information on all but 20% of the population. Fifty per cent of the population with past or present mental illness had been referred to the psychiatric service during the 18-year-period 1957–74; the proportion varied from 85 % for patients with psychoses (100 % for schizophrenic patients, and 90% for manic-depressive patients) to 43 % with non-psychotic disorders. The frequency of past and present mental illness was 24 %, higher for women with manic-depressive disorders, psychogenic (reactive) psychoses, and neuroses. The possible reasons for these and other findings are discussed.

A representative sample of 130 people was interviewed shortly following self-poisoning or self-injury. The interview method is described. Events in the week prior to the attempt, and the incidence of various kinds of chronic problems are reported. Events involving key relationships were much more common than other kinds. The most important event was a quarrel, particularly in the 48 hours prior to the attempts and more common with female than with male attempters. The possible relevance of quarrels to understanding overdose behaviour is discussed.

Nearly a third were receiving non-psychiatric treatment at the time of the ‘attempt’ Approximately one quarter were currently receiving psychiatric treatment and a half had received it at some time. A substantial proportion had been admitted to either psychiatric or non-psychiatric hospitals within the past year.

The proportions indicating the need for various kinds of help are reported. Most people said they needed ‘someone to talk to’. More than half had been in contact with some form of helping agency during the week prior to the attempt. The possible significance of these findings is discussed.

An attempt was made to look for ‘syndromes’ or groupings of problems. The resulting analysis, whilst of interest, did not lead to a satisfactory method for classifying individuals. It was concluded that a more satisfactory typology of ‘attempters’ is likely if types of relationship problems are investigated in more detail.

The former belief that immigrants always suffer from an excess of mental disorder is no longer valid, and the old rivalry between social selection and social causation hypotheses has lost much of its relevance. The mental health of a migrant group is determined by factors relating to the society of origin, factors relating to the migration itself, and factors operating in the society of resettlement; and all three sets need to be considered if one seeks to reduce or merely to understand the level of mental disorder in any immigrant group. Illustrations from each set of factors are presented, with indications of whether they appear to have general relevance or be related to specific mental disorders.

The performance of 21 chronic schizophrenic patients was investigated on two tests of feature selection. It was found that patients with negative symptoms (muteness, withdrawal, etc.) were characterized by an extreme lack of persistence, but selected usual features; whereas patients with positive symptoms (hallucinations, delusions, etc.) had a normal degree of persistence, but selected unusual features.

A random sample of 237 women in a south-east London area were seen by non-medical interviewers, trained to use a standard technique (the Present State Examination) to elicit and record psychiatric symptoms. Ninety-five were interviewed a second time by psychiatrists, who also rated audiotape recordings. The reproducibility of the techniques is adequate though not as high, in some respects, as that obtained from out-patient or in-patient samples. This is true at the level of symptom, syndrome, total score, and index of definition of psychiatric disorder. It is concluded that nonmedical interviewers can obtain as high reproducibility as psychiatrists on most of the non-psychotic sections of the PSE if they have appropriate training. Repeatability is lower than reproducibility, partly due to fluctuations in clinical condition, partly to environmental changes between interviews, and partly to differential responses to medical and non-medical interviewers. Over a short period of time, such as a week, repeatability is satisfactory.

A pilot study is reported of costs and benefits from behavioural psychotherapy by nurse-therapists for selected neurotic problems. Figures are based on the treatment of 42 neurotics (mainly phobics and obsessive-compulsives) who completed treatment with nurse-therapists in a mean of 9 sessions (16 hours). The year before and after treatment was studied. Apart from significant and lasting reduction in patients' distress, economic benefits to them, their families and the community yielded a worthwhile internal rate of return when benefits from the cohort continue for 3 years, a reasonable assumption on available other evidence. Though untreated phobics did not improve elsewhere over 5 years follow-up, a controlled study would seem desirable.

In a controlled population study 111 families of children with asthma and wheezy bronchitis were screened. The mothers of asthmatics suffered more depressive illness than controls. This correlates with the severity of the child's asthma. There was no difference in immunological status between depressive and non-depressive mothers of asthmatics.

The Present State Examination (PSE) is discussed with regard to its use in surveys of subjects who are not psychiatric patients. Although the PSE was originally developed for use by psychiatrists with patients with obvious mental illness, the interview also contains sections dealing in considerable detail with the commoner and less severe complaints and symptoms that are found in a significant proportion of ‘normal subjects’. A shortened version of the PSE (8th edition) is described, limited to these sections, which has been used in population surveys, by interviewers who are not psychiatrists. The training of such interviewers is described, and information on a reliability and repeatability study is presented. This shows that with proper training, non-psychiatric interviewers can achieve standards of inter-rater reliability that are comparable to those previously reported between psychiatrists.

Faculty ratings of 22 foreign medical graduates (‘FMGs’), all of whom entered psychiatric residency training at the University of Missouri–Columbia from 1966 through 1973, were compared with those of a similar group of North American medical graduates (‘AMGs’). An on-going evaluation programme provided data for a variety of parameters ranging from ‘theoretical knowledge’ to ‘clinical skills’. Results indicated that in most areas of performance the median FMG started at a level substantially lower than that of the median AMG and very slowly caught up. When achievement criteria were utilized it became apparent that, at least by the third year of training, ‘superior’ FMGs could equal or surpass the median performance of ‘superior’ AMGs, whereas ‘marginal’ residents, whether foreign or native-born, seldom attained even competence in most major spheres of functioning. Implications of these findings and those in related studies are discussed.

The paper sets out a method for evaluating changes in psychiatric services in a cost-benefit framework. The first section of the paper analyses some of the problems which arise with those elements which can be measured in monetary terms – the ‘hard’ costs and benefits. The second section looks at a method of presenting the less tangible effects – the ‘soft’ costs and benefits. Finally, it is suggested how these can be brought together to aid rational decision-making.

Seventy-five mentally handicapped adult individuals attending a training centre were compared with 75 adult patients in a mental subnormality hospital using a standardized psychiatric interview. Ten of the individuals at the training centre were rated in the pathological range for overall psychiatric disturbance compared with 23 patients in hospital. Details are presented for the various psychiatric symptoms.

All West Africans and West Indians living in Camberwell who made a psychiatric contact between 1 January 1965 and 31 December 1968 were selected using the Camberwell Psychiatric Register as a sampling frame. Inception rates of psychiatric illness were then calculated using the 1966 10% census figures for West Africans and West Indians in Camberwell. The rates found were compared to those among the British living in Camberwell. For each major diagnostic category, with the exception of reactive depression and paranoid states, the inception rates are significantly higher among West Africans than West Indians. They are also significantly higher among West Indians than the British. However, the differences in inception rates are generally greater between West Africans and West Indians than between the latter and the British.

Several indices of occupational stability are discussed and the importance of controlling for age in assessing occupational stability emphasized. The ability of 6 indices to predict the stable resettlement of psychiatric patients at work after a course of rehabilitation was examined. Though mean job length was a significant predictor, indices based on change of occupation rather than change of job were more successful. Stable resettlement at work was related to how much time people had spent in long jobs but not to how little time they had spent in short jobs. The amount of unemployment during the 2 years before hospital admission predicted return to work immediately after discharge, but did not predict stable resettlement at work.

Chronic in-patients from a sample population of 48 women and 43 men were selected for an experimental hospital-hostel and for local authority hostels. Two-thirds were found suitable for the former but only a sixth for the latter. The problems of selection for and management at the experimental hostel are described, and the overall results discussed in relation to recent proposals for the residential care of chronic patients.

A psychologist interviewing patients referred to the psychiatric service of a health centre rated twice as much morbidity, measured by total PSE score, as a psychiatrist interviewing equivalent patients. Scores on the self-rated GHQ showed no difference between the 2 groups. It is suggested that such differences could be avoided by giving careful attention to training interviewers.

Over 90% of the 1202 patients investigated in the 9 centres collaborating in the International Pilot Study of Schizophrenia were traced 2 years after the initial examination and on the average over 75% of them were re-examined, using standardized instruments and methods. Results indicate that patients diagnosed as schizophrenic on the basis of standardized assessments and clearly specified diagnostic criteria demonstrated very marked variations of course and outcome over a 2-year period. Schizophrenic patients in the centres in developing countries had considerably better course and outcome than schizophrenic patients in the centres in developed countries.