The Care Programme Approach (CPA) was introduced as a cornerstone of the Government's mental health policy in 1992 (Kingdon, 1994). It was meant to clarify the complex issues surrounding the coordination of care for the severely mentally ill and to promote interprofessional communication and effective targeting of resources by community mental health teams (CMHTs). The Ritchie report into the care of Christopher Clunis (Ritchie, 1994) underlined the need for clarity about who has overall responsibility for coordination and review of the progress of care – the key worker. The report makes a compelling case for a clearly documented care plan with identified problems, therapeutic goals and an unambiguous statement of who is responsible for what and when. How, then, could this virtuous proposal generate conflict and bad feeling? And why is there relatively little debate about it in the professional press?

A survey of the current practice of lithium monitoring in a general hospital and the general practices it serves revealed erratic and infrequent assessments of serum lithium levels and also of renal and thyroid function. General practitioners, who in this study monitor approximately a third of the patients on lithium, performed worse than psychiatrists, but in neither case was there cause for complacency.

The experience of a paediatric placement is described. Difficulties encountered mirror those experienced in liasion child psychiatry and the basis for this is dicussed. Early collaboration during specialist training of paediatricians and child psychiatrists can enhance the working relationships between the disciplines and the clinical skills of both.

A repeat audit of referrals to the CAT Clinic of Guy's Hospital is reported. Changes in training and supervision of therapists instituted since earlier audits are believed to have contributed to a lower drop-out rate and a higher attendance for follow-up. Mean score reductions on three questionnaires are significant and consistent in the three cohorts. Some characteristics of samples of patients who dropped out and failed to attend for follow up are described.

The Criminal Procedure (Scotland) Act 1995 came into force on 1 April 1996. It contains major new provisions in respect of defendants found insane, together with changes concerning other mentally disordered offenders.

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

This study evaluates the effects of moving an acute psychiatric ward from a psychiatric hospital to a district general hospital. A repeated measures design is used covering the three phases of shortly before and after the move and a follow-up 10 months after the move. Eleven measures were used including daily measures of patient disturbance and staff stress, length of stay, diagnosis and a consumer survey. Overall there was little change from before the move to follow-up. Two second-order variables relating to staff stress did, however, show a clear reduction.

A great number of terms in modern psychiatry, medicine and related disciplines originate from the Greek, including pathology, schizophrenia, ophthalmology, gynaecology, anatomy, pharmacology, biology, hepatology, homeopathy, allopathy and many others. There are also many terms that originate from figures from ancient Greek mythology (or the Greek words related to those figures) and I think that it might be interesting to take a look at some of them.

It seems to be increasingly taken for granted by politicians and commentators that it is more effective to attack one's opponent than to promote a positive vision in order to sway voters in an election campaign. This article examines the relevant evidence in the psychological literature to see if this belief is justified. This includes the evidence on information processing, emotion and the specific effects of negative campaigning.

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.

A questionnaire addressing various aspects of research activity was administered to 172 trainees in the Eastern region of Ireland. An 80% (n=138) response rate was achieved. While 98% of trainees regarded research activity as important, almost half rated their research opportunities as poor. The commonest reasons cited for doing research included c.v. enhancement, personal interest and consultant pressure. The most frequently reported problems in doing research were time allocation, funding and adequate supervision.

After seven years of circulars, monitoring, conferences and discussion, frank talking about the CPA may still be welcome, but proposals to CPA coordinators and members of community mental health teams (CMHTs) to revise the procedures implemented by trusts are less likely to be. The previous paper (Burns & Leibowitz) identified a number of difficulties that have accompanied the implementation of the Care Programme Approach, particularly confusion related to care and case management. The CPA was introduced in response to the Spokes Inquiry (Spokes, 1988) as a therapeutic strategy to ensure that a coordinated safety-net of care for people with severe mental illness (SMI) was put in place in every district. Identification of those with SMI means that the approach includes all those accepted by mental health services; those with SMI need a coordinated multidisciplinary response. The CPA Audit Tool developed by the College Research Unit for the National Health Service Executive (NHSE) and disseminated to all districts in 1995/96 may be valuable in reassessing CPA implementation.

There is an identified need for more psychiatrists who have been trained in cognitive-behavioural therapy (CBT). The Royal College of Psychiatrists' guidelines for psychotherapy training recommend that all psychiatric trainees receive CBT training. This paper describes a brief programme of CBT training for psychiatric senior house officers (SHO) which demonstrates a viable model achieving limited training objectives.

Within the ageing population there exists a small number of elderly transsexuals. There is a growing impression that they are beginning to require the services of old age psychiatry. Most services are ill equipped to deal with this group and require specialist support. This case history illustrates this need and describes the social dilemmas involved.

“Prince was far too stressed out to fly says royal shrink … Bungling Prince Charles was lashed by a top psychiatrist last night” (Airs, 1994). This colourful fragment from a national tabloid illustrates one of the less savoury aspects of the increasing visibility of psychiatry in the media. The College Public Education Committee (PEC) was established in 1988 and has monitored press references to the College. In the three years prior to its establishment, it was able to find only seven press references to the College. A more recent survey, from September 1992–1993, found 736 such references (D. Hart, Royal College of Psychiatrists, personal communication). This dramatic increase has been partly due to the increasing politicisation of health care in general. However, a significant role has been played by the PEC. It has established an efficient machine which not only disseminates information from the College to the media, but also responds to inquiries from the media. On the whole, the results of this sort of activity are beneficial, the main complication being that of misrepresentation. We tend to be painfully aware of the dubious practices of the media, in particular the iniquities of the tabloid press. However, we also need to consider the possible ethical blunders that we may commit. The whole enterprise of speaking or writing about psychiatry in the public arena has generated several areas of ethical concern.

Section 135 of the Mental Health Act (1983) allows a Justice of the Peace, on information provided on oath by an approved social worker, to issue a warrant allowing any constable named in the warrant to enter, if need be by force, any premises in which there is reasonable cause to suspect that a person believed to be suffering from a mental disorder:

1. (a) has been, or is being, ill-treated, neglected or kept otherwise than under proper control: or

2. (b) being unable to care for himself, is living alone in any such place, and, if thought fit, to remove him to a place of safety.