bluuebunny/crossref_metadata_2025 huggingface dataset:
Survey into the Availability of Higher Specialist Training in the Psychiatry of Old Age (November 1985)
Authors: Blessed Garry
Published: May 2008

Psychogeriatrics began to develop as a specialty within general psychiatry in the 1950's, but few pychiatrists became involved in establishing clinical services until a decade later. An ad hoc enquiry carried out by the DHSS in 1972 of Regional Hospital Boards revealed that 18 consultants then had a substantial (defined as five or more sessions) commitment to psychogeriatrics. At the same time a survey of psychogeriatric service provision revealed 31 units containing a total of 1,123 beds. Presumably, a number of units were being managed by general psychiatrists with less than a substantial commitment to old age psychiatry.
50 Years Ago—Psychiatry in Lahore
Authors: Lodge-Patch I. C.
Published: May 2008

At the recent sixth international conference of the Pakistan Psychiatric Society (11–14 December 1986) in Lahore, it seemed appropriate to give an account of the state of psychiatry in that city half a century ago. Such an evaluation, granted the circumstances of history, might be expected to start with a comparison with English psychiatry at the time. That association had not worked altogether to the advantage of the speciality in a city such as Lahore. Progressive ideas about the care of the mentally ill in the thirties percolated very slowly into a central administration, far removed from the local community and occupied with other urgent issues of public health.
Sexual Abuse of Children: ‘The Facts’
Authors: Rose Nicholas
Published: May 2008

“We are confident that at least 10% of children have been engaged in sexual activities with adults…” opens this important trilogy of teaching videotapes on sexual abuse of children, “… and of children alive today in the UK., 1,117,000 will have been sexually abused by the age of 15”.
The presentation of madness in the Victorian novel
Authors: Beveridge Allan , Renvoize Edward
Published: May 2008

The major novelists of the Victorian era enjoyed a large readership amongst the general public. They dealt with the pressing social issues of the day and their work both reflected and shaped society's attitudes to contemporary problems. The 19th century saw fundamental changes in society's response to the mentally ill with the creation of purpose-built asylums throughout the country. The Victorians were ambivalent in their reaction to the mentally disturbed. Whilst they sought to segregate the insane from the rest of the population, they were also terrified by the prospect of the wrongful confinement of sane people. The trial of Daniel McNaughton in 1843 for the assassination of Sir Robert Peel's Private Secretary, and the subsequent legislation, provoked general public debate about the nature of madness.
Report from the People's Republic of China
Authors: Henderson J. H.
Published: May 2008

An international workshop on Epidemiology of Mental and Neurological Disorders of the Elderly was held in the Medical University of Beijing in the People's Republic of China from 16–20 November 1987. The workshop was organised jointly by the Beijing Institute of Mental Health and the WHO Collaborating Centre for Research and Training in the Neurosciences, Milan, Italy.
A psychiatric liaison service for a social services office
Authors: Grant William , Richardson Anne
Published: May 2008

Although there has been considerable interest into the amount of liaison work that general psychiatrists do with general practitioners in primary health care settings, and into the role that social workers can play in liaising with the primary health care team, less is known about the extent to which general psychiatrists have established liaison links with particular social services offices, what form the liaison takes and whether the liaison has worked satisfactorily.
Family therapy research: a challenge and a proposal
Authors: Lask Bryan
Published: May 2008

The question is often asked: “Does family therapy work?” This is an important but useless question. It is important because an enormous amount of time, energy and money is put into the clinical practice of family therapy. It is practised in every continent; there are many training courses and qualifications in very many countries, and there are over 40 journals devoted to families and family therapy. Yet there is a healthy and justified scepticism. So yes, we ought to ask whether it works.
Recommended amendments to the Mental Health Act 1983
Authors: Azuonye Ikechukwu
Published: May 2008

Having been closely involved in the admission of patients into hospital under various provisions of the Mental Health Act 19831,2,3 (and its predecessor, the 1959 Act), I have made notes over the years of aspects of the 1983 Act which need to be amended in the interests of the patients, their families and the professionals who have to care for them in hospital and in the community.
Community-oriented psychiatric care
Authors: Connolly Joseph , Marks Isaac
Published: May 2008

The College is debating how to train psychiatrists for community care (CC) that is spreading – ahead of hard evidence of its value for certain problems in the UK. Much future psychiatry will be practised in the community outside hospital within multidisciplinary teams not always led by a psychiatrist, and wherein the lead-rôle changes frequently within a single meeting depending on whose expertise and readiness to accept responsibility emerge.
Psychogeriatrics in Nigeria
Authors: Ogunlesi A. O.
Published: May 2008

This century has been characterised by a substantial increase in the number of elderly residents in the community in the technologically advanced countries. One obvious consequence of this has been a pressure on existing mental and socio physical facilities that cater for the elderly. The medico-social factors responsible for this rise in the proportion of the elderly in advanced countries are subtly creeping into many developing countries like Nigeria (Lambo, 1966). It is with this perspective in view, coupled with the dearth of literature on psychogeriatrics in developing countries, that I decided to review the socio-demographic and clinical aspects of elderly (60 years and above) admissions to the Nigerian National Neuropsychiatric Hospital and WHO Collaborating Centre for Research and Training in Mental Health over a five year period (1 January 1982 to 31 December 1986). An attempt will also be made to draw comparisons with my experience of psychogeriatrics in the United Kingdom (I trained in psychiatry at the Royal Edinburgh Hospital in the early 1980s).
A ten-year survey of trainees' days
Authors: Morris Michael , Lynch Sean
Published: May 2008

This year sees the tenth anniversary of the Collegiate Trainees' Committee (CTC). One of the functions undertaken by the CTC representatives is to organise an annual trainees' day in their division. This gives the trainees an opportunity to meet each other, lobby their divisional representatives and raise awareness of College activities. Another important aspect of the day is the talks, usually of a practical nature and concerning topics like the MRCPsych examinations and administration. There have been a number of single trainees' days reported (Lovett, 1987; Rice & Medley, 1987; Jones et al, 1989) but this is the first review of a larger sample.
The SafetyNet project
Authors: Taylor Jason , Bhumgara Kurush
Published: May 2008

SafetyNet is a computerised, networked patient care system currently under development in the South Camden sector of Bloomsbury Health Authority. The project is primarily targeted at the clinical monitoring of people suffering from schizophrenia and the system incorporates measures which can provide a basis for quality assurance of care and a clinically driven approach to audit. SafetyNet is being designed to help keep track of individual sufferers, chart their needs as they change over time, prompt the services to action and knit together the responses needed from different agencies. It is a modular system which can be adapted to the needs of people with different kinds of mental illness and to different community populations.
Final MB — Disturbing or disturbed judgement?
Authors: Gowers S. G. , Lacey J. Hubert
Published: May 2008

The decision concerning who is fit to practise medicine is rightly considered a serious one and universities hand this responsibility to a small number of senior clinicians. However, it is on patients that the doctor will practise and while all patients have a concept of what makes a good doctor, their views are never canvassed in the Final MB.
Consent to treatment and clinical decision analysis
Authors: Worrall Ernest P.
Published: May 2008

The 1984 Scottish Mental Health Act (and its counterpart in England and Wales) invoked unique restrictions in medical practice in this country. For the first time certain standard treatments could not be given to particular patients unless an independent second opinion doctor authorised that treatment. Fortunately, in respect of drug treatment and ECT the second opinion doctors are themselves practising clinicians. Second opinion doctors are asked to give their opinion about the suitability of a proposed treatment using the following guidelines: “the appointed doctor will have in mind his/her understanding of practice accepted as proper by a responsible body of medical men skilled in this particular art in Scotland at this time and should avoid any idiosyncratic view of treatment however firmly held”.
Working in consultation-liaison psychiatry in the USA
Authors: Foster Paul
Published: May 2008

Consultation-liaison psychiatry had its inception in North America, the term making its first appearance in the 1930s to describe the department at Colorado General Hospital in Denver. As Mayou (1987) points out, when comparing British and American liaison services, the role, boundaries, and organisation of this subspecialty are very different in the two countries. Money and resources do not exist in Britain within the National Health Service to provide the extent of involvement liaison psychiatry now enjoys with the general wards of many American hospitals. Thomas (1985) refers to basic differences between the countries. He points out that few British district general hospitals have consultation psychiatric units now in place and that the theoretical background of psychiatrists in the two countries are different. In addition, he suggests that there may well be differences in the referral patterns and expectations with regard to psychiatric consultation requirements of general hospital doctors in the two health care systems.
A year in Auckland
Authors: Watts Darryl
Published: May 2008

I had acquainted myself with the psychiatric services in New Zealand some years ago during my student elective. I wanted to return to experience further a system which was both similar and different to the NHS. The New Zealand hospital system was funded in a similar way to the NHS. One organisational difference was the managerial layer, which was still filled by medical superintendents. Another difference was the extensive no-fault accident compensation scheme through which settlements were made without resort to lawsuits. Thus doctors paid low medical defence fees and were rarely sued, but the Government had regularly to meet a large bill. The psychiatric services were in the process of moving from hospital-based to community-based, in line with prevailing clinical and public attitudes. This was fuelled by some headline-making scandals over patient care in the asylums. One cause for general alarm was the poor health of ethnic minorities, especially the indigenous Maori. This issue resonated with racial and political overtones.
The role of the satellite clinic in reaching intravenous drug users at risk from HIV
Authors: Coleman Rosie M. , Curtis David , Sharpe Margaret
Published: May 2008

The arrival of HIV has challenged the traditional services for intravenous drug users providing the impetus to re-examine working practices. Only 10% of intravenous drug users attend hospital based treatment centres offering out-patient programmes based on reducing doses of oral methadone with an ultimate goal of abstinence (Hartnoll et al, 1985), yet for public health programmes designed to limit the spread of HIV it is important to increase the contact between high-risk groups and health professionals. Satellite clinics originally introduced to provide low cost help for drug users at a more local level may also be effective as a means of reaching intravenous drug users at high risk of HIV who would otherwise not be exposed to treatment and health education. Strang has described how a satellite clinic may be established with few resources, with staff who can be supervised by more senior workers at a central site (Strang & Creed, 1985). In this study the client groups of a satellite clinic and a conventional drug dependency unit were compared in order to characterise the clientele of the satellite clinic and to discover whether it was indeed fulfilling a useful role in terms of attracting such high-risk individuals for treatment.
A new appraisal of Mental Health Review Tribunals
Authors: Grounds A. T.
Published: May 2008

Mental Health Review Tribunals were introduced in the Mental Health Act (1959) to safeguard psychiatric patients against unjustified detention in hospital. The powers of tribunals form “an important part of the fabric of civil liberties” (Wood, 1974). However, in exercising their prime function of preventing unjust detention, tribunals in practice also have to take into account patients' clinical needs and the protection of the public. Further weight was added to this complex burden of decision making following a judgement by the European Court of Human Rights in 1981 which upheld the right of all detained patients to a periodic judicial review of their detention. As a result of this judgement the Mental Health Act (1983) extended tribunal powers to include the release of offender patients sentenced by Crown courts and given hospital orders with restrictions on discharge. Such individuals may have been convicted of grave criminal offences, and their discharge or transfer from hospital would otherwise require the consent of the Home Office.
Who cares for the older adolescent?
Authors: Watts E. L. , Jenkins M. E. , Richardson G. J. R.
Published: May 2008

One of the first principles on which a good service for adolescents will be based, according to the Health Advisory Service Report Bridges Over Troubled Waters (1986), is “The age group concerned from 12–19 years requires separate consideration and provision”. Up to the publication of this report, many adolescent psychiatrists dealt only with those up to the age of 16 (Bruggen & O'Brien, 1987) or up to school leaving age. Such a recommendation means a considerable change of practice, and this study was designed to assess the nature of that change.
A visitor's view of Madison's Program for Assertive Community Treatment (PACT)
Authors: Muijen M. , McNamee G.
Published: May 2008

Before commencing work on the Daily Living Programme at the Maudsley Hospital, in London, to compare the benefits of community care with standard hospital admission for patients with serious mental illness, a visit to Madison was arranged, where some ten years ago a similar study had been carried out (Stein & Test, 1980). We had the impression from the substantial literature which has appeared on the mental health service in Madison (Stein & Test, 1985) that they have implemented in practice their positive research findings on community care. It was felt that their lengthy experience with such a service could be beneficial to the UK, where such services are now being developed. This visit included PACT (Program for Assertive Community Treatment); a research programme investigating the long-term prognosis of mainly schizophrenic patients, and the various units of the mental health services in Madison.
Psychiatry in Canada
Authors: Kennedy Sidney
Published: May 2008

There are two episodes which remain in my mind from the first night I was on call at the Clarke Institute of Psychiatry, Toronto in 1980. The first person I assessed in the Emergency Room was a young university student in her early twenties who had been reading “Jung” and urgently needed to discuss “archetypes and the animus”; the second incident some hours later involved a middle aged man who was manic on admission and responded rapidly to the 10 mg of haloperidol I administered intravenously in front of a silent and, as I later discovered, astonished night nurse and junior resident. The patient settled rapidly and my unorthodox treatment was a talking point for several weeks. These two vignettes alerted me to the fact that things were different here. No-one had ever used intravenous neuroleptics in Toronto at that time, and equally no-one in Newcastle on Tyne, which I had left only two weeks earlier, would consider the casualty department of the Royal Victoria Infirmary a necessary stop as they waded through Jung.
Training in community psychiatry — a year's experience
Authors: Malcolm Katy
Published: May 2008

As the move towards community based psychiatry gathers momentum, it becomes increasingly important that psychiatrists are adequately trained to take on their changing role in the new model of psychiatric care (Sturt & Waters, 1985;Lancet, 1985). Indeed, it has been recommended that “every psychiatrist should be familiar with the conduct of community psychiatry” (Freeman, 1985). Difficulties arise, however, due to the fact that there is no accepted definition of the practice of community psychiatry (Fink & Weinstein, 1979) let alone well established training programmes designed to equip future community psychiatrists to practise competently. Not surprisingly, few psychiatrists are satisfied with their community psychiatry training. Brook (1981) reported that only 38% considered their community psychiatry to be adequate in quantity and suitably supervised. Even then, their subjective view may not have reflected the actual adequacy of their training. Nevertheless, useful guidelines have been drawn up by the Collegiate Trainees Committee Working Party (Scott, 1988), outlining what would constitute a rounded training programme in community psychiatry. However, there is scant literature evaluating the usefulness of the few existing posts providing such experience
Privatisation of psychiatric care in the USA
Authors: Das Mohan P.
Published: May 2008

Privatisation of psychiatric care is an increasing phenomenon in the USA. This is a relatively new trend and has followed on the heels of other trends like the deinstitutionalisation of the 1960s and 70s. Until recently the majority of in-patient population was in public hospitals, with some in psychiatric units of general hospitals. In the 1980s, the private hospital corporations seem to have discovered that there is money to be made in the business of psychiatric care and started building and marketing psychiatric hospitals on a wide scale.
Community psychiatry — a training experience
Authors: Naismith A. Jane
Published: May 2008

The emphasis of psychiatric care is being moved from the large mental hospitals towards community-orientated care and there seems also to be a need for a shift in the training of psychiatrists to include greater emphasis on the special issues involved in this approach to service provision.
Self-help books for depression
Authors: Macaskill N. D.
Published: May 2008

Depressed patients and their families can benefit enormously from being given appropriate information about their illness, their treatment and the steps that they and their families can take to cope with and overcome the problem. All too frequently, the doctor or psychiatrist, through lack of time, may pay too little attention to this aspect of treatment. Self-help books provide a useful solution to the problem, and not surprisingly the market has been flooded with books which cover, with varying degrees of success, the many facets of depression and its treatment.
The quality of life of severely mentally handicapped patients in hospital
Authors: Walker Phyllis J. , Naylor Graham J.
Published: May 2008

It is unclear how much the profound changes which have occurred in mental handicap hospitals in the last decade have improved the lot of the profoundly handicapped, since Baker & Urquhart (1987), in a national survey of Scottish Mental Handicap Hospitals, found that 45% of all hospital residents had no set occupation and that there was a relationship between occupation and ability level. Between 14% and 32% of all patients were without occupation and unable, or not allowed, to leave the ward without a member of staff.
Autonomy and safeguards in people with impaired decision-making abilities
Authors: Morgan John
Published: May 2008

In everyday life we all make choices and decisions with regard to ourselves and our environment. Such decisions may be quite trivial, for example which pair of trousers we should wear, or major, for example to move home. The freedom to make such decisions may be called the right to self-determination or autonomy. For adults, such a right is recognised by the law, either explicitly as in USA or more implicitly as here in the United Kingdom. Such a right is also partially acknowledged in children although if the child or young person is not capable of making a reasoned decision then the parent or guardian may make the decision on their behalf. Some adults through mental disability (mental illness, mental handicap) have a diminished ability to make reasoned decisions. However, it is important to recognise that in any given situation there should be an assessment of the person's ability to make a reasoned decision and assumptions not made for convenience's sake. Even people with substantial intellectual impairment are capable of making some decisions.
Caring for People: a critical review of British Government policy for the community care of the mentally ill
Authors: Holloway Frank
Published: May 2008

The development of ‘community care’ for the elderly, mentally ill, mentally handicapped and physically disabled has been Government policy in Britain since the 1950s. Problems with implementation of this policy led the Audit Commission (1986) to conclude that “the one option that is not tenable is to do nothing about present financial, organisational and staffing arrangements”. Sir Roy Griffiths was commissioned to review “the way funds are used to support community care policy …”. Radical solutions were proposed and subsequently incorporated in the Government White Paper Caring for People (Department of Health, 1989a). However, two very significant measures were not accepted: the ‘ring-fencing’ of community care monies and the creation of a ministerial post within the Department of Health with specific responsibility for community care.
Audit of a psychiatric liaison service – the value of general practice casenotes
Authors: Curran Sheila M. , Pullen Ian M.
Published: May 2008

The practice of out-patient psychiatry has undergone a number of significant developments in recent years: the number of patients referred by general practitioners has steadily increased: a large number of psychiatrists are now seeing patients in the primary care setting and more patients are being seen on one occasion only.
Clinical examinations for professional qualification in psychiatry: the patients' views
Authors: Persaud Rajendra D. , Meux Clive J.
Published: May 2008

As part of testing candidates' abilities, patients are used in clinical examinations for professional qualifications throughout all specialties and levels of medicine. However, the patients' views on being used for these purposes have not been investigated. Examiners use the opportunity presented by candidates interviewing patients in an examination setting as part of the test of a candidate's ability in psychiatry. Psychiatric patients' experiences of such examinations may be so different from that of most clinical practice that there may be profound effects on their views of themselves, their illnesses, hospitals and of the profession itself.
Trainees' attitudes to forensic psychiatry, the courts, and attending conferences
Authors: Mendelson Eric F. , Hurley Alexander , Williams Tegwyn
Published: May 2008

Having gone to the trouble of organising a day conference on ‘The Psychiatrist in Court’, primarily directed at trainees, we were disappointed to find that on the day the considerable audience was composed mostly of consultants. This seemed a pity, particularly as we knew that this was an area of concern to many young psychiatrists. Kindly colleagues assured us that it is always difficult to get juniors to attend conferences. Nonetheless we were curious to know why trainees seemed more reluctant to take time away from their normal duties than perhaps their ‘more pressed’ consultants.
Banished to a Greek island
Authors: Ramsay Rosalind
Published: May 2008

In October, public attention focused on psychiatrists gathering for the Eighth World Congress in Athens. Was psychiatry still being abused for political purposes in the Soviet Union (Bloch, 1990)? And were mental patients elsewhere being mistreated? At the Stadium of Peace and Friendship overlooking the Aegean Sea, delegates had the chance to meet and talk about these important issues concerning human rights and human dignity.
A district service for bereavement care
Authors: Parkes Colin Murray
Published: May 2008

Bereavement counselling is one of the few examples of preventive psychiatry to have proved its worth in well conducted random allocation studies (Raphael, 1977; Parkes, 1981). If, as the work of Paykel (1974) and Brown & Harris (1978) suggests, major losses are the life events most often associated with the onset of clinical depression, then psychiatrists would do well to involve themselves in the work of any organisation which aims to meet the psychological needs of the bereaved.
The role of the clinical tutor – a personal experience
Authors: Jones Jeffrey R.
Published: May 2008

The role of the clinical tutor may differ from that set out in the helpful guidelines given by the Royal College of Psychiatrists. It may differ depending on the setting of the training for instance. I was made clinical tutor some three and a half years ago for a large, mainly rural area – North Wales. The area does not have its own medical school, but is associated with the University of Wales College of Medicine, at Cardiff, some 150 miles away.
Cold comfort
Authors: Ramsay Rosalind
Published: May 2008

A psychiatrist's interest in human suffering is not restricted to daily work. Trainees in Oxford, asked to pick out six novels which had been important to them, chose books concerned with “alienation, sexuality and suicide” (Harrison & Day, 1988). Respondents to such a survey in the future might well include The Comforts of Madness (Sayer, 1988), surprise winner of the Constable Trophy for fiction in 1988 and subsequently the coveted Whitbread prize. It is former psychiatric nurse Paul Sayer's first book. He started writing in his twenties after taking a break from nursing to run a corner shop with his wife. In his spare time he read. He explains, “I was standing in the corner shop one day, and I just felt this urge to write” (Winder, 1989). He returned to nursing and at the same time, started to write about a world that was familiar to him.
The history of Japanese psychiatry and the rights of mental patients
Authors: Totsuka Etsuro
Published: May 2008

In ancient Japan, written characters and religions were largely based on Chinese cultures. The first foreign physician was invited from Korea to Japan during the Shiragi Dynasty, when an Emperor became ill at the beginning of the 5th century. Since then, Chinese medicine dominated in Japan until Western medicine was introduced in the middle of the 19th century.
The nuts and bolts of writing papers
Authors: Footring Ralph
Published: May 2008

Some jargon is useful. Though I invariably place inverted commas around ‘caseness’, just so that everybody knows that I know that it is jargon, I would be a lost man if I diligently replaced it with a statement to the effect that this particular patient has achieved an index of definition of 5 or over on the Present State Examination.
A deaf world in Rampton Hospital
Authors: Roberts Julia
Published: May 2008

Rampton Hospital is one of four Special Hospitals in England and Wales. Along with the other Special Hospitals, it usually has a small number of deaf patients. I had developed a special interest in the particular problems of psychiatrically ill deaf patients and it seemed fortuitous that I should spend a year of my senior registrar training at Rampton Hospital.
Psychiatric court reports for bail applications
Authors: Barker Ann
Published: May 2008

The presence of the Official Secrets Acts of 1911 and 1920 precludes comment from doctors working within Her Majesty's prisons on the state of remand prisons in Britain. Her Majesty's Chief Inspector of Prisons, Judge Tumin, has described them as “intolerable, and representing much human misery”. In an article entitled ‘Under the prison outrage: a quieter scandal’, Kilroy-Silk (1989) refers to a report implying that, at any one time, one third of remand prisoners suffer from mental illness.
SHO posts in psychiatry in the 1990s
Authors: Crisp A. H.
Published: May 2008

Some of the proposals in Achieving a Balance (DHSS, 1987) seem to have developed with little regard for postgraduate training in psychiatry. In psychiatry it has become common practice for SHO posts to be incorporated in training schemes with registrar posts, allowing several years of overall basic specialist training in preparation for obtaining the MRCPsych. This is in accord with the GMC Education Committee's position (GMC, 1987a) that specialist training can, on the ‘fast track’, follow on immediately from satisfactory completion of pre-registration posts (general clinical training) and full registration. Achieving a Balance states clearly that specialist training begins at registrar level and that any doctors in SHO posts should be receiving further general training. There are few guidelines concerning the necessary nature of such general training.
Facilities for mentally impaired patients: three years experience of a semi-secure unit
Authors: Mayor Janet , Bhate Milan , Firth Hugh , Graham Anne , Knox Pam , Tyrer Stephen
Published: May 2008

The Working Party on Security in NHS Hospitals (The Glancy Report, DHSS, 1974a) and the interim report of The Butler Committee (DHSS, 1974b) both recommended that secure provision should be made available for the treatment of mentally disordered patients who required greater security than could be provided in a standard hospital setting. They recommended that patients with mild or borderline mental handicap should be treated together with the mentally ill but that “severely subnormal patients” should be treated separately. Later the Royal College of Psychiatrists (1981) largely endorsed this advice proposing that:

(a) individuals with borderline and mild mental handicap could be adequately treated in the secure units for mentally ill individuals

(b) individuals with moderate mental handicap needed a special secure facility

(c) individuals with severe mental handicap did not need high security, and should be managed in high-staffed wards in mental handicap hospitals.
Defaulting at the Nigerian National Neuropsychiatric Hospital
Authors: Adelekan M. L. , Ogunlesi A. O.
Published: May 2008

Defaulting from out-patient surveillance constitutes a major problem among neuropsychiatric patients globally. In an extensive review of default studies (Baekeland & Lundwall, 1975), it was concluded that between 20–50% of psychiatric patients fail to return after their first visit and 31–56% attend not more than four times before defaulting.
All Birmingham rotational scheme for training in psychiatry (1984–1989)
Authors: Davies Martin H.
Published: May 2008

This very large training scheme was formed at the suggestion of the then newly appointed Professor of Psychiatry, Ian Brockington, who saw that in the existing rotations the balance between specialty and general posts was very uneven. He also argued convincingly that it would attract more trainees of high calibre and improve the morale and enthusiasm for training of the consultants, particularly in those rotations which had difficulty recruiting junior doctors or had failed to achieve more than provisional approval by the Royal College on repeated accreditation visits. The new scheme was launched in 1984 following the establishment of a Steering Committee including representatives of the psychiatric divisions of the five Birmingham Health Authorities and the adjacent Sandwell and Solihull Health Authorities, of the University Department and of the various specialties such as child psychiatry. All the Authorities agreed to pay jointly for a clerical officer to service the scheme and Solihull undertook to provide accommodation and a Medical Personnel Officer with specific responsibility for the scheme. A senior universally respected Clinical Tutor, Eddy Sethna, was elected Organising Tutor and given full authority to manage the rotation, reporting twice yearly to the Steering Committee which would advise on any difficulties which he could not resolve directly with trainees, trainers or divisions and would agree additions or modifications to the scheme.
Multi-centred day units in a psychiatric rehabilitation service
Authors: Rothwell N. , McKechnie A. A. , Lorimer D.
Published: May 2008

Psychiatric day care has expanded considerably over the past 20 years. Day hospitals may serve as alternatives to short-stay in-patient units or speed discharge from them. Day services are also necessary to ensure appropriate support for patients with chronic disability, especially chronic functional psychosis, if they are to remain in a community setting (these are often called day hospitals to ensure NHS support). The present paper focuses on this latter group and describes the characteristics of day attenders in a service that has developed a multi-facility approach to community support.
‘Lillian’ - a play on schizophrenia
Authors: Johl Surinder S.
Published: May 2008

“Welcome to ‘Lillian’. This is all about schizophrenia. Schizophrenia is an illness, a serious mental illness which affects one person in a hundred. It is an illness which causes strange thoughts and strange feelings. It leads to emotional disturbances and a withdrawal from the reality of the external world. Those who suffer from it withdraw into their own world, into an unreal world of fantasy. Often they are tormented by strange and frightening experiences. Some develop strange ideas and fear that they are persecuted. Others hear voices, see and feel things that are not there, though they are real to them. Sometimes it is difficult to understand them because their thoughts are jumbled. They may even feel that someone else is interfering with their minds. In time, some lose their ability to do their everyday activities and lose their drive and initiative but this is not laziness. They often become very anxious and have periods of depression. For many the ability to express their emotions is blunted and in others their behaviour is unusual. These experiences are all very real to them and sadly some never realise what is happening to them. Most do recover with treatment, understanding and support but often under stress, relapses occur. We ask for your understanding and support”.
Do patients need a psychiatric emergency clinic?
Authors: Kehoe Robert F. , Newton Richard
Published: May 2008

When planning new service initiatives it is important to review the role and functioning of existing services. As more patients are discharged from long-stay beds, there is increasing concern regarding the quality of community care and the accessibility of urgent psychiatric help. The Department of Health has recently expressed concern over the level of such services provided (DoH, 1989). In Edinburgh, alternative methods of delivering psychiatric emergency care are currently being considered. Community-orientated crisis intervention teams may be useful, but only a small proportion of people presenting to general psychiatric services fit into the stereotyped model of crisis. Centres with short-term admission facilities have been developed in other countries and within the United Kingdom many general hospital casualty departments have a psychiatrist available on call. Walk-in or self-referral psychiatric clinics provide an easily accessible service but few have been systematically reported (Lim, 1983; Haw, 1987). Such clinics have been described as seeing mainly chronic patients of the hospital who are already in current contact and who present with less severe psychiatric disorders than GP-referred cases. In a climate of NHS financial restraint it is pertinent to ask whether such clinics are needed.
Who cares for the adult brain damaged? Hamble Ward revisited
Authors: Shawcross Charles R. , Crowder John , Brownrigg Karen , Read Allan , Street Jane , Watkins Jill , Pomeroy Val
Published: May 2008

In 1983, Dr Newson-Smith wrote an article in the Bulletin on services for the younger brain damaged persons. In particular she described Hamble Ward, which provides care for such people and for which she had medical responsibility. At that time, this type of service was very rare in the UK and the article generated considerable interest. In 1984, Dr Newson-Smith left the hospital and was replaced by one of the authors (CRS).
Psychiatric aspects of the exchange visit between Bexley Hospital and Centre Hospitalier Specialisé de Ville-Evrard
Authors: James Adrian
Published: May 2008

The Centre Hospitalier Specialise de Ville-Evrard is situated 17 kms from the centre of Paris and serves an area of approximately a quarter of the north-eastern outskirts of the city. I visited as one of a multi-disciplinary party of 20. The visit took place over five days and returned their visit to Bexley Hospital, Kent in South East England, which took place in November 1989. English lessons take place in the hospital as part of the hospital's responsibility for continued education for its employees and they had initiated the visit to England to improve the standard of their English.
3. Old age psychiatry
Authors: Black Dawn , Guthrie Elspeth , Jolley David
Published: May 2008

The old age psychiatrist's role has been evocatively described as “physician to the soul of the elderly”. A more practical definition is psychiatrist to patients over the age of 65 with both functional and organic illnesses.
A short series of short pieces (with questions)
Authors: Culliford Larry
Published: May 2008

It is in the nature of eagles to fly. It is in the nature of human conditioning to develop attachments and aversions. The story is told of the court monkey who finds a luscious fruit inside a narrow-necked bowl. When the fruit is grasped however the monkey's full fist does not allow him to withdraw his hand, yet to the amusement of onlookers he will not relinquish the object of his desire. How foolish!
Hostages returned from the Gulf
Authors: Gath Ann
Published: May 2008

Recent reports show that continuing problems are being experienced by the returned hostages and their families. The Department of Health advised at the time of the hostages return that, apart from those who needed immediate emergency treatment, the initial point of referral ought to be the persons general practitioner. General practitioners in many cases now employ their own staff who are able to offer support and counselling. In some cases the general practitioner may, however, decide that the most appropriate response is referral to the psychiatric service. All local psychiatric services should be able to respond to the needs of people suffering continuing stress as a result of traumatic experience.
Part-time training in psychiatry: what trainees want
Authors: Routh Christina P.
Published: May 2008

The proportion of female medical graduates has steadily risen in the past decade. Although it may be argued that men should take on an equal share of the child-rearing and housekeeping roles of the housewife, there is evidence that women doctors are falling behind in their careers because of domestic pressures (Rhodes, 1990). Part-time work is perceived in theory as being a suitable option for women doctors with domestic commitments, but the number who choose this option in practice is surprisingly small. The following study sought to establish what demand there is for part-time training in psychiatry among junior doctors and whether what is on offer meets that demand.
A visit to Romania in October 1990
Authors: Gath Ann
Published: May 2008

Council agreed to sponsor the Registrar on a visit to Romania to join a team from the Wolfson Centre, Great Ormond Street, and the Newcomen Clinic at Guy's Hospital. The main focus was the Neuropsychiatric Children's Hospital at Lugos in the region of Banat in Western Romania. The Director of this hospital had asked for this visit.
Suicide
Authors: Rossiter J.
Published: May 2008

In an attempt to discover what can be learnt from records kept on suicide victims, all data collected by one health district about suicides occurring in patients in close contact with psychiatric care over four years were examined.
A New Zealand experience
Authors: Timney Brian
Published: May 2008

Hamilton is New Zealand's fourth largest city. Situated on the banks of the Waikato river in the central North Island, it was my home during a year's experience as a psychiatric registrar in the Waikato Hospital. This paper describes aspects of a medical and psychiatric practice, including training in New Zealand, and offers general advice to trainees planning or considering overseas placements.
Substance misuse services in the USSR
Authors: Fleming Philip M.
Published: May 2008

Exchange visits with Soviet colleagues are being encouraged. I recently had the opportunity of spending two weeks visiting services for drug misusers in the Soviet Union with two colleagues, a visit sponsored by the British Council as a UK/USSR collaborative project. We spent most of our time in Leningrad and the surrounding region, and a short time in Moscow. Since then a party of Russian specialists has visited the Wessex Region to see drug and alcohol services.
Failure to recognise tardive dyskinesia in the long stay population
Authors: Macpherson Robertson , Collis Rachel
Published: May 2008

Tardive dyskinesia (TD) is an involuntary movement disorder associated with long term neuroleptic exposure. Gerlach & Casey (1988) reported a 15% prevalence rate of TD among patients on neuroleptics, the rate increasing to 54% in patients over 60 years old.
Information technology for child and adolescent psychiatry
Authors: Byrne Patrick
Published: May 2008

The purpose of this paper is to examine existing information technology (IT) options for child and adolescent psychiatry (CAP) and to propose a strategy for continuing developments in the light of current NHS policy and priorities. It is the outcome of discussions among a group of colleagues within the South West Thames Association for Child and Adolescent Psychiatry. I offer it for discussion as the issues facing us have obvious wider relevance to the profession. The case for investment in health care IT systems has been made most recently in Working Paper 11: Framework for Information Systems (HMSO, 1989). The priorities spelled out in the paper are for management of contracts, measurement of quality of care, costing of services and management of resources.
Repatriation of mentally ill patients
Authors: Hooper Carl A. , Hughes Gareth W.
Published: May 2008

Of all the decisions taken by psychiatrists with or on behalf of their patients, few are as potentially far-reaching as the decision to repatriate a mentally ill person to his or her country of origin. Although many psychiatrists have anecdotal experience of individual cases, published research on repatriation is surprisingly sparse. Burke (1973) reported 66 persons repatriated from Britain to Jamaica over a four year period, and Asuni (1968) found 82 returning via Aro Hospital, Nigeria, over a similar period. Although it is difficult to extrapolate an estimate of the number leaving the UK each year, these figures suggest that the practice is not uncommon and that significant, possibly increasing, numbers of people are affected.
Carers, the community and the White Paper
Authors: Atkinson Jacqueline M. , Coia Denise A.
Published: May 2008

The role of relatives as carers of people with chronic mental illness has long been emphasised and was legitimised by Sir Roy Griffiths in his report to the Secretary of State in 1988. The White Paper (Caring for People), however, merely pays lip service to the role of the family. It does not suggest how such help might be provided. There is no reference to relatives, or even ‘informal carers’ (the most recent way of describing relatives), in its sections on provision of services by Social Services or the Health Service. While ‘informal’ is clearly used to indicate ‘unpaid’, it emphasises that relatives, even as carers, are not part of the formal caring process and can, therefore, be ignored as part of the team. If relatives are to be part of the service, as carers, then they need, as Griffiths and the White Paper point out, to receive support and resources to fulfil this role. But what support and services? And who is to provide them?
Hospital cases
Authors: Musson Jeremy
Published: May 2008

It could be said that one of the chief architectural legacies of the late 20th century, when it comes to be considered retrospectively, will be the wanton destruction and dispersal of buildings constructed in the previous century for the public benefit. Churches, schools and hospitals have been systematically sold off, and a good number of them, if not totally demolished, have lapsed into a pathetic state of limbo, particularly in this time of economic recession. Some of the worst cases of this known to the Victorian Society are hospitals of great architectural quality, constructed for the treatment of the mentally ill, then known as lunatic asylums.
Wensleydale
Authors: Simpson C. J.
Published: May 2008

One morning last week, I had said goodbye to my family, and as usual went to feed my chickens. They were excited to see me except for one, which was lying on its back with its feet up in the air, motionless and stiff. My medical training helped me diagnose death, and after I recovered from the initial shock, I had to consider the aetiology. Unfortunately, a few days earlier, I had found some tunnelling into the chicken shed and eggs had gone missing. I thought this was most likely to be rats. Can rats kill chickens? I was able to clarify the position later in the day, from a patient who was a poultry farmer, who informed me that rats do not kill chickens, but only baby chicks and that it was common for chickens at the age of nine months to suffer from sudden death.
The task of treatment and the multidisciplinary team
Authors: Ambelas Aris
Published: May 2008

Throughout society there is an increasing tendency to approach the various activities of human existence in a way which eschews blind acceptance, but requires instead thorough examination and analysis of the processes involved in those activities in the belief that the insight gained will improve performance. Treatment is a central activity of the Health Service, and this paper will attempt an analysis of the processes involved in it within the context of the clinical team delivering it.
The psychiatric MCQ: are ‘possibles’ always true?
Authors: Bisson Jonathan I.
Published: May 2008

The above specimen MRCPsych Part 1 question (Royal College of Psychiatrists, 1989) illustrates well the difficulties facing the examination candidate who is required to make a TRUE/FALSE/DON'T KNOW decision in the knowledge that an incorrect response will result in a negative mark.
4. Community psychiatry
Authors: Guthrie Elspeth , Black Dawn , Osborn Madeline
Published: May 2008

Community psychiatry is at present an ill defined specialty. The emphasis is on psychiatry practised in the community, often in the context of a community mental health centre (CMHC), although in-patient facilities are still an important component of most services.