There is emerging evidence that individuals who are mentally ill are over-represented in the group of defendants prosecuted under the blasphemy laws of Pakistan. This article discusses the background of blasphemy legislation in Pakistan, and proposes causal interactions between underlying mental illness in the defendant and prosecution for blasphemy. It sketches possible legal safeguards for such blasphemy defendants with mental illness in mental health legislation.

The frequency and content of articles of psychiatric interest in the Irish print media were investigated. Issues of psychiatric interest were commonly featured. Contrary to popular opinion most articles are either supportive or neutral in tone. Where negative imagery occurred it was more frequently associated with articles in the tabloid papers. Mental health professionals, in particular psychiatrists, contributed very little towards articles of psychiatric interest (especially in the tabloid press) and need to become more actively involved in shaping the portrayal of mental illness in the print media. Their involvement is associated with a more positive portrayal of psychiatry.

Complaints made against doctors are increasingly important given the current emphasis on consumerism in the National Health Service and the publication of the report of the Wilson Committee which reviews complaints procedures. There have also been recent changes in medical indemnity and increased litigation. The origins of complaints made against psychiatrists were studied. Most complaints were made by relatives and advocates rather than the patients themselves and half were made after the patient was discharged from hospital. It was found that most complaints arose out of a breakdown of communication between psychiatrist and patient.

Thomas Szasz's essay misses several key points about the undoubted changes that psychiatry has undergone since he wrote his original screed against the discipline in 1961. Szasz fails to recognise that the discipline today acknowledges a neurological basis for much psychiatric illness. Thus, his fulminations against psychiatry for treating ‘mental illness' is off-base. Szasz's original diatribe was heavily against psychoanalysis. Yet today Freud's doctrines can scarcely be said to play even a marginal role in psychiatry, and it is absurd to keep levelling the same old charges of 50 years ago. One has the feeling of looking at one of the last veterans of the Esperanto movement in confronting Szasz: lunacy at the time, bizarrely outdated today.

Ninety-six successive acute psychiatric admissions were assessed with regard to dress, level of hygiene, the presence of tattoos, bodily piercing/decoration and surface marks of self-harm. These features were also examined in relation to ICD–10 category diagnosis. One-third were described as ‘dishevelled’, 21% ‘unclean’, 7% had multiple pierced ears and 3% other pierced body parts. Sixteen per cent had tattoos, rising to 34% in the F10–19 (substance misuse) category, and 15% had scars of self-harm. People with schizophrenia and related disorders were more likely to present in an unclean state. Those with personality disorders were no more likely to bear the scars of self-harm, tattoos or body piercing.

High attrition rates in psychiatric out-patient departments are well documented in the literature (Baekeland & Lundwall, 1975; Gillis & Egert, 1973). Non-attenders' attitudes and beliefs about their illness and treatment may provide valuable insight into reasons for not attending. This consumer orientated approach could enable clinicians not only to improve clinic attendance but to assess their treatment efficacy.

Offender health is an important part of general mental healthcare. To improve the health of offenders, we need reforms similar to the reforms in community care of the last decade – early intervention, alternatives to the institution and multi-agency community services. Front-line clinicians are in a key position to bring about such reforms. It will be crucial to argue that improvements in offender health will help bring about broader government aims such as reduced reoffending.

Violence in the workplace is of great concern to trainee psychiatrists. A questionnaire was devised to assess knowledge of safety Issues, and precautions available, among junior doctors. The results, which revealed gaps in provision of safety training and facilities in this area, have been forwarded to the relevant directorates with a view to setting standards suitable for audit review.

General practice fund-holders purchase secondary care for their patients directly, encouraging competition between providers. The scheme now includes almost all community mental health services. Practice counsellors may now be funded from secondary care budgets. Fund-holders may use their purchasing power to influence out-patient policies, have consultant sessions in their surgeries, gain direct referral to community psychiatric nurses, resist sectorisation, or change to a different provider altogether. The implications for mental health teams and their patients are discussed. Mental health workers must define their roles very dearly, and get involved in negotiating contracts now, to influence future service provision.

In the past decade there has been a rapid diversification of services provided for patients with chronic psychiatric illnesses. Although these services are thought to be beneficial for those who use them, there has been little in the way of objective evaluation. As new services begin to compete for the limited resources available, it has been recommended that they should demonstrate their effectiveness. This paper reports a small pilot study on the value of an arts based service known as START (Bridges & Brown, 1989) which won a BBC ‘It's My City’ competition in 1989. It has been a popular component of the rehabilitation services of the Department of Psychiatry, Manchester Royal Infirmary since its inception in 1986.

Recent years have seen a substantial increase in the use of crisis resolution home treatment (CRHT) teams as an alternative to psychiatric in-patient admission. We discuss the functions of these services and their effectiveness. Our research suggests high rates of suicide in patients under CRHT. Specific strategies need to be developed to improve patient safety in this setting.

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).