The term Afro-Caribbean is used to describe black people of Caribbean origin in Britain. Migrants from the Caribbean, their children and their children's children are all covered by this term. The group as a whole is reported to have a higher incidence rate of schizophrenia than white groups, (King et al 1994), and British-born children of Caribbean parents have an even higher rate (Harrison et al, 1988). These reports have led to the hypothesis that Afro-Caribbeans may have a special vulnerability to schizophrenia. While limitations to these studies have been identified, (Wessly et al 1991) none has sought to question the use of the term Afro-Caribbean as a valid and reliable ethnic grouping. If we are to be able to produce good hypotheses for the aetiology of the reported increases in incidence, or to produce research which is useful to Black and ethnic minority groups, we need a clear understanding of the people under study.

The term ‘liaison psychiatry’ is becoming increasingly popular. Indeed, the Royal College of Psychiatrists has set up a special interest group, the Liaison Psychiatry Group, which has a growing membership. There appear to be developments in training and in service provision but it is difficult to assess their clinical impact. Ongoing research is required to quantify the actual level of service provided to general hospitals.

Old age psychiatry has been steadily developing as a specialty in the United Kingdom. In 1978 the Royal College of Psychiatrists established a specialist section for old age psychiatry, and since October 1989 it has been formally recognised as a sub-specialty of psychiatry. In 1989 the Royal College of Physicians and the Royal College of Psychiatrists published a joint report entitled ‘Care of Elderly People with Mental Illness’ in which recommendations were made about both postgraduate and undergraduate training.

The UK's services for adult attention-deficit hyperactivity disorder (ADHD) are in crisis, with demand outstripping capacity and waiting times reaching unprecedented lengths. Recognition of and treatments for ADHD have expanded over the past two decades, increasing clinical demand. This issue has been exacerbated by the COVID-19 pandemic. Despite an increase in specialist services, resource allocation has not kept pace, leading to extended waiting times. Underfunding has encouraged growth in independent providers, leading to fragmentation of service provision. Treatment delays carry a human and financial cost, imposing a burden on health, social care and the criminal justice system. A rethink of service procurement and delivery is needed, with multiple solutions on the table, including increasing funding, improving system efficiency, altering the service provision model and clinical prioritisation. However, the success of these solutions hinges on fiscal capacity and workforce issues.

‘But don't they get lost?’ This is usually the first comment made when the authors mention the use of patient-held records (PHRs) to colleagues. Nevertheless, PHRs have been used in mental health care as well as several other settings, including services for diabetes, cancer, maternity and child health. In some of these services, including mental health, PHRs have been an addition to clinician held standard notes, whereas in others the patient holds the only record for their care. The main purposes of introducing PHRs have been to empower patients with a sense of ownership of their care and to improve communication, between both patients and clinicians, as well as between different clinicians involved in that person's care (Laugharne & Stafford, 1996).

This paper will outline some of the long-standing problems and new challenges facing acute in-patient care, some of the recommendations for change and various difficulties encountered in trying to improve the situation. It will describe how a collaborative approach (led by the Northern Centre for Mental Health, the Centre for Best Practice in Leicester and both the Northern and Yorkshire and the Trent regional offices) can bring about tangible and measurable change for the better and what lessons there may be for the management and delivery of mental health care in the future.

A retrospective survey was undertaken to evaluate the prescribing practices of medical staff in a District General Hospital in light of the Consensus Statement by the Royal College of Psychiatrists on the use of high dose antipsychotics (1993). Two per cent of 247 patients were prescribed a higher than recommended dose of antipsychotic. None of these cases had been prescribed ‘supra-BNF doses of antipsychotic on a regular basis, but with the addition of ‘as required’ (PRN) medication the recommended dose was exceeded. In only one patient was the high dosage administered. A further analysis of these patients is made.

Respite needs for carers of persons with severe mental illness were assessed using a semi-structured inverview. Very few carers were currently using respite facilities. The need for respite was widespread, although largely unmet. Carers shared clear and definite ideas concerning the layout of a good respite service.

Perceived difficulty in obtaining hospital admission for acute psychiatric patients was investigated in one health region using a self-reporting method. Over 17 months both inner city and rural districts reported a total of 327 episodes of difficulty in finding a bed. One hundred and six (32%) of reported cases could not be admitted, the remainder being admitted to a ‘leave’ bed, a bed booked for another patient, or elsewhere, solutions likely to compromise care. Attempts to locate a vacant bed required numerous telephone calls and led to considerable delays. Thirty-nine (12%) of the patients were described as particularly ill, but five of them absconded during the prolonged search for a bed, and a further 17 had to remain in the community, pending a vacant bed, including two aggressive and eight suicidal patients. Considerable under-reporting was confirmed. Possible consequences of the situation are discussed.

The civilian population of southern Lebanon has endured military conflict, civil war, and two invasions since the foundation of the State of Israel in 1948. Currently part of the south is under Israeli occupation forming a buffer zone between Israel and the hostile forces of the Hizbollah and Amal militias. The Israeli Defence Forces are aided by the South Lebanese Army which is the remnants of a Christian militia. The Hizbollah is supported by Iran and Syria and is the dominant force outside the occupation zone. In the south of Lebanon there is a United Nations mandate force which is attempting to return Lebanese government control over the south, decrease hostilities, protect the civilian population and provide humanitarian aid. This is part of the humanitarian mandate of the United Nations Interim Force in Lebanon (UNIFIL) that I had the opportunity to observe and to treat the mental health problems of the civilian population who were living under long-term artillery bombardment and living with continuous fluctuating conflict. Under such circumstances, rigorous scientific methodology in assessing the mental health of the population is extremely difficult. In order to operate effectively, as well as my own rudimentary Arabic, a translator was required. A translator does more than just translate language they also translate custom, culture and provide a valuable source of local information. Utilising my own observations and those of my valued translator, Basima, I did my best to assess how the civilian population coped with what was difficult circumstances. These assessments are value laden and I suppose are in many ways personal. My position as a military psychiatrist in the United Nations allowed me access to both the occupation zone and unoccupied Lebanon.

Freeman pointed out that in 1968 the Royal Commission on Medical Education suggested that “every psychiatrist should be familiar with the conduct of community psychiatry”. In 1987, we still seem to be no nearer achieving this recommendation despite the fact that 60,000 patients have since been discharged into the community, most mental hospitals are being reduced in size and 32% are due to be closed. Whilst doubts have been expressed about the wisdom of these changes, it is unlikely that the process will be reversed. Progress towards adequate training in community psychiatry has been both sluggish and sporadic.