At one time, I knew what psychiatrists should do and it was very satisfying. They should, so far as humanly possible, restore the mad and the distressed to sanity and tranquillity. Now things are less clear, and there are three main reasons for this. First, many of the incurably mad are distressed because they live in conditions of unspeakable social squalor which one does not have the power to relieve. Second, most of the curably distressed are cured by time or their GPs and we see only a small proportion of them. Third, many of the people referred to us have personality or alcohol problems for which, in most cases, no effective treatment can be given.

Issues of identity and contemplation of the future have been preoccupations of Australian psychiatry recently and will be identified and contemplated in this report. While aware that to direct attention to such issues is ipso facto evidence of insecurity about identity, and is certain to be a relatively unsubtle exercise in convoluted nationalism, your reporter suggests that jingoism, if properly defined as ‘love of Australia’, is an adequate defence.

The development of an effective psychiatric service for the elderly is dependent upon the allocation of adequate resources. A good candidate, trained in psychiatry for the elderly, is unlikely to consider a post where the provision is inadequate.

Bids for new posts for 1982–83 will be decided by Regional Authorities on the advice of Regional Manpower Committees within the next few months on the basis of guidelines formulated and issued by the DHSS. There seems little likelihood that cash limits will be significantly eased by 1982–83, and the case for psychiatry will have to be argued in face of a greater degree of consultant expansion to be allowed in the support specialties—e.g., anaesthetics, radiology, and unlimited expansion, as far as central approval is concerned, in general medicine, general surgery, and obstetrics and gynaecology. It may be expected that the non-metropolitan Regions will be better placed financially to meet consultant expansion, so that while on average two to three adult mental illness consultant posts will be permitted in each Region, Regions with resources may be encouraged to bid above this average, as preference will normally be given to Regions with the lowest ratio of establishment to population. The same principle would apply in child and adolescent psychiatry where on average one post per Region may be allowed. Only two new consultant posts in mental handicap will be created in the year in England and Wales. Applications for forensic psychiatry posts for regional secure units will be treated sympathetically, and, while there is no limit proposed for psychotherapy posts, the small number of senior registrars who will have completed training suggests that few bids are anticipated for this specialty.