Early in 1992, two articles were published on the subject of multidisciplinary teams in child and adolescent psychiatry. In the first, Mathai (1992) challenges the “accepted multidisciplinary model” as being “unworkable”. He comments that in many teams an appearance of multidisciplinary working can hide covert conflicts and goes on to propose that all referrals should be made to the consultant psychiatrist who will then decide to whom these referrals should be allocated within the team.

“I am superior in many ways but would gladly give it up to be human.”

Lieutenant-Commander Data – on android and serving officer on the Starship Enterprise Circa the 25th century at Encounter Farpoint. (See Fig. 1).

Striking advances in artificial intelligence (AI) have brought to life philosophical debates about the concept of the mind, and of consciousness. Strong advocates of AI suggest the symbiosis of man and computers is the next step in our evolution, and to control this process, we need to address the “Big Question”: what is the meaning of life, and specifically, what are we? Understanding what we are is of great interest to us all; for psychiatrists, philosophers, and psychologists it is their life's work. In this paper, I shall introduce some of the main ideas about AI under the following headings. Can computers have a mind, improve our understanding of, or be integrated with our mental processes?

The presence of a generalised seizure is necessary, although not sufficient, for effective ECT. Awareness of this has led to a widespread practice of documenting not only the occurrence but also the duration of seizures; a minimum duration of 25 seconds has been suggested (Royal College of Psychiatrists, 1989). Yet even the most recent surveys of practice have shown that on most occasions when a seizure is brief or absent the treating doctor does nothing about it (Scott et al, 1989; Pippard, 1992).

Rotational training schemes are now well established as appropriate means of organising psychiatric training in the UK. There are already a number of good descriptions of how schemes are organised and managed (Soni et al, 1987; Davies, 1990) and one report of the experiences of trainees in a particular scheme (Fahy & Beats, 1990).

The author J. R. Hartley and his book on fly fishing do not exist in external reality. They are instead a product of the advertising fantasy world, dreamt up to promote the Yellow Pages. This advertisement was at its prime when I was trying to develop a suitable analogy for teaching medical students and junior doctors about psychotherapy and some of its techniques. When taking a short break in front of the television set, it suddenly struck me just how appropriate this advertisement was. J. R. Hartley himself lends credence to the analogy, while fly fishing as a sport provides an excellent comparison for the art of psychotherapy. Like the fictitious publication in the advert, psychotherapy and its techniques can prove exasperatingly elusive, as they constitute a series of shared internal beliefs and representations which exist largely within the collective mind. I therefore felt that this ambiguous character who is not part of the external real world, yet has a special inner meaning for a wide number of people, seemed like the ideal analogy for describing psychotherapeutic processes.

It is 25 years since the Royal Commission on Medical Education recommended that “every psychiatrist should be familiar with the conduct of community psychiatry”. This is now more important than ever. As the National Health Service and Community Care Act (1990) comes into force and community care initiatives are developed throughout the country, psychiatrists are at risk of being left behind. To be effective players in these developments, psychiatrists need to be armed with a thorough knowledge and understanding of the workings of community care. Training future consultants in all aspects of community care must be a continual priority.

For some time it has been recognised that death and non-death loss events are commonly associated with the onset of psychiatric illnesses, especially affective conditions (e.g. Murphy, 1982). Studies have shown that counselling targeted at high risk grievers can significantly reduce their psychological and psychosomatic manifestations of grief, with an associated reduction in the use of statutory services (Raphael, 1977; Parkes, 1980). Bereavement counselling thus offers one of the few opportunities to implement preventive psychiatry.

Several trainees have described their experiences of training in community psychiatry (Lock, 1991; Malcolm, 1989; Naismith, 1989; Shah, 1991). Their reports indicate disadvantages as well as advantages in this type of training but are generally positive.

There is growing concern about the care received by mentally disordered offenders (MDOs). The prevalence of psychiatric disorder among the remanded group has received considerable attention (Coid, 1988). Some MDOs are remanded in custody following even petty offences on account of their vulnerability or because their homelessness prejudices bail. Where the offence is serious a remand in custody may be inevitable.

The inaugural meeting of the Association of Teachers of Sexuality within Medical Education was held in London on 2 July 1993. The list of participants reflected the fact that teaching about sexuality does not fit neatly into any subject area, and although some departments of psychiatry see this as their responsibility, others seem happy to leave it to colleagues in reproductive medicine. So as well as psychiatrists and psychologists, we included gynaecologists, specialists in family planning and general practitioners with psychosexual training. We represented a wide geographical area with participants attending from as far apart as Aberdeen and Southampton. What we had in common was some responsibility for teaching about human sexuality, and a belief in the importance of this topic in medical education.

The Court of Appeal in its judgement of this case ruled that special care needs to be taken in cases where the defendant suffers from “a significant degree of mental handicap” (This term is used with a specific legal meaning – see below) if the only evidence against him is his confession.

Despite the increased availability of psychotherapy within the NHS, inequalities remain (Holmes & Lindley, 1989). Traditionally, psychotherapy services have been provided from teaching centres in cities and patients have had to travel for treatment. This may account in part for the middle-class predominance in psychotherapy patients and Holmes (1991) has identified the need for psychotherapists to reach out and cater for the disadvantaged in large housing estates and rural areas. While services are changing to meet such needs (Pedder, 1989) there are powerful economic restrictions on service expansion. The potential for communications technology such as interactive television to aid the delivery of general psychiatric services has been reviewed by McLaren et al (1992) and similar arguments apply to the delivery of psychotherapy.