Although psychiatry's future looks less and less likely to be in large psychiatric hospitals, trainees at SHO/registrar level still spend nearly all their time in them. Although the White Paper looks set to dismember comprehensive provision as we know it, few psychiatrists have experienced self-employment, and most are untrained in practical management skills. Although our consumers – as we must now view them – are getting more discerning about what services we offer, psychiatrists only see them after they become ill, and less able to decide for themselves.

Experience in group therapy is recommended by The Royal College of Psychiatrists (1986) as an important aspect of training in psychiatry. However direct experience is unusual. It was reported in the Bulletin that a group formed by trainees in psychiatry to study the group process found a demand for personal therapy for its members (Whewell, 1987). In this paper a group is described which attempted to meet both needs.

A leader in the British Medical Journal (BMJ) last year (Marks, 1988) suggested that the uptake of social security benefits among mentally ill people is low. However, this statement was based on the only data the writer could find – a study of 37 patients conducted in Islington based on the old social security system, prior to April 1988 (Linney & Boswell, 1987). Two weeks later, another BMJ leader (Marcovitch, 1988) bemoaned the fact that insufficient research had been conducted on the impact of changes in the social security system.

The declared aim of the World Health Organization, based on the Alma Ata declaration (1978), is to promote health care for all by the year 2000. It is recognised that this can be achieved only by the channelling of efforts into the development of primary health care, with medical care greatly augmented by the utilisation of non-medical carers, traditional healers and public health measures. As in more developed countries, where psychiatry struggles to maintain its share of national health resources against the ever increasing demand of technical advances in physical health care, so the mental health services of the less developed countries constantly are in danger of losing out to physical health in the battle against illness and natural disasters. To redress this balance and to meet the needs for mental health by the year 2000, the less developed world needs more psychiatrists (who are currently estimated to relate to the population at a rate of approximately only one per million) and these psychiatrists need to be appropriately trained to meet the challenges. How can the more developed nations help in this training of trainees from the less developed world? Can a partnership be formed between nations that ensures that trainees in psychiatry, in whichever country, are equipped as well as possible for the needs of their home country?

Sexual abuse of children by family members varies in its incidence depending on the reports used but its presentation among the adult population has largely been under-reported and unrecognised by mental health workers. Since 1984 we have become increasingly aware of survivors of childhood sexual abuse within our own district service presenting initially as psychiatric cases and more recently seeking help directly for the distress which their childhood experiences have caused them. Gradually we have come to recognise the persistent negative effects of this trauma and have attempted to evolve a model for therapy which deals with this and is suitable for use within a district psychiatric service. The pattern of therapy follows the usual psychotherapeutic rules in that it is on a one-to-one basis at the same time and same place each week. It differs, however, in that the therapist is active and when necessary, directive. Our experience has taught us that each patient will present with certain common basic issues that need to be worked through. We have recognised that to do this work sensitively and efficiently it is important that all the relevant questions are asked and feelings explored. We have evolved a list of themes which we expect each therapist to cover during the contracted sessions. We believe that this ensures work is carried through to resolution. If any of the points on the list are omitted then a patient's ability to be free from the past might be impaired. The majority of our patients have been dealt with as out-patients or in a community setting, but a number may already be within the in-patient unit or day hospital setting, and, for a few, attendance at the day hospital is arranged whilst undertaking individual therapy.

A review of the role and function of the Mental Health Act Commission is a natural outcome of the first five years experience of its workings. By the Autumn, when the third Biennial Report will be published, the new direction and operation of the Commission will be determined by the Secretary of State for Health on the basis of the recommendations of the review. It is too early to indicate the changes that are likely to be wrought by this development. It is possible, however, to reflect on the activities to date.

Opportunities for training in psychotherapy have become more extensive in Britain over the last decade or so, though the increase – as always – has been seen mainly in London and its satellites. The diversity of these training organisations, most of which are outside the mainstreams of NHS and university courses, does not make it easy for their value to be assessed in conventional terms, as well as raising problematic issues about the interface between the public and private sectors.