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The Care Programme Approach and its accompanying register were introduced in response to difficulties encountered in a young adult population. This paper describes the use of the register by an old age psychiatry service who do not routinely accept ‘graduate’ patients. Few patients had a diagnosis of dementia and most had psychiatric histories in excess of 10 years.

Sir: Dr Raymont ( Psychiatric Bulletin , February 2002, 26 , 201-204) is right to draw to our attention the complexities involved in the legal basis of our ministrations to the patient who may lack the capacity to give informed consent. We especially welcome discussion of the issue of belief and

In 1961 Shaw & Macmillan claimed that there was no doubt of the value of the day hospital as an “alternative to in-patient care and prophylaxis” for the elderly mentally ill (EMI). Thirty years later the day hospital remains central to many EMI services. During these years little has been done to evaluate this method of service delivery against other models of service provision.

Despite the increased availability of psychotherapy within the NHS, inequalities remain (Holmes & Lindley, 1989). Traditionally, psychotherapy ser vices 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 predo minance 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. This study was performed as part of a project to use a new communications technology, computer based interactive television, to aid the delivery of psychiatric services including psychotherapy. The aim was to get a detailed description of professional user responses to using the system for assessing patients for psychotherapy as a preliminary to a clinical trial.

Greater care in the community will lead to the geographic dispersal of psychiatric services and the role of communications technology will become increasingly important. McLaren et al (1991) described the potential role for new communications technology, such as interactive television, in the provision of psychiatric services but before resorting to new communications technology it will be important to ensure that full use is being made of existing technology such as the telephone. The telephone is widely used in the UK health service but poorly understood, in contrast to the USA where it has been recognised as an important medium for care delivery (Hallam, 1989). This pilot study was designed to gather information on the current role of the telephone in an acute psychiatric service and to aid the planning of the use of more advanced communications technology such as interactive television.