"OBJECTIVE--To compare the efficacy of home based care with standard hospital care in treating serious mental illness. DESIGN--Randomised controlled trial. SETTING--South Southwark, London. PATIENTS--189 patients aged 18-64 living in catchment area. 92 were randomised to home based care (daily living programme) and 97 to standard hospital care. At three months' follow up 68 home care and 60 hospital patients were evaluated. MAIN OUTCOME MEASURES--Use of hospital beds, psychiatric diagnosis, social functioning, patients' and relatives' satisfaction, and activity of daily living programme staff. RESULTS--Home care reduced hospital stay by 80% (median stay 6 days in home care group, 53 days in hospital group) and did not increase the number of admissions compared with hospital care. On clinical and social outcome there was a non-significant trend in favour of home care, but both groups showed big improvements. On the global adjustment scale home care patients improved by 26.8 points and the hospital group by 21.6 points (difference 5.2; 95% confidence interval--1.5 to 12). Other rating scales showed similar trends. Home care patients required a wide range of support in areas such as housing, finance, and work. Only three patients dropped out from the programme. CONCLUSIONS--Home based care may offer some slight advantages over hospital based care for patients with serious mental illness and their relatives. The care is intensive, but the low drop out rate suggests appreciation. Changes to traditional training for mental health workers are required."

The effects of a range of tree densities on native herbage (mainly AnsXida ramosa, Bothriochloa decipiens and Themeda australis biomass in a Eucalyptus crebra woodland near Kingaroy, Queensland, were investigated between March 1977 and July 1981. Rainfall in this area averages 750 mm year~'. Initial tree density was 640 trees ha^' and this was manipulated using arboricide chemicals to leave plots containing 640, 320, 160, 80 and nil live trees ha~'. Fires were excluded from the whole area, and half the plots were grazed by cattle. The largest increase in herbage biomass was recorded in the 'all trees killed' treatment (nil trees ha~'), closely followed by the 'scattered tree'treatment (80 trees ha"'}. The relationship between tree density and herbage biomass was linear. Recruitment of grass andforb plants, as reflected by changes in density, varied according to treatment. Increased grass recruitment was correlated with cattle grazing, whilst forb recruitment was influenced mainly by tree density.

"This paper discusses the advantages and disadvantages of case management systems for the co-ordination of care of people with long-term mental illness living in the community. Many of the principles are equally applicable to other client groups with long-term needs, e.g. elderly people or people with learning difficulties. Some of the historical background to the emergence of case management concepts is discussed, culminating in the recent White Paper on Community Care. The underlying concept of case management is examined, together with a number of fundamental questions concerning who should act as case managers, what kinds of training they will require, problems of inter- and intra-agency co-operation, and the empirical evidence regarding its effectiveness. It is concluded that case management could be an important element in a comprehensive range of mental health services, but it is not a substitute for basic community provisions."

No abstract

A survey of all admissions of patients under the age of 65 during the first 6 years of a District General Psychiatric Department without mental-hospital support is reported. Three high-uptake groups of in-patients were defined; the long-stay (12 months or more), the medium-stay (6-12 months), and the revolving-door group (more than three admissions in any period of 12 months). Identifying characteristics which distinguish between these groups were examined. During a 7-year period there was no accumulation of long-stay patients, and a striking lack of schizophrenic patients who remained in hospital for more than 6 months or who had more than three admissions in any twelve-month period. This was not accounted for by drift of the high-uptake groups out of contact with the service, but may be related both to the style of service provision and to the socially cohesive nature of the area under study. Local variation should be given due importance when community services are being developed.

No abstract

Larvae of Meloidogyne incognita failed to penetrate root tissues 4 cm from the root tip and only a few penetrated 2 cm from the tip. Following penetration, larvae initially became oriented acropetally, parallel to the stele and could migrate up to 12 mm towards the growing tip. However, by 32 hr they were randomly oriented. The inoculation procedure utilized assures uniform, synchronous penetration of cotton roots by these nematodes.

The practice of modern high quality psychiatry would be well served by the abandonment of the expression ‘community psychiatry’ and a moratorium on its further use for at least a decade.