How many psychiatrists does it take to change a light bulb?

Ileft Manchester at the end of March 1999 after 14 years as a consultant in psychiatry of learning disability. My former clinical director looked dismayed when I said I intended to write a personal view. “Please don't say anything that will make it harder to recruit a replacement,” he said.

Recruitment in this specialty in the north west of England has always been difficult, with the worst consultant:patient ratio in the United Kingdom. Before 1987 there were no senior registrar posts. In 1985 I was appointed to an innovatory community based service, which provided a mental health service for people with learning disabilities from the resources used by the rest of the population. Patients needing hospital care were admitted to the unit where I also worked half time in general psychiatry. The service showed that specialist skills can be provided without segregating patients from mainstream services.

Seventeen months after I left neither post has been advertised

As the service developed, it achieved recognition. …