In this article, the Director of the NHS Health Advisory Service describes the task which he was given upon appointment and the new roles of the HAS. A senior registrar in forensic psychiatry illuminates one of its new roles by describing his attachment.

He was commenced on an alcohol detoxification regime and further investigation of his hypokalaemia was attempted. During the course of his admission he confided to a member of staff that he had been vomiting on an almost daily basis for 25 years, following criticism of his weight by his father. He admitted bingeing (often daily), but denied the use of diuretics or laxatives. Following this he received some cognitive psychotherapy and his depressive symptoms were treated with a serotonin specificreuptakeinhibitorantidepressant.Onthisregimehis depressive and bulimic symptoms improved dramatically. His clinical chemistry returned to normal.

The Primrose Project has been developed, as part of the Dangerous People with Severe Personality Disorder (DSPD) programme in England and Wales, to specifically address the complex needs of women prisoners who pose a significant danger to the public. It has been recognised that the needs of these women prisoners may differ from those of men in the DSPD programme. The Primrose project therefore aims to deliver more effective prison-based healthcare interventions to these dangerous women prisoners to reduce risk to self and others.The Primrose Project expects to initially support up to 12 women prisoners in HMP Low Newton, Durham. These women prisoners will be placed with other 'non-DSPD' women prisoners in the prison and will receive a variety of therapeutic interventions.Overall, the Primrose Project aims to develop into a comprehensive assessment, treatment and management facility and the proposed evaluation aims to facilitate this development. The evaluation will look at the project as a whole, identifying strengths and limitations to overall improve the service for these women prisoners, who have not previously been provided for. The research is based on a list of comprehensive questions, which form the basis of evaluation of the existing four male DSPD sites in England and Wales, which will prove useful when comparisons are later made with the Primrose Project.

It is of course impossible to It is of course impossible to disagree with Dr Van Houdenhove's state-disagree with Dr Van Houdenhove's statement that it is important to listen to the ment that it is important to listen to the patient's life history. We have been doing patient's life history. We have been doing this for many years. Therefore, the reason this for many years. Therefore, the reason that he finds PTSD in so many of his that he finds PTSD in so many of his patients with CFS and we do not is not patients with CFS and we do not is not our lack of listening. From previous presen-our lack of listening. From previous presentations by this group from Belgium we tations by this group from Belgium we know that they recruit patients with CFS know that they recruit patients with CFS with higher psychopathology scores than with higher psychopathology scores than we do in our centre and than is usually we do in our centre and than is usually found in other CFS cohorts. Hence it is found in other CFS cohorts. Hence it is understandable that they find higher rates understandable that they find higher rates of psychiatric comorbidity. To date there of psychiatric comorbidity. To date there are no controlled studies indicating that a are no controlled studies indicating that a history of abuse is a characteristic of many history of abuse is a characteristic of many patients with CFS. patients with CFS.

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