Maintaining the treatment of mentally ill people in the community.

diagnosis should be verified laparoscopically before treatment is begun. Considerable degeneration of the endometriosis occurs after two months of medical treament, and symptoms should therefore diminish. Uncontrolled evidence suggests that laparoscopic ablation of endometriotic implants improves symptoms.'4 Successful surgical and medical treatments are both followed by an appreciable rate of recurrence. Because the denominator for the visual diagnosis of endometriosis has changed recently, the true incidence and prevalence of the disease are unknown. Pain is the main indication for treatment, and the disease should be regarded as chronic and relapsing rather than as an acute phenomenon treatable by a single medical or surgical intervention. A placebo controlled comparison of danazol and high dose medroxyprogesterone acetate in the treatment of endometriosis. 11 Evers J. The second look laparoscopy for the evaluation of the results of medical treatment of endometriosis should not be performed during ovarian suppression. Maintaining the treatment ofmentally ill people in the community Some compulsion is necessary, butfor supervision, not treatment Neglected social issues often attract the serious attention of the public and the government only as a result of a tragic and dramatic incident. The case of the mentally ill young man who climbed into an enclosure at London Zoo on 31 December and was mauled by a lion is the most recent example.' The Secretary of State, Virginia Bottomley, at once committed herself to finding an urgent solution to the problem of maintaining the treatment of discharged patients suffering from chronic mental illness, who can all too easily be missed by current community psychiatric services. This matter has preoccupied mental health workers for many years. The Royal Commission on Mental Illness and Mental Deficiency introduced the concept of guardianship,2 and the Mental Health Act 1959 gave the guardian wide powers of control. In effect, these were the same as the general powers of a parent over a child of less than 14 years. Such guardianship was seen as a way of protecting vulnerable people from exploitation, ill treatment, or neglect. The use of guardianship was never widely taken up, however, and in 1978 a total of 138 people were subject to it, of whom only 37 were mentally ill. The powers of control were considered too extensive and paternalistic. Alternative approaches were subsequently proposed. In 1977 the British Association of Social Workers suggested community care orders.3 A white paper considered a changed form of guardianship, and ultimately …