M ental I llness C oncerns A ll	Reminiscent of the Viner report, the carer is left holding a situation beyond their resource, and without the means to get immediate help. Help is on its way, and it will be too late. The professional observation is at points along the illness trajectory, and it does not make any connection with observation of 'in-between while' illness behaviour from easily available and accessible observers. If this at the door of confidentiality then confidentiality as presently conceived by professional care systems must go. It is negligence not to get a system whereby some input into specialist reaction is obtained about what has been going on in between attendances. That information is essential. This cannot go on. Neither carer nor patient elected for community care. It was imposed upon them, by professional compliance with management decisions, national and local. Seven years on from the introduction of the Care Programme Approach as a summary of ordinary good practice, it is still not pursued by management, directly by examination of the delivery system 'in the field' until they are satisfied it is a habit in working order. It is the carers in the community, particularly family carers, who are in the best position to judge the performance of local community mental health services, and yet they continue to be denied access for their care experience to go into implementation management or into professional response. Result - no prompt and complete response to their predicament from those services. A simple provision will be the presence of carer support workers in every catchment area - given management backing so as to be able to force into the professional loops, the anxieties and experience of carers, and to obtain a reaction appropriate to that uncertain position. The position of the family doctor - as a person concerned about a patient on their list, who can get a response from specialist services - seems quite to have disappeared, usurped by a community service that turns out to be deficient - a prospectus rather than an activity. A similar predicament - in the good old bad old days would have drawn a family doctor intervention, a recommendation to admit, and if refused, a call to an Approved social worker and the duty area Consultant psychiatrist or the catchment area Consultant and a subsequent admission under Section, probably with the assistance of the police. Now nobody seems to be in charge, and nobody takes a lead. Inquiry Eldergill; Cameron	E-mail reaction is welcome mica@didgy.freeserve.co.uk