The Kingdom of Bhutan lies in the folds of the eastern Himalayas, sandwiched between India to the south and China to the north. It has a total area of 38394 km2, which is roughly the size of Switzerland, and a population of a little over 70 0000 (Royal Government of Bhutan, 2002). It is a mountainous country, except for a small flat strip in the southern foothills. The official language is Dzongha, but English is widely spoken. English is the medium of instruction from pre-primary level onwards. In 1999 Bhutan allowed viewing of television and use of the internet, as a step towards modernisation. In the early 20th century, Bhutan came into contact with the British Empire; Bhutan maintains strong bilateral relations with India. Business Week magazine in 2006 rated Bhutan the happiest country in Asia and the eighth happiest in the world, based on a global survey. Bhutan is in fact the only country where happiness is measured in the form of an index, ‘Gross National Happiness’. The main religion practised in the country is Buddhism, with Hinduism as the second most prevalent. The capital and largest city is Thimphu. In 2007, Bhutan made the transition from absolute monarchy to constitutional monarchy, and held its first general election in 2008. Bhutan is a member of the United Nations and of the South Asian Association for Regional Cooperation (SAARC); it hosted the 16th SAARC summit in April 2010.

Despite attempts made in recent years to address the diagnosis and treatment of mental illness in Mozambique, service provision remains deficient. The present paper focuses on the attitudes to mental illness and its diagnosis and treatment in Mozambique. This paper is based on both a thorough literature search and on the results of qualitative interviews carried out with six individuals of Mozambican origin now living in the UK.

A major barrier to the large treatment gap in mental healthcare in low- and middle-income countries is the shortage of psychiatrists, partly caused by a brain drain. This qualitative study aimed to gain an in-depth understanding of the motivations and experiences of migrant psychiatrists in order to address retention factors. We interviewed a convenience sample of 11 psychiatrists from Afghanistan, Iraq, South Asia and Africa. Interviews were semi-structured and based on questions about the participants' reasons for emigrating, their expectations and experiences of the move, their views of psychiatry as a profession in their country of origin and whether any incentives would persuade them to return. Prevention of emigration appears to be far more effective than encouraging expatriates to return; an improvement in training and job opportunities could have a drastic impact on retention. Almost all the psychiatrists interviewed intended to contribute to training and raising the profile of psychiatry in their country of origin, and therefore their emigration may have long-term benefits. It could potentially break the cycle between lack of understanding, lack of demand for mental health services and lack of training. It should therefore be an ethical obligation of UK employers to offer migrant psychiatrists time and support to facilitate these contributions.

In Denmark, the parliament passed the first Mental Health Act (MHA) in 1938. A new Act was passed in 1989, based on a thorough report from the Ministry of Justice. The 1989 Act emphasised the protection of citizens' legal rights in relation to compulsory admission, detention and treatment in psychiatric hospitals. That Act is still in operation, although it has been amended several times. In 2006 the definition of ‘compulsion’ was changed, and a 2010 amendment introduced compulsory treatment in the community for a trial period of 4 years.

Nigeria's current mental health legislation stems from a lunacy ordinance enacted in 1916 that assumed the status of a law in 1958. The most recent attempt to reform the law was with an unsuccessful Mental Health Bill in 2003. Currently, though, efforts are being made to represent it as an executive Bill sponsored by the Federal Ministry of Health. The present paper reviews this Bill, in particular in light of the World Health Organization's recommendations on mental health legislation.

The Republic of The Gambia, on the west coast of Africa, is a narrow enclave into Senegal (which surrounds the nation on three sides), with a coastline on the Atlantic Ocean, enclosing the mouth of the River Gambia. The smallest country on mainland Africa, The Gambia covers 11 295 km2 and has a population of 1705 000. There are five major ethnic groups: Mandinka, Fula, Wolof, Jola and Sarahuleh. Muslims represent 95% of the population. English is the official language but a miscellany of minor languages are also spoken (Serere, Aku, Mandjago, etc.). The Gambia has a history steeped in trade, with records of Arab traders dating back to the ninth century, its river serving as an artery into the continent, reaching as far as Mauritania. Indeed, as many as 3 million slaves were sold from the region during the trans-Atlantic slave trade. The Gambia gained independence from the UK in 1965 and joined the Commonwealth of Nations.

An increased incidence of psychiatric disorders has been reported in homeless young people. These disorders are often related to their childhood experience of trauma, although less is known about how secondary traumatic experiences while being homeless affect psychopathology. The aim of this study was to establish the relationship between life adversities – living on the street, physical and sexual abuse (during both childhood and young adult life) and substance misuse – and depressive symptoms and self-harm among homeless young people.

This paper first briefly reviews the history of psychiatric services in Egypt. It then details the legislation in place during the last years of the Mubarak regime and goes on to set out recent developments, in particular the Code of Practice introduced for the Mental Health Act of 2009.

Natural disasters can result in a range of mental health outcomes among the affected population. Appropriate mental health interventions are required to promote recovery. In the aftermath of the 2009 bushfires in Victoria, Australia, a collaboration of trauma experts, the Australian and Victorian state governments and health professional associations developed an evidence-informed three-level framework outlining recommended levels of care. The framework was underpinned by an education and training agenda for mental health professionals. This framework has been successfully applied after further natural disasters in Australia. This paper outlines the steps included in each of the levels.

A tradition of Romano-Germanic or civil law defines the legal system in Finland. Laws of relevance to psychiatry are the 1990 Mental Health Act and, insofar as it pertains to forensic psychiatry, the Criminal Law (1889) and the Law on State Mental Hospitals (1987, revised 1997). These are outlined in the present paper.

This paper reports on the training of primary care physicians in the family medicine programme at the University of Gezira, Sudan, using the World Health Organization's Mental Health Gap Action Programme Intervention Guide (mhGAP-IG). The training had a positive impact on their knowledge of and attitudes to mental disorder. More field tests of the mhGAP-IG would be useful to make further recommendations on its cultural relevance and its adaptation for use in low- and middle-income countries. Distance supervision of training of primary care physicians by internal facilitators is seen as critical for the sustainability of the intervention.

This paper reports admission rates within the acute service at a major South African tertiary psychiatric facility, Lentegeur Psychiatric Hospital (LPH) in Cape Town.

To monitor global representation in the psychiatric literature, we compared publication rates in the ten psychiatric journals with the highest impact factors in 1998 and 2008 by world regions. In both 1998 and 2008, North America, Northern Europe, Western Europe and Oceania produced the majority of psychiatric research papers published in these journals, despite representing only a small fraction of the world's population. This suggests that much of the world's population continues to be underrepresented in highly influential psychiatric journals.

Traditional healers' centres may constitute community resources for people with a mental illness. Many low-income countries are seeking to integrate mental health into their mainstream health services and primary healthcare, so as to decrease the duration of untreated illness. Traditional healers can help to meet these needs. A series of four studies has been conducted in central Sudan. In-patients with mental disorders undergoing treatment with traditional healers were recruited, as well as some of the healers themselves. The resulting observations should help practitioners trained in Western psychiatry to better understand traditional healing as an alternative healthcare system. The results should contribute to current debates on whether or not traditional healers in Africa should be officially recognised as healthcare providers. They should also deepen social scientists' understanding of the role of culture in mental health and help policy makers to improve mental health services.

In the aftermath of the major earthquake that hit Pakistan in 2005, there appeared to be a paucity of psychometric tools validated in Urdu. It was decided to translate the Impact of Event Scale - Revised (IES-R) so as to obtain an internationally validated and recognised psychometric tool for use in research into post-traumatic stress disorder. The resulting Urdu and English versions of the IES-R were compared for linguistic, conceptual and scale equivalence. The Urdu version of the IES-R (UIES-R) can be used for clinical, psychological trauma populations in Pakistan with evidence of good reliability and satisfactory validity. In trauma research in Pakistan the UIES-R will be an extremely useful psychometric tool.

The authors wanted to learn whether it was possible to deliver cognitive-behavioural therapy (CBT) in a low-income country where English is neither the first nor the preferred spoken language and to evaluate the effectiveness of the training in terms of skills acquisition. Twenty participants attended a 3-day workshop on the technique. All had experience of communicating in Hindi with patients, although their medical training was in English. There is no manual for CBT in Hindi. Role-plays focused on basic CBT skills such as Socratic dialogue, the ‘five area’ approach, the use of the ‘downward arrow’, developing an automatic negative thought record and devising behavioural experiments, in Hindi. The findings suggested that it is feasible to train mental health professionals in CBT where English is not the first language.

The community psychiatry movement started in India in the early 1950s. It has gone through different phases of development, beginning with family care of people who are mentally ill in the campus of the mental hospitals, followed by satellite clinics and a national mental health programme. Other initiatives have included the camp approach, initiatives by non-government organisations and the media, and mental health services for disaster-affected populations. The paper traces the development of community psychiatry in India over the past six decades.

We aimed to find the depression rating scale with the greatest accuracy when applied by psychiatrists in Iraqi Kurdistan. We recruited 200 patients with primary depression and 200 controls living in the Kurdistan region of Iraq. The Mini International Neuropsychiatry Inventory (MINI) was used as a gold standard for DSM-IV depression. We also used: the two-item and the nine-item versions of the Patient Health Questionnaire (PHQ2, PHQ9), the Hospital Anxiety and Depression Scale (HADS), the Calgary Depression Scale for Schizophrenia (CDSS) and the Centre for Epidemiological Studies Depression (CES-D) scale. Interviews were performed by psychiatrists who also rated their clinical judgement using the Clinical Global Impression (CGI) scale and other mental health practitioners. All scales and tools performed with high accuracy and reliability. The least accurate tool was the PHQ2; however, with only two items it was efficient. Sensitivity and specificity for all tools were above 90%. Clinicians using the CGI were accurate in their clinical judgement. The CDSS appeared to be the most accurate scale for DSM-IV major depression and the PHQ2 the most efficient. However, only the CDSS appeared to offer an advantage over psychiatrists' judgement.