This issue

During my tenure, our mission has been primarily to promulgate examples of novel mental healthcare practice from countries where there is little or no formal psychiatric care available to most of the population. In many such regions, patients turn first to traditional healers or the Church. Among articles published in this issue, we find mention of these traditional pathways to care in Qatar (Mohammed et al),^{Reference Mohammed, Makki and Ghuloum1} Oman (Al-Sinawi et al),^{Reference Al-Sinawi and Mirza2} Malawi (Kokota et al)^{Reference Kokota, Stewart, Bandawe, Chorwe-Sungani, Liwimbi and Mwale3} and Kenya (Matoke).^{Reference Matoke4} I was particularly struck by the revelation in the article on the management of psychosis in Malawi^{Reference Kokota, Stewart, Bandawe, Chorwe-Sungani, Liwimbi and Mwale3} that up to 60% of caregivers of people with psychosis initially seek help for their relative from traditional healers. The authors emphasise that traditional and religious beliefs and practices continue to play a large role in the pathway to care. These systems are integral to the core values and belief systems of Malawian culture and ‘should not be ignored’.

The North East England South Asia Mental health Alliance (NEESAMA) is the subject of an article (Devgun et al)^{Reference Devgun, Kittridge, Seshadri, Rodgers and Sharma5} that describes a partnership with mental health organisations in Afghanistan, Bangladesh, India, Nepal, Pakistan and Sri Lanka. The authors opine that lessons learned from collaborating with those providing mental health services in the ‘Global South’ could lead to the delivery of more appropriate services to ethnic minorities in wealthier northern hemisphere countries too. Sensitivity to cultural beliefs is an especially important issue to consider when managing mental health problems among those caught up in the movement of traumatised refugees from south to north.

Although I am stepping down as Editor, I am hopeful that my successor will build on our initial reports on the role of traditional healers around the world, who have too often been ignored (or even suppressed) by those whose mental health training has been ‘evidence based’. A collaboration between traditional healing practitioners and psychiatrists seems to me to be essential in so many countries, not only in the Global South. We need to understand how best to encourage those afflicted by mental disorders in societies and cultures that do not conceptualise those disorders in the same way as we do to come forward for evidence-based treatments. Lydia Matoke reminds us of the Kenyan traditions of medical care that were lost when Britain colonised the country and endeavoured to eliminate what the colonisers regarded as ‘witchcraft’. In conclusion, I suggest we should be a little humble and recognise that although our Western education in medicine has brought about many benefits internationally in the practice of medicine and surgery, the mind remains mysterious and far less accessible to empirical research. Susceptibility to poor mental health is massively influenced by culture. Remember, the opportunity to explore this little-understood entity is what brought many of us into psychiatry in the first place.