The paper reports a descriptive survey of the referrals received by a new psychiatric liaison service in Rawalpindi in the first 2 years. The survey showed a rapid increase in use of the service, particularly by the emergency department. There was a lower proportion of referrals for self-harm and substance misuse than occurs in similar services in high-income countries but a higher proportion of patients presenting with dissociative (conversion) disorders. The large proportion of patients who had abnormal findings on physical examination remains unexplained and warrants further investigation.

This study aimed to examine the suitability and challenges of implementing in a Nigerian tertiary mental health facility the guidelines for the management of schizophrenia produced by the UK National Institute for Health and Care Excellence (NICE). The study was based on a group discussion at the Psychiatric Hospital, Yaba, Lagos. A panel of ten individuals (consultants, senior registrars, senior psychologists and senior social workers and nurses) discussed the guidelines, having been given ample time to study the document. Five patients were also interviewed. Some of the recommendations of the NICE guidelines are already being practised in the hospital to various extents. Full implementation would be hampered by a shortage of human resources and financial constraints. The guidelines need to factor in sociocultural differences. The NICE guidelines with modifications are suitable for use in a Nigerian setting.

As part of a pilot programme to scale up community mental health services, local health centre directors, community health workers and key informants were interviewed in two neighbouring political districts of Niger. Major priorities for improving services included training staff on the diagnosis and treatment of mental illness, collaborating with traditional healers, educating the community about the origins of psychiatric illness and building infrastructure for medication delivery. Barriers to care included long distances for travel to the nearest hospital and lack of funding for home-based visits by health workers. This study was the first step in Niger's plan to implement the World Health Organization's Mental Health Gap Action Programme (mhGAP) at a national level.

In recognition of the treatment gap in mental health, the World Health Organization (WHO) Mental Health Gap Action Programme (mhGAP) was launched in 2008 and has proved successful. The paper describes the launch of the first mhGAP intellectual disabilities pilot project in Sri Lanka. It reports on the development of the materials and the key lessons learnt.

In Malawi, mental health services account for only 2% of the health budget; there are just 4.5 full-time psychiatrists and 433 psychiatric beds. The Scotland Malawi Mental Health Education Project (SMMHEP) aims to provide sustainable support for psychiatric training for healthcare professionals and has increased the number of psychiatrists in the country. There has been a recent change in the educational programme in order to maximise clinical exposure and experience, particularly with the care of in-patients. The new programme has had a positive effect on students' attitudes towards psychiatry and their consideration of psychiatry as a career. This paper supports the ongoing work SMMHEP does in developing psychiatric services through education.

A questionnaire was sent to all consenting doctors at the University of Ilorin Teaching Hospital, Nigeria. It asked about their management of psychological problems in their clinical practice. Over 90% would welcome more time to talk to patients and agreed that psychological and social factors should be routinely assessed and recorded for patients. Most respondents would refer patients with depression or disturbed behaviours. ‘Ineffective treatment’ and ‘dislike of psychiatric referral’ were not the main reasons for non-referral. A majority of the doctors had initiated treatment for anxiety and insomnia but not for alcohol withdrawal, psychosis, acute confusional state or depression. Doctors' awareness of ‘the impact of psychological factors on the course of physical illness' was high. To sustain this high level of awareness and encourage referral, in-house psychoeducational training of hospital doctors should be intensified. In addition, an increased doctor/patient ratio, public education to reduce stigma and a well developed liaison psychiatric service are imperative.

We investigated the efficacy of aerobic exercise alongside antidepressant medication as an adjuvant maintenance treatment for depression. Fifty patients in remission were randomly assigned to either medication only or medication plus exercise. Assessment of psychopathology was made at 6-weekly intervals (for 24 weeks) using the Hamilton Rating Scale for Depression. The medication-plus-exercise group showed significantly more improvement at 12 and 24 weeks than the medication-only group. This study adds to a growing evidence base that suggests aerobic exercise is worthy of further development in the treatment of depressive disorders.

Publications on mental health were collected using PubMed and PsychINFO for 21 Arab countries. The data were then categorised according to the first author's country of affiliation, the year of publication, the topic of research and the type of journal. In 2006–12, the Arab world published 1029 articles (an average of 147 per year). The estimated increase in yearly productivity during this period was about 25% over the 7 preceding years. When considering the research output per million population, Kuwait, Bahrain and Lebanon were the top three producers, as they had been over the preceding four decades. After adjusting for gross domestic product (GDP) per capita, the five top producers were Egypt, Jordan, Tunisia, Lebanon and Morocco. Based on child and adolescent mental health research only, the Arab world's productivity was around one-sixth that of the United States and Europe.

This paper describes the evaluation of a pilot e-supervision programme, with a focus on feasibility. The findings suggest that e-supervision in mental health using the World Health Organization (WHO) Mental Health Gap Action Programme (mhGAP) Intervention Guide and case-based discussions is valued by participants and can improve the knowledge, confidence and beliefs of primary care doctors in low- and middle-income countries.