Dr Trevor Turner was asked to provide a commentary on the preceding paper in this issue, ‘“Freedom is more important than health”: Thomas Szasz and the problem of paternalism’, by Joanna Moncrieff.

Maternal mental health problems are widespread worldwide, especially against the backdrop of population growth. There is an increasing prevalence of perinatal mental illness in low- and middle-income countries, and Malaysia is no exception. Despite significant improvements in the Malaysian mental health system over the past decade, there are substantial gaps in the delivery of perinatal health services in Malaysia. This article seeks to give a general overview of perinatal mental health in Malaysia and provide recommendations for the development of Malaysia's perinatal mental health services.

This paper reports the results of a cross-sectional survey of 11- to 16-year-old school-going youths in ten southern African countries. The survey instrument recorded both the experience of coerced sex and the perpetration of forced sex. There were prominent school and community risk factors for increased risk-taking behaviours, revictimisation and the perpetration of sexual violence. This supports the idea that the local culture can reinforce the antisocial consequences of sexual abuse of boys and girls. There was a suggestion that the school environment can compound the effects of child sexual abuse in terms of conscious knowledge, high-risk behaviour, the risk of revictimisation and disdain for the safety of others.

Asians represent more than half the world's population but themselves consist of very diverse genetic, ethnic, cultural and linguistic groups. Understanding the role of ethnicity in an individual's response to psychotropic medications is of importance in treating psychiatric disorders among Asians. Recent research has supported the notion that Asians carry distinct genetic profiles that can influence both the pharmacokinetics and the pharmacodynamics of a given medication (Lin & Smith, 2000; Pi & Simpson, 2005). In this brief review, we summarise the research findings in the field, focusing on pharmacogenetic variations between Asians and other ethnic groups.

This article provides a brief overview of the legislation that has been enacted in Ireland with respect to mental health, in particular the 2001 Mental Health Act. Although that Act was a positive step towards developing an Irish mental health service that protects the human rights of service users, a number of concerns remain, including issues related to consent and capacity, involuntary out-patient treatment and admission, the adversarial nature and timing of tribunals, and the lack of safeguards for voluntary patients.

This article discusses the factors that have shaped the development of the new mental health legislation within the Falkland Islands. The process of implementing new legislation within this remote island community is discussed, including the aspirations underlying the new legislation, the management of psychiatric emergencies and the needs of the clinical team.

The purpose of this study was to investigate whether the Strengths and Difficulties Questionnaire (SDQ) may be considered a reliable measure of child behaviour, social functioning and adjustment in an Indian Gujarati context. The sample comprised 351 children who were classified as coming from a ‘poverty’ or ‘non-poverty’ background. The means and standard deviations for the SDQ total and five behavioural scales, as rated by children themselves, were first calculated for the entire Gujarati sample, then for the poverty and non-poverty subgroups. The SDQ did prove to be an appropriate measure for behavioural assessment. Its cross-cultural sensitivity was ascertained by comparing it against a British normative population. Small effect sizes were seen in the Emotional subscale scores and scores for total difficulties, and medium and large effect sizes on the Prosocial and Peer subscales, respectively, with greater difficulties experienced by the Indian Gujarati sample than their British counterparts.

Sudan has endured the longest civil war in the history of Africa. The conflict between the northern (mainly Arab) and southern (mainly sub-Saharan African) populations started in 1983, and in its first phase continued for 22 years. The combination of civil war and famine has taken the lives of nearly 2 million people and displaced an estimated 4 million people from their villages and homes. This paper presents some data on the prevalence of mental disorder and the mental health service response to the situation.

Several international proclamations in the last decades have advocated for the dignity and autonomy of persons with mental disorders. Few discussions have been generated regarding the implication of this transition in low- and middle-income countries. The objective of this publication is to review how the concept of mental capacity has been defined in Colombian law. We then briefly compare the Colombian and UK situations and propose a few points of discussion, addressing some difficulties and challenges of both countries. Finally, we propose that the first steps in the Colombian context would be to strengthen understanding about mental capacity in medical schools, postgraduate and other health related programmes, the adoption of standardized tools to improve its assessment in everyday clinical settings and the establishment of community care services from collaborative efforts between governmental and civil organizations.

The opioid crisis continues to affect many areas worldwide, raising questions regarding prescribing indications. There is no consensus on negotiating the need for pain relief and the potential for medically prescribed opioid-related harm/addiction. These issues present an enormous educational challenge to physicians in training, particularly those whose mandate is to understand and respond to varying forms of pain. This article examines the perspectives and educational challenges faced by two psychiatry residents from different parts of the globe during the crisis. Is the educational experience of future psychiatrists sufficient to prepare them for the responsibilities that lie ahead?

The availability and use of mental health treatments are influenced by many different factors. Prominent among these are scientific evidence, cost, ethics and politics. However, the social sustainability of treatments can also have a considerable influence on their use.

Uganda, in common with many countries in sub-Saharan Africa, has many population risk factors predictive of high levels of mental disorder but poor coverage of mental healthcare (Kigozi, 2005). Recent population studies conducted in Uganda have shown rates of disorder in excess of 20% (Kasoro et al, 2002; Bolton et al, 2004; Ovuga et al, 2005) and the survey by Kasoro et al (2002) showed a high prevalence of patients with severe mental illness and poor access to services. There are 19 psychiatrists for 24.8 million people in Uganda, all but one of whom is based in the capital city, Kampala (Kigozi, 2005). The provision of mental health services relies on the use of psychiatric clinical officers (a cadre of trained mental health workers, similar to community psychiatric nurses, who currently cover 18 of the 56 districts in Uganda), primary care personnel, non-governmental organisations and members of the community. Liaison with traditional healers is encouraged (Ovuga et al, 1999).

Commissioning of health services has become an intensely political issue in the UK and there is no reason to believe that the conflicts that have arisen domestically would not be mirrored overseas. A key ideological issue in the UK concerns the relative merits of public and private provision of services. In their guest editorial in this issue, ‘Governance, choice and the global market for mental health’, Sugarman & Kakabadse take a particular ideological stance: they write on the one hand of commercial-style efficiency and on the other of monopoly state provision risking inefficiency and ineffectiveness. This perspective is addressed here.

Schizophrenia is a chronic illness with a lifetime prevalence of 1% and with serious physical, social and economic consequences. Over the past decade, atypical antipsychotic medications have become the first-line treatment for schizophrenia (Breier et al, 2005).

Alcohol use and misuse among young people continue to be a major public health concern, despite decades of initiatives aimed at educating young people about the hazards of alcohol. Yet where do young people learn about alcohol use? How do they form attitudes about the effects and risks of drinking? Increasing evidence suggests that young people learn not only from real people (e.g. peers and parents) in their everyday lives but also from characters whose lives they witness through the media. In fact, the mass media have been recognised as significant sources of information about substance use that can influence young people's beliefs and expectations (Bahk, 2001; Sargent et al, 2002).

The Philippines, known as the Pearl of the Orient, is an archipelago of 7107 islands, bounded on the west by the South China Sea, on the east by the Pacific Ocean, on the south by the Sulu and Celebes Sea, and on the north by the Bashi Channel. The northernmost islands are about 240 km south of Taiwan and the southernmost islands approximately 24 km from Borneo. The country has a total land area of some 300 000 km2. It is divided into three geographical areas: Luzon, Visayas and Mindanao. It has 17 regions, 79 provinces, 115 cities, 1495 municipalities and 41 956 barangays (the smallest geographic and political unit). It has over 100 ethnic groups and a myriad of foreign influences (including Malay, Chinese, Spanish and American).

French psychiatry is currently facing a period of profound change, as many of what were considered its most specific characteristics and traditions have been called into question. It is therefore difficult to draw a profile of French psychiatry, because it has to take into account a radical splitting between, on the one hand, what is still the common profile of most French psychiatrists and, on the other, the new model imposed by stakeholders and policy makers who want French psychiatry to take on a more Anglo-Saxon profile, with evidence-based practice coming to the fore, for instance.

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.

It has been recognised that work is a positive factor for mental health since the days of Galen (2nd century CE). It was central to the theories and practice of William Tuke at the Retreat in York (founded 1796) and has continued in different forms as a therapy and/or a form of rehabilitation ever since. These forms can be usefully divided into four main categories: sheltered work, vocational training, transitional employment (or work experience) and supported employment. These broad categories have been adapted to different cultures and economic circumstances across the world. There are advantages and disadvantages to all forms, but the burgeoning research literature of the past 20 years does show that when it comes to finding people paid work in the open labour market, supported employment is markedly more successful than other methods.