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.

Around three-quarters of the Singaporean population are of Chinese ethnic origin, and so traditional Chinese medicine is the most widely practised non-Western system of healthcare on the island.

The Malaysian Mental Health Act 2001 did not come into effect until the Mental Health Regulations 2010 came into force. The Act provides a framework for the delivery of comprehensive care, treatment, control, protection and rehabilitation of those with mental disorders. The Act governs the establishment of private and government psychiatric hospitals, psychiatric nursing homes and community mental health centres. This paper outlines the provisions of the Act and the Regulations.

In Canada the ten provinces and three territories are responsible for their own health laws and services. The 13 mental health acts have core similarities, but there are clinically significant differences. In most Canadian jurisdictions legislation is based on common law; in Quebec, it is based on a civil code. Canadian jurisdictions favour voluntary admission and sometimes make this explicit in their mental health acts. For involuntary admission or compulsory in-patient or community treatment to be valid, three elements must be applied correctly: the process, the criteria and the rights procedures. These are reviewed in this paper.

The Arab world has struggled with conflict and political turmoil for several decades, rendering its already underdeveloped mental healthcare system unable to serve the psychiatric needs of victims of violence and trauma, with consequences that extend far beyond the cessation of hostilities. This role has become incumbent on international relief agencies, which have expanded mental health programmes in countries of conflict and refuge. Although their intervention has overall been positive, their mission is usually short term, leaving countries unable to maintain these advantages when the funding ends. The authors advocate for a sustainable framework that emphasises a larger role for regional and local actors. Expertise that is culturally and socially grounded could take the initiative in research, training and deployment in collaboration with non-governmental organisations, allowing for comprehensive development of the mental health sector.

Many African countries gained political independence in the 1960s and 1970s and went through difficult times in economic, political and security terms in the 1980s and early 1990s. Mental health services and research were not spared and stagnated or deteriorated during this period. The effects of poor governance, inequitable distribution of resources and environmental degradation conspired with natural and man-made disasters (wars in particular) to drive Africa into an abyss of despair.

There are striking and significant differences in psychiatric training across Europe and procedures for the assessment of trainees vary widely (Strachan, 2007). The introduction of competency-based training represents a major shift in medical education and a challenge to harmonising psychiatric training in Europe. This paper discusses the development and implementation of competency-based training in the Netherlands and the UK and focuses on its effects on trainees.

Videoconferencing has increased patient access to psychiatric care by linking specialists at academic or regional health centres with primary health care professionals in shortage areas (Hilty et al, 1999, 2002). Preliminary studies have demonstrated positive outcomes and user satisfaction (Hilty et al, 2002). Information is still being sought regarding costs because of a paucity of clinical outcome studies, cost data and randomised trials.

Approximately 17 000 individuals have claimed asylum in Malta over the past 10 years. Maltese law stipulates mandatory detention. Here, we review Malta's asylum procedures and detention policy, and explore the impact of detention on mental health. We review the current mental health services and make recommendations to help fill the gaps.

Refugees have high rates of mental health morbidity as a result of conflict. However, their needs for mental healthcare and psychosocial support are often unmet, despite the efforts of professional and humanitarian organisations. The war refugee crisis is a global challenge that needs a global solution. We call on all governments, regional and international organisations to take responsible humanitarian actions to intervene and support people affected by these disasters and for all humanity to unite against the forces of injustice and degradation. The thematic papers in this issue report on the Syrian crisis from a variety of perspectives.

In Ghana, the main burden of ill-health, as in many sub-Saharan countries, consists of communicable disease, illnesses due to inadequate nutrition and poor reproductive health. As these conditions are tackled, other diseases, such as mental disorders and substance misuse, are also becoming the focus of development efforts. In Ghana, it has been estimated that there are 2166 000 individuals experiencing a mild to moderate mental disorder, with a further 650000 suffering from a severe mental disorder, out of a population of 21.6 million (World Health Organization, 2007). In 2003, the country's mental health workforce consisted of 9 psychiatrists (only 4 of whom worked in mental health services), 451 nurses and 160 community psychiatric nurses (World Health Organization, 2003). Currently there are just 5 consultant psychiatrists in active service in the public sector and 11 retired psychiatrists. As just under 33 000 individuals are seen each year in Ghana by mental health services, there is an estimated treatment gap of 98% (World Health Organization, 2007). Most mental healthcare is undertaken at the three large psychiatric hospitals, in the south of the country. This is reflected in the ratio of out-patient attendance to admission, which is 4.64 for mental health, compared with 14.6 for all health conditions (Ghana Health Service, 2005).

Psychiatry in Greece is undergoing a prolonged reform. Deinstitutionalisation is at an advanced stage and there are active efforts to support primary care and community psychiatry, and to establish local administration of services in each sector of the country (i.e. the equivalent of Mental Health Trusts in the UK). Quality assurance and continuing professional development require further development, as do a series of other issues pertaining to the day-to-day clinical practice of psychiatrists. Recent economic difficulties have undoubtedly affected the mental health of the population, but also mental health services and psychiatrists themselves. These financial difficulties coupled with pre-existing organisational issues present important, yet rectifiable, challenges. We conclude by identifying preventive psychiatry as an especially important target for progress and by advocating for continued support for the public system of mental healthcare as well as for the continued psychiatric reform.

The tsunami which affected South Asia on 26 December 2004 caused over 41 000 deaths in Sri Lanka, representing 0.2% of the total population, and displaced over 880 000 people from their homes and livelihoods (World Health Organization, 2004). Kilinochchi, Jaffna and Mullativu districts in the Northern Province of Sri Lanka were affected by the tsunami and, as of April 2005, in the whole province, 6200 people had lost their lives, 961 were still missing, 19 618 were still housed in welfare centres and 45 548 were housed with relatives and friends (Government of Sri Lanka, 2005).

Northern Ireland is still riven by segregation, caught between peace and reconciliation. Extensive survey research shows that inter-group contact has a key role to play in achieving reconciliation, whether through generic contact, cross-group friends (most effective) or indirect. Segregation is most profound in education. The new Shared Education Programme (SEP), which provides children with the opportunity to study with and meet pupils from the other community, has demonstrated benefits. The Northern Ireland Assembly's support for SEP is based on sound psychological principles and robust research evidence.

According to the 2001 census, India is home to more than 76 million people aged 60 years and over. This age-group, currently only 7.4% of the population, is expected to grow dramatically in the coming few decades. Analysis of the census data shows substantial variation in the rate of demographic ageing across India: at present, 10.5% of Kerala's population is older than 60 years, while in Dadra and Nagarhaveli this proportion is only 4%. Regions with more favourable health indicators seem to be ageing faster and the demand for specialist services will soon be evident in such places. There is a growing realisation that the care of older people with disabilities makes enormous demands on their carers. Terms such as ‘dementia’ and ‘Alzheimer's disease’ are now better understood. This was not the case when the Alzheimer's and Related Disorders Society of India (ARDSI) initiated awareness programmes. However, dementia remains a largely hidden problem in those disadvantaged parts of India where poverty and illiteracy remain prevalent.

The prevalence of mental illnesses in Finland generally reflects global trends, with a clear increase in the occurrence of depression and anxiety. At any time, between 4% and 9% of the population of 5.2 million suffer from major depressive disorders. Some 10–20% of the population experience depression during their lifetime. Bipolar depressive disorders affect 1–2% and schizophrenia 0.5–1.5% of the population. The prevalence of alcoholism is 4–8%.

Ukraine is a newly independent state with a population of about 48 million. It inherited its national health system from the USSR. The Soviet system was conceived as part of a massively expensive socialist planning economy that was generally delivering poor value for money. Some aspects of the Soviet health system were, however, undoubtedly sound and certain public health measures were superior to those in the West. For example, infant mortality, despite possible underreporting, was probably lower in the USSR than in many Western countries (Anderson & Silver, 1986). The health system became increasingly corrupt and inefficient during the final years of the USSR's existence. Since independence, the health system has not been a state priority and has been chronically under-funded. In the past few years of rapid economic development in Ukraine, the share of the state budget allocated to the health system has remained static, leaving Ukraine in a disadvantaged state compared with other European countries (United Nations, 2007).

Non-attendance at mental health clinics is an international problem. A survey was conducted in the UK investigating communication methods used by staff to inform and remind patients about appointments. Increased number of communication methods used was associated with a reduced non-attendance rate. A care modelling analysis is provided that explores the healthcare use of three hypothetical patients following clinic non-attendance. The financial and environmental costs of each are then calculated and results discussed. Reducing non-attendance is achievable through the use of multiple communication methods. This small change can improve the sustainability of mental healthcare in different countries by improving quality of care and reducing financial and environmental costs.

Psychopharmacotherapy dominates the therapeutic arsenal of psychiatrists and, not surprisingly, psychotropic drugs are widely consumed in psychiatric practice. The pattern of prescribing of these drugs needs to be appraised in terms of ‘rational drug use', which may be defined as ‘the use of the least number of drugs to obtain the best possible effects in the shortest possible time and at a reasonable cost’ (Gross, 1981).