Coercion has always been integral to the care and treatment of people who are mentally ill and there is no ‘perfect’ model in which coercion is absent. A number of interventions have shown promise in reducing the use of coercion, however, and we believe the evidence points to ways forward that may improve both the experience and the outcome of care.

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.

Mental health is a core part of the Sustainable Development Goals (SDGs) agreed by the United Nations General Assembly. This follows on from the World Health Organization's 2013 Global Action Programme. The World Bank is also expected to give mental health greater priority. Moreover, mental health is now seen as essential in disaster relief management. However, although global policy towards mental health has improved, there are only rare examples where this has been translated at scale into action. There are, nonetheless, reasons for optimism in the new policy background, in the many innovative practical developments around the world and in the way that evidence is being gathered and learning shared. The understanding that mental health is intimately connected to physical, social, environmental and economic health – which is so evident in the SDGs – represents a major change in mind-sets globally.

In this issue, three papers discuss the issue of the brain drain: of psychiatrists from Egypt and Nigeria, and of nurses from East Africa. They explore the complexities of professional migration and its impact on the health of populations in source and recipient countries; they also review how recommendations for changes in policy and practice might influence the so-called ‘push’ and ‘pull’ factors that aggravate the brain drain.

Almost 5 million Syrians have been registered as refugees since the conflict started in 2011. Their mental health and psychosocial needs continue to grow as the situation at home gets more complicated. Syrian non-governmental organisations (NGOs) and mental health professionals have been offering their support to help meet these needs. They have set up various centres and teams on the ground that focus their efforts on the most needy individuals. They train and supervise healthcare volunteers, encourage self-management and build on people's resilience. These NGOs require support to deal with the consequences of this unprecedented crisis.

This paper highlights the extent of the brain drain in relation to human resources for health (HRH) that is currently challenging Kenya, and suggests strategies that have the potential to change current working environments and improve HRH retention rates. Governments in partnership with health professional bodies and regulators could improve the working conditions for psychiatrists and mental health nurses: by promoting career choices in mental health; by providing accessible professional development opportunities; and by easing workload pressures by expanding service reach through thoughtfully planned and delivered task-shifting to primary care. While these strategies have the potential to make a significant difference, the evidence suggests a brain drain will continue as long as working conditions remain sub-optimal and global HRH shortages persist.

As fellow human beings uproot their lives in search of protection, and for those who survive to reach European shores, many countries are faced with an unprecedented, highly complex challenge of managing huge and immediate need. Clearly, immigration agencies are front line in this scenario, but they are closely followed by accommodation, subsistence, community and health agencies. It is widely recognised that the mental health burden of asylum seekers is large and the stir of growing interest at a clinical level in addressing that burden is encouraging. Mental health services have been aware of asylum seekers and refugees for decades but we have grappled with our role, been confused by the relevance of a political dimension and overwhelmed with how to manage diverse need, in the face of endless competing demands. Mental health services for asylum seekers and refugees have largely evolved in many and varied ways, dependent on local need and interest.

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.

Global events like wars and natural disasters have led to the refugee population reaching numbers not seen since the Second World War. Attitudes to asylum have hardened, with the potential to compromise the mental health needs of asylum seekers and refugees. The challenges in providing mental healthcare for asylum seekers and refugees include working with the uncertainties of immigration status and cultural differences. Ways to meet the challenges include cultural competency training, availability of interpreters and cultural brokers as well as appropriately adapting modes of therapy. Service delivery should support adjustment to life in a foreign country. Never has the need been greater for psychiatrists to play a leadership role in the area.

The conflict in Syria has led to an unprecedented humanitarian crisis that extends across multiple countries in the area. Mental health services were undeveloped before and now face huge strain and unmet need. The World Health Organization and others have developed a programme to build capacity in the delivery of mental health services in an integrated healthcare package to refugees and displaced people. The tool used for this is the mhGAP Intervention Guide and complementary materials. In this paper we refer to training in Turkey, Iraq and Syria where health professionals were trained to roll out this community-based integrated approach through primary healthcare. We describe field case examples that show the complexity of situations that face refugees, displaced people and those caught in active conflict. Training improved the knowledge and skills for managing mental health disorders in primary healthcare. Further work needs to be done to demonstrate greater access to and utilisation of services, client outcomes and organisational change with this approach.

Recovery colleges offer an educational approach which is believed to develop people's strengths rather than focusing attention on their problems. We have reviewed the literature on this subject, with the aim of determining whether this approach to the management of mental health disorders is socially acceptable. We found preliminary evidence that they are indeed acceptable to families and service users. However, the literature is limited. We therefore recommend that further research is undertaken to confirm the status of recovery colleges, with particular reference to the attitudes of family and friends.

The practice of Egyptian psychiatrists emigrating to high-income countries is not a recent phenomenon. Egyptian doctors have long travelled in search of training and education and to better their standards of living. The debate continues. What effective measures can be taken to reduce the brain drain, or at least its effect on Egyptian mental health services?

People were not well prepared for the psychological aftermath of the earthquake in Nepal in April 2015. A higher rate of mental disorder was noted in the ensuing months and there was a need to develop psychosocial interventions, especially for those with poor mental health literacy. Acceptable, affordable and accessible mental health awareness programmes were required. Through examples of strategies adopted by the author, this article asserts that the aftermath of natural disasters can give mental health professionals opportunities to improve mental health literacy.

The brain drain of medical professionals from lower-income to higher-income countries contributes to the current inequity that characterises access to mental healthcare by those in need across the world and hinders efforts to scale up mental health services in resource-constrained settings, especially in Nigeria and other West African countries. The migration of skilled workers is driven by a combination of the globalisation of the labour market and the ability of highly resourced countries to attract and retain specialists from poorer countries. If we are to ameliorate the worldwide shortage of mental health professionals, we need to find innovative ways of attracting young doctors into psychiatric training in all countries. We must also introduce measures to improve health worker retention in low- and middle-income countries.

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.

The Lebanese Ministry of Public Health has launched a National Mental Health Programme, which in turn has established the Mental Health and Substance Use Strategy for Lebanon 2015–2020. In parallel, research involving refugees has been conducted since the onset of the Syrian crisis. The findings point to an increase in mental health disorders in the Syrian refugee population, which now numbers more than 1 million.

The recent influx of refugees and immigrants to Greece has coincided with the ongoing and deteriorating financial crisis. This situation does not allow the Greek authorities to provide help to the desired extent. Yet, the church, local communities, medical societies and non-governmental organisations are offering good psychosocial support. In parallel with support for refugees it is important to provide support for the citizens of the host country. The rich countries of northern Europe should help the poorer countries of southern Europe cope with the refugees. A number of important declarations on refugee mental health and related issues have been produced recently, including the Anti-war Declaration of Athens.

The number of people seeking refugee status in Ireland is increasing year on year and the burden of mental illness experienced by refugees and asylum seekers is high. The College of Psychiatrists of Ireland has recommended the establishment of a number of specialist refugee mental health teams. In this paper we discuss the Irish asylum system, the Irish evidence regarding mental illness in this population, and current health service policy regarding refugee mental health. We propose a model of specialist refugee mental healthcare delivery.

There is robust evidence that electroconvulsive therapy is an effective treatment for some mental illnesses. Despite this, its use remains controversial and is declining in some countries, with a consequent loss of skills and knowledge. This, and the view of it as a ‘treatment of last resort’, may undermine its sustainability.