Addiction is a chronic yet treatable disorder. Patterns of addiction, whether substance related or behavioural, vary among countries and regions. Addiction medicine practice and approaches used in management are not only different from one country to another but are influenced by other factors, including environmental ones. The COVID-19 pandemic is one of the major environmental changes that had an impact on addiction. In this editorial, light will be shed on three articles covering recent updates in addiction medicine, ranging from types of substances and service provision to inclusion of gaming disorder in ICD-11.

Training and education must be frequently reviewed and developed to match the pace of rapid advances in psychiatry, preparing current and future psychiatrists to cope with the increasing amount of knowledge and skill required. In this, there is a need to ensure that training delivered internationally meets a common standard. This is essential not only to provide equivalent quality of care worldwide, but also to eliminate one of the obstacles faced by international medical graduates working abroad. Having the basic skills to publish work and viewpoints is essential in this era of rapid development and technological advancement to ensure sharing of knowledge and expertise.

Climate change is closely linked to rising levels of atmospheric carbon dioxide and methane due to human activities, and soaring temperatures might themselves pose a risk to natural carbon sequestration in the land. This editorial introduces three papers in the current issue exploring the adverse effects on mental health of climate-related loss of biodiversity and cultural heritage markers and the beneficial effects of adopting a plant-based diet. It also suggest three simple steps that clinicians can themselves take to act against climate change: choosing and recommending a plant-based diet, reducing personal use of fossil fuels and integrating climate change in discourse in all areas of their professional work.

Climate change can have various psychopathological manifestations which have been more actively addressed by scientific research only in recent years. Indeed, extreme weather events and environmental changes have been shown to be associated with a range of mental health problems. Following the destruction of ecosystems, biodiversity loss can cause mental distress and emotional responses, including so-called ‘psychoterratic’ syndromes arising from negatively felt and perceived environmental change. Studies investigating relationships between biodiversity and mental health reveal a complex landscape of scientific evidence, calling for a better understanding of this challenging issue.

As defined by the World Health Organization, the Eastern Mediterranean Region (EMR), given its special geopolitical situation and internal/external conflicts, faces an increase in illegal activities such as drug production and trafficking, highlighting the need for a comprehensive understanding of the substance use situation. On the basis of a review of published papers between 2015 and 2021 we briefly review substance use in the EMR with special focus on the emerging drugs pertinent to this region, namely tramadol, captagon and khat.

Our mission on BJPsych International is simple. First, to promote best practice in the care and treatment of people with mental health problems worldwide. Second, to educate psychiatrists and other mental health professionals about international developments in policy and the delivery of mental health services. We aim to provide a publication platform for authors globally, with a focus on those from low- and middle-income countries who have a message to send about innovations in their country's mental health services that would be of interest to our readership. Our recent success in obtaining a listing on PubMed makes all our articles accessible to a much wider audience and will enhance interest in the journal's unique content. Importantly, the journal, which has a distribution of over 20 000 copies, is entirely open access.

International medical graduates provide a valuable service to the healthcare of their adopted countries. However, there remain a significant number of challenges in their adjustment and acculturation in the post-migration phase. We believe that the cultural capital these doctors bring with them can act as a support as well as a challenge. They are likely to face subtle and not-so-subtle, covert and overt discrimination at a number of levels. In this brief report, we highlight some of the issues faced by them and some potential solutions.

Undergraduate psychiatric education is essential for the training of medical students and for their recruitment into psychiatry. A significant shortage of graduates choosing a career in psychiatry has been recently documented, and this trend might have many causes. When medical students have positive experiences of teaching, elective placements and exposure to psychiatric patients, their attitudes towards psychiatry are significantly better. Therefore, there is a need to improve the quality of undergraduate training courses in psychiatry. Innovative teaching strategies are suggested, including the use of movies, virtual reality, simulated patients and multiprofessional training wards.

It is now widely acknowledged that low- and middle-income countries in Africa are among global hotspots for high vulnerability to climate change, despite making comparatively low contributions to this phenomenon. Climate change has been shown to affect mental health as a result of disruption of social and economic structures that populations depend on for good health, including mental health. After decades of neglect, recent efforts by governments such as in Kenya to address the twin issues of climate change and mental health demonstrate the growing importance of these issues. Here we briefly review the evidence of climate change impacts on mental health in Africa and demonstrate that there is need for more contextual awareness and research in this area in Africa to mitigate or forestall potential mental health crises in the near future. We recommend systematic efforts to support funding for research and interventions at the nexus between climate change and mental health in Africa, and urge institutions and governments in Africa to begin paying attention to this emerging threat to the health of African populations.

The World Health Organization (WHO) has added gaming disorder to ICD-11 as a clinical condition associated with distress or interference with personal functioning. This inclusion leads to clinical and public health benefits, such as harmonising terminology, offering clinical landmarks and improving monitoring capabilities and data comparability. Training health professionals to identify and manage gaming disorder is a key challenge for countries. In the present paper we compiled opinions from different countries around the globe on their state of preparedness and needs to tackle this issue. The global views on the topic feed arguments for developing an evidence-based and cross-cultural training tool for gaming disorder management by health professionals.

When people living in poverty are asked to describe their living conditions, mental health issues quickly come to mind (grief, sadness, anger, fear, bitterness, frustration, discontent, anxiety, and emotional damage consisting of low mood and depression, fatigue, hypersensitivity, sleep difficulties and physical pain). Although the association between poverty and mental health have been widely demonstrated in the literature, care must be taken to avoid the psychiatrization of poverty. However, how can healthcare be provided to people living in poverty when basic needs are not met? This article explores the global challenge of providing mental health services in impoverished populations, using the example of the poorest country in America: Haiti. It examines the availability of services offered through the Mental Health Centre at Morne Pelé, and the necessity for innovative and comprehensive approaches to provide culturally appropriate care that meets the real needs of populations. It highlights effective measures that policy makers should implement to develop an efficient mental healthcare system based on the lessons of the Mental Health Centre at Morne Pelé.

Getting an article published in a scientific journal requires skills that are rarely taught, but are almost invariably learned by (bitter) experience. Yet, there are generally applicable guidelines that facilitate the process. This article summarises them.

The history of psychiatry as a discipline in Nepal has been poorly studied. We have attempted to summarise historical landmarks to explore how it began and its evolution over time in relation to contemporary political events. Although Nepal has achieved several milestones, from establishing a psychiatric out-patient department with one psychiatrist in 1961 to having more than 500 psychiatric in-patient beds with 200 psychiatrists by 2020, the pace, commitment and dedication seem to be slower than necessary: the current national mental health policy dates back to 1996 and has not been updated since; there is no Mental Health Act; the number of psychiatric nurses and in-patient psychiatric beds has increased only slowly; and there is a dearth of professional supervision in rehabilitation centres. Thus, despite making significant progress, much more is required, at greater intensity and speed, and with wide collaboration and political commitment in order to improve the mental health of all Nepali citizens, including those living in rural areas and or in deprived conditions.

There is growing interest in the health and environmental benefits of whole-food plant-based (WFPB) diets. The current global food system is harmful to our planet and is a key driver of climate change, pollution and biodiversity loss. A transition to WFPB diets will mitigate against these impacts and potentially reduce agriculture greenhouse gas emissions by up to 80%. Emerging evidence suggests that such diets also have significant physical and mental health benefits and can be useful in preventing and treating a range of conditions. Psychiatrists therefore have an important role to play in promoting WFPB diets among patients.

The COVID-19 pandemic has significantly affected treatment services for people with substance use disorders (SUDs). Based on the perspectives of service providers from eight countries, we discuss the impact of the pandemic on SUD treatment services. Although many countries quickly adapted in provision of harm reduction services by changes in policy and service delivery, some went into a forced abstinence-based strategy. Similarly, disruption of abstinence-based approaches such as therapeutic communities has been reported. Global awareness is crucial for responsible management of SUDs during the pandemic, and the development of international health policy guidelines is an urgent need in this area.

This paper concerns mental health services in The Gambia. It describes local concepts, experiences and knowledge about mental illness and the implications of such beliefs and attitudes for access to mental health services. A pretested questionnaire and interview guide were administered to a sample of patients/family members. Barriers to accessing mental health services were identified. These included beliefs about the causes of mental illness; family decision-making; the scarcity and high cost of services. Obtaining access to mental health services in The Gambia is currently challenging. Importantly, increased community and family education about the causes and treatment of mental illnesses will be required to address these issues.

Paraguay is a landlocked country in South America. It is a democratic low-middle-income nation, and the Ministry of Public Health and Social Welfare is responsible for its healthcare system. Mental health services receive just 1–2% of healthcare budgets, and there are only 1.6 psychiatrists per 100 000 inhabitants. There are insufficient resources to adequately assess and treat mental disorders in high-risk populations such as children, adolescents and prisoners. Despite several improvements to mental health policies within the past two decades, the nation still lacks a Mental Health Act and specific policies required to optimise the mental health of the population.

Indigenous people face numerous challenges to their mental health across the world. We consider the situation in Bangladesh, where those living in the remote hill tracts areas of Eastern Bangladesh experience widespread difficulties. Few seek attention for their problems from professional services, in part because of stigma or a lack of awareness that help could be made available, but also because in these remote areas few resources are available. We make recommendations to improve this situation, which could be implemented with the assistance of primary healthcare services and traditional healers.

The article provides a brief overview of the legislation governing involuntary admissions to psychiatric hospitals in Luxembourg. The legislation was completely overhauled in 2009 and several human rights principles are enshrined into it. Emphasis is placed on voluntary, community-based treatment, and where compulsory treatment is required, it uses the least restrictive treatment option. Mentally ill offenders are dealt with through separate specialist legislation. Young people under the age of 18 are often detained using family law.