As clinicians, we are used to making often fast and life-altering decisions. As professionals, the clinical decisions we make depend upon our training, knowledge base, supervision, expertise and experience. Sociodemographic factors such as age, gender, ethnicity and cultural background can also influence our views. However, rarely do we step back to think about the mental processes behind our decision-making. In cognitive–behavioural therapy and in our general dealings with patients, we aim to help them identify their cognitive schema and attribution errors as a way forward; but we rarely reflect on our own cognitive schema and possible misattribution in making decisions. Both patients and healthcare professionals are affected by cultural norms, mores and expectations.

As the median age of populations around the world increases, due to the provision of better diets and better medical care, the number of elderly persons vulnerable to mental illness will inevitably increase too. We are not good at providing high-quality geriatric care, even in high-income countries. For example, Age Concern (a UK-based charity) states on its website: ‘Health and social care services have made some progress in tackling age discrimination, but older people still report feeling that they have had second class treatment and care simply because of their age’ (www.ageconcern.org.uk/AgeConcern/ageism-in-healthcare.asp). How much worse these matters are in low- and middle-income countries is the subject of our theme in this issue. We have drawn articles from three distinct geographic regions: India, Africa and South-East Asia. We often assume that cultural factors in lower-income areas lead to greater respect for, and better care of, the elderly than we experience in many parts of the Western hemisphere. This appears to be a misapprehension, and attitudes towards the elderly are changing as the impact of industrialisation increases.

Sixty per cent of the global elderly population live in low-and middle-income countries, and this proportion was expected to rise to 70% by 2010 (International Institute of Ageing, 2001; Ferri et al, 2005). The 2001 Indian census found over 70 million people aged 60 years or more (considered senior citizens according to the Indian National Policy on Older Persons). Most of those senior citizens live with younger family members and are dependent on them for financial and social support. Hence, any physiological and psychological changes in the older family members affect the younger supportive members as well.

Mental health disorders account for about 14% of the global burden of disease. Neuropsychiatric disorders may be responsible for more than 1.2 million deaths annually (Prince et al, 2007). Around 80% of those affected live in low- and middle-income countries. Yet, despite the fact that older persons carry a disproportionate burden of non-communicable disease and mental disorder, they are not seen as priority issues for healthcare provision in these countries. Logically and ethically, older persons should be prioritised for targeted interventions, alongside the generic strengthening of primary and community health provision. African governments, spurred on by the specific agendas of non-governmental and parastatal organisations, continue with more urgent tasks; their healthcare provision is oriented towards the ‘younger generations’ (maternal and child healthcare, and infection). In most African countries, the expenditure specifically targeted for mental health is below 1% of the total healthcare budget, that is, effectively non-existent (Saxena et al, 2007).

The report World Population Ageing 1950–2050 (United Nations, 2002) estimated that in 2005 there were 37.3 million elderly people (i.e. aged 65 years or more) in South-East Asia (a region incorporating Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand and Vietnam). There are only a few epidemiological studies on mental disorders among elderly people in this region and the published data are mainly from Singapore, Malaysia and Thailand. Using Singapore's prevalence rate of 3% for dementia and 5.7% for depression, the numbers of elderly people with dementia in this region would be 1.2 million and with depression 2.12 million (Kua, 1992; Kua & Ko, 1995). However, even in Singapore, we have identified only 10% of all potential cases of dementia and depression — meaning that the large majority of elderly people with mental disorders are not detected, although they may be known, for other reasons, to the health services.

The Republic of Hungary is a landlocked country of 93000 km2 in central Europe; it is bordered by Austria, Slovakia, Ukraine, Romania, Serbia, Croatia and Slovenia. Its official language is Hungarian. Hungary joined the European Union (EU) in 2004. About 90% of the population of c. 10 million is ethnically Hungarian, with Roma comprising the largest minority population (6–8%). Currently classified as a middle-income country with a gross domestic product (GDP) of $191.7 billion (2007 figure), Hungary's total health spending accounted for 7.4% of GDP in 2007, less than the average of 8.9% among member states of the Organisation for Economic Co-operation and Development (OECD, 2009). The proportion of the total health budget for mental health is 5.1%, which is low when compared with, for instance, the UK (England and Wales 13.8%, Scotland 9.5%) (World Health Organization, 2008, p. 118, Fig. 8.1).

The Russian Federation is a country with an enormous territory, of over 17 million km2. Its population is 141.9 million (2010 figure). The population was declining, especially at the end of the 1990s, but in more recent years the tendency has been towards stabilisation. Life expectancy has remained relatively low, although it has increased somewhat over the past few years, to reach 67.5 years in 2008 (61.4 for men and 73.9 for women), up from 65.3 years in 2004 (58.9 for men and 72.3 for women).

The delivery of mental healthcare in the Democratic Republic of Congo (DRC), formerly Zaire, is influenced by geography, politics, legislation and the structure of the health system, as well as traditional beliefs and culture.

There is limited information about stakeholder perceptions of health service provision in low- and middle-income countries. We conducted a cross-sectional survey of 821 stakeholders of the community mental health services in Pemba Island, Zanzibar, Tanzania. The aim was to obtain systematic information about coverage, barriers, accountability and room for improvement as a baseline before implementation of a new mental health policy to strengthen mental health services.

The elderly population is increasing all over the world, a trend expected to continue well into the next century, particularly in low-income countries (Levkoff et al, 1995). There is an established association between increasing age and cognitive decline (Fillenbaum, 1984) and dementias are common in this age group.

In early 1933, the members of the British Federation of University Women (BFUW), an organisation which was established in 1907 to provide a supportive network for the growing number of academic women, embarked upon a unique humanitarian mission to aid their counterparts in Europe (Sondheimer, 1957; Dyhouse, 1995). This remarkable undertaking, which came to provide academic women refugees with professional, financial and practical support, was in direct response to the growing threat from Fascism and Nazism. Almost from the moment that Hitler came to power in Germany in January 1933, the BFUW Executive Committee began to receive a steady stream of calls from German members of the International Federation of University Women (IFUW), whose lives and careers were affected by restrictions imposed upon them by the Nazi regime. Some were seeking help finding work and settling in Britain, while others were looking for temporary help as trans-migrants on their way to the USA, New Zealand or Australia.