A Caribbean Diaspora has emerged worldwide after 500 years of European colonial exploitation of the Caribbean geopolitical region. This exploitation has a two-tiered social legacy: the ‘haves'; and the ‘have-nots', characterised by poor educational achievement, underdevelopment and unemployability of the many. The Caribbean Diaspora is a product of ever-increasing fantasies of escape from poverty by migration to greener ‘First World’ pastures. The complex, contradictory Caribbean society generates a crucible of misery and violence amid opulent wealth and luxury, which requires a burgeoning private and public police and military apparatus for its containment, and an ever-increasing health, mental health and penal correctional system to buttress the casualties of this conflict that is spiralling out of organisational and economic control. This two-tiered society was inherited from the hierarchical legacy of European colonialism. The colonisers existed in a system of high productivity and order, which imposed its will on the colonised, who lived in relative disorganisation and need. The resultant vector of this unequal yoke is the virtual anarchy of present-day Jamaica and other Caribbean territories, characterised by a subculture of violence and increasingly violent crime. The physical, psychological and economic costs of this seeming conundrum are bewildering and unaffordable.

Globally, poverty has been noted to be a high risk factor for mental disorder. Although there is limited information on the baseline prevalence of mental disorders in low- and middle-income countries, the known risk factors for poor mental health, such as poverty and violence, afflict many of these areas (Miller, 2006). It is clear that poverty and the mental health consequences of war and displacement significantly hinder the achievement of the Millennium Development Goals (Njenga et al, 2006).

Recent decades have seen renewed interest in the study of poverty and its repercussions on various health problems, including mental disorder (Patel, 2007). There are various ways of measuring poverty; some approaches define it in economic terms, whereby health is included only as an asset that must be given to those defined as poor (Damián & Boltvinik, 2003). Other conceptions propose definitions based on the capacity of the poor to improve their standard of living, and consider health and education as essential elements in this process. This is the case of the Human Development Index (HDI), which, in addition to the economic dimension, measures other social indicators such as life expectancy, literacy and school enrolment and drop-out rates, among others (United Nations Development Programme, 2000). On the basis of the HDI, Mexico ranks 52 out of 177 countries. According to its percentage of gross domestic product invested in health, it is regarded as a country with a medium/high income level.

This paper describes the historical background, development and current status of psychiatric services in Kuwait. In addition, present practices and the outlook for further development of services are outlined.

Ireland is the third largest island in Europe and the twentieth largest island in the world, with an area of 86 576 km2; it has a total population of slightly under 6 million. It lies to the north-west of continental Europe and to the west of Great Britain. The Republic of Ireland covers five-sixths of the island; Northern Ireland, which is part of the United Kingdom, is in the north-east. Twenty-six of the 32 counties are in the Republic of Ireland, which has a population of 4.2 million, and its capital is Dublin. The other six counties are in Northern Ireland, which has a population of 1.75 million, and its capital is Belfast. In 1973 both parts of Ireland joined the European Economic Community. This article looks at psychiatry in the Republic of Ireland.

Zambia, previously called Northern Rhodesia, was a colony of Great Britain until 1964, when it gained independence and changed its name. It is a landlocked country located in southern Africa and shares its borders with Zimbabwe, Namibia, Botswana, Mozambique, Malawi, Tanzania, Congo and Angola. It has an area of 752 612 km2, about three times the size of Britain, but a population of only 12 million.

Misinterpretation in major surveys of alcohol use disorder as described by DSM-IV (Hasin et al, 2007) has raised serious questions regarding the extent of alcohol use disorder, and the relationship between alcohol abuse and alcohol dependence. While the adverse social, physical and mental effects of alcohol misuse are well known (Council on Scientific Affairs, 1996), there is little information on the determinants of alcohol abuse (societal impact) and alcohol dependence (physiological impact). We therefore examined their separate and combined associations with demographic, social and health characteristics in a representative community-resident sample aged 60 years and over. We hypothesised that, while for each of the three groups (those with alcohol abuse, those with alcohol dependence, and those with both) there would be associated demographic characteristics, abuse would be more closely associated with social characteristics, dependence with health characteristics, and the combined presence of abuse and dependence with both social and health characteristics.

A recent editorial in International Psychiatry (Cox, 2008) described the importance of a new initiative by the Lancet (Horton, 2007) to promote the development and delivery of mental health services and treatments in low-and middle-income countries (LMICs). This initiative was supported by a series of outstanding papers (Chisholm et al, 2007; Jacob et al, 2007; Patel et al, 2007; Saraceno et al, 2007; Saxena et al, 2007).

According to Beauchamp & Childress (2001) the fundamental principles of biomedical ethics include ‘justice'. But how do we approach ‘justice'? Justice may be thought of in relation to an individual or society. An individual may be just or unjust. Justice in society may be thought of as ‘retributive justice’ (fair punishment), ‘civil justice’ (fair recompense), ‘distributive justice’ (fair shares) or ‘social justice’ (a fair social contract for citizens of a society).