All psychiatrists would acknowledge that communication between individuals is fundamental to their speciality, but it is perhaps less obvious that the increasing ease and speed of communication worldwide are also having a profound effect on psychiatric practice. With this improved communication comes an awareness of the commonality of many mental health issues and recognition that there is much to learn from others working in very diverse environments. It is also true that many mental health problems have an international dimension, particularly when large numbers of people are displaced by war or other disasters. Increasingly we need to have a better understanding of other cultures and the relationship between culture, mental health and psychiatric disorder.

In this, the inaugural issue of International Psychiatry, we are highlighting the first of many themes that are of interest and concern to psychiatrists around the globe. Terrorism is both directly and indirectly the predominant topic in our media at present. What impact does living with such a threat, an ‘ever-present danger’, have on our mental health? Even if we are not directly affected by terrorism, psychiatrists cannot ignore the effects such incidents have had on societies in both the developed and the developing world.

On 11 September 2001, the United States suffered the worst terrorist attacks in its history. In New York City, approximately 3000 persons were killed at the World Trade Center, while many thousands fled for their lives. Millions of other city residents observed the burning towers and breathed the acrid smoke that blanketed the city. Compounding the massive physical destruction and loss of life, the psychological impact of these terrifying events on the populace was profound – there were significant increases in mental distress and symptoms of disorder.

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.

The consequences of terrorism, wars and natural disasters are a challenge to the psychiatric profession. The large numbers of people estimated to have mental health problems surpass the capacities of existing mental health services, whether modern or traditional. The bulk of the 35 million refugees and internally displaced people worldwide reside in countries that, on average, have less than one psychiatrist or psychologist per 100 000 people (WHO, 2001). Even the 500 000 people estimated to need some form of psychological support after the attack in New York on 11 September 2001 exceeded the service capacity, despite the fact that New York has the highest density of mental health professionals in the world (Herman & Susser, this issue, pp. 2–4). Elsewhere, many survivors of various types of disaster reside in peripheral areas of countries and are not covered by modern mental health services.

Many psychologically informed books and papers have been published during the past 30 years that have explored different elements of the Northern Ireland problem. These have ranged from Padraig O'Malley's (1990) fascinating examination of the world of the hunger strikers and their families, to a recent socio-psychological study of sectarianism in young children, which was sponsored by the Community Relations Council (Connolly et al, 2002). The latter careful piece of work demonstrated that while children of three years of age are beginning to identify different cultural symbols, there is not much evidence of sectarian attitudes until about five or six years of age. By this time they have not only begun to recognise and identify with partisan symbols, but also to express deeply antagonistic sectarian attitudes. These are not wholly unexpected findings, but the purpose of good research is to enquire whether things are in fact the way one might expect them to be. When it comes to research on clinical psychiatry there is less material but the most interesting and unexpected finding that emerges from the published work of psychiatrists in Northern Ireland is the limited evidence of any increased violence-related psychiatric illness in the population as a whole.

Pakistan is a country comprising four provinces: Punjab, Sind, Northwest Frontier Province and Baluchistan, in addition to the federally administered tribal areas and the federal capital territory of Islamabad. It is bordered by China, Afghanistan, Iran and India. It has a population of 152 million (excluding an estimated 3–4 million Afghan and Bangladeshi immigrants) and an area of 796 095 km2.

Chile has approximately 600 psychiatrists for its 15 million people. Although in the capital city, Santiago, the provision (per capita) is twice as high as in the rest of the territory, it is possible to see over the past decade a progressive increase in the number of these specialists in the other main cities. There are no more than 50 child psychiatrists and several cities have no local resource in this sub-speciality.

Brazil is a country with 170 000 000 inhabitants (census for the year 2000), of whom 138 000 000 live in urban areas. The illiteracy rate, that is, people over 15 years of age who cannot write or read even a simple message, is 13.4%. About 25.6% of the population live on a family income less than half the minimum wage (1999 figures). Brazil's gross internal revenue is R$564 800 per capita (1998 figures, about US$1680 today).

India is a low-income country that is characterised by huge diversity within and between its 35 states and union territories. For example, the infant mortality rate (per 1000 live births) ranges from a low of 16.3 in Kerala to a high of 86.7 in Uttar Pradesh, over a fivefold difference (International Institute for Population Sciences & ORC Macro, 2001). This considerable variation is evident in virtually every aspect of human development in India, and any summary figures are likely to be unrepresentative of most parts of the country. Within the scope of this short article, this important limitation of averages must be recognised at the outset.

I greatly welcome this opportunity to contribute to the first edition of International Psychiatry and to wish it well on its maiden voyage; the aim of this contribution is to outline those structures and objectives of the World Psychiatric Association (WPA) that are relevant to members of the Royal College of Psychiatrists.