Systematic evaluations show that placebo treatments can have large effects, sometimes larger than those of ‘evidence-based treatments’. This is the ‘efficacy paradox’. The neurobiology of placebo effects is being mapped out. Placebo effects are no less real or, in some illnesses, clinically important than the effects of direct biomechanical or pharmacological interventions. The technical model of medicine seeks impersonal technologies that can be applied independently of context and person. This approach has had spectacular success in the treatment of disease but meaning, cultural context, interpersonal effects, personal preferences and values are enormously important in the treatment of illness. The study of placebo reveals aspects of the biology of interpersonal relationships and the social environment. The evidence demonstrates that interpersonal healing (sometimes called placebo) in illness is just as real, scientific and biological as technological healing. This is a paradigm shift.

The concept of ‘recovery’ as applied to severe mental illness has fostered a cultural change in attitudes to the long-term outcome of conditions such as schizophrenia. ‘Recovery’ has a specific meaning in this context. It refers to the possibility that even in the presence of a chronic psychiatric disorder there is hope for a life that has value. The affected individual can still make a contribution to society; he or she can expect to live independently and with dignity. The term implies that our traditional medical model of illness lacks the longer-term perspective on how patients might learn to cope with their condition.

For almost a century the medical model has been the overarching framework for mental healthcare but since the 1980s it has been challenged by a consumer/survivor movement. Central to this revolution is the recovery model, which suggests that mental illness is only one of many facets of the life of an individual with mental illness, and that a full, meaningful life is possible despite illness (Anthony, 1993). The medical model emphasises the role of symptomatic improvements and functional status, and considers recovery as an ‘outcome’ or ‘end state’, at which point symptoms are remitted and community functioning is restored. In contrast, the recovery model underscores hope, empowerment, the self-management of illness and some aspects of community functioning, such as social support and role functioning, which operate in a non-linear fashion throughout the recovery journey.

The ideas of ‘recovery’ arise from the experiences of people with mental health problems. The recovery approach emerged in the North American civil rights and consumer and survivor movements from the 1970s onwards. It is concerned with social justice, individual rights, citizenship, equality, freedom from prejudice and discrimination. In this paper we discuss a project in England that has examined how mental health services may be transformed to be more supportive of recovery and the implications that this has for professional practice.

The International Pilot Study of Schizophrenia (IPSS) was a seminal, ground-breaking study that revealed important information regarding schizophrenia on a global scale. Perhaps the most interesting and controversial finding was that for all outcome variables considered, patients suffering from schizophrenia in Nigeria and India (‘developing countries’) tended to ‘recover’ better than patients in the other six sites. However, in recent times, this finding has been repeatedly challenged. The renewed debate led to a vigorous rebuttal by some of the original IPSS study authors. In an increasingly globalised world, the IPSS stands as a reminder of the importance of the cultural determinants of recovery from schizophrenia.

The Kingdom of Bhutan lies in the folds of the eastern Himalayas, sandwiched between India to the south and China to the north. It has a total area of 38394 km2, which is roughly the size of Switzerland, and a population of a little over 70 0000 (Royal Government of Bhutan, 2002). It is a mountainous country, except for a small flat strip in the southern foothills. The official language is Dzongha, but English is widely spoken. English is the medium of instruction from pre-primary level onwards. In 1999 Bhutan allowed viewing of television and use of the internet, as a step towards modernisation. In the early 20th century, Bhutan came into contact with the British Empire; Bhutan maintains strong bilateral relations with India. Business Week magazine in 2006 rated Bhutan the happiest country in Asia and the eighth happiest in the world, based on a global survey. Bhutan is in fact the only country where happiness is measured in the form of an index, ‘Gross National Happiness’. The main religion practised in the country is Buddhism, with Hinduism as the second most prevalent. The capital and largest city is Thimphu. In 2007, Bhutan made the transition from absolute monarchy to constitutional monarchy, and held its first general election in 2008. Bhutan is a member of the United Nations and of the South Asian Association for Regional Cooperation (SAARC); it hosted the 16th SAARC summit in April 2010.

A major barrier to the large treatment gap in mental healthcare in low- and middle-income countries is the shortage of psychiatrists, partly caused by a brain drain. This qualitative study aimed to gain an in-depth understanding of the motivations and experiences of migrant psychiatrists in order to address retention factors. We interviewed a convenience sample of 11 psychiatrists from Afghanistan, Iraq, South Asia and Africa. Interviews were semi-structured and based on questions about the participants' reasons for emigrating, their expectations and experiences of the move, their views of psychiatry as a profession in their country of origin and whether any incentives would persuade them to return. Prevention of emigration appears to be far more effective than encouraging expatriates to return; an improvement in training and job opportunities could have a drastic impact on retention. Almost all the psychiatrists interviewed intended to contribute to training and raising the profile of psychiatry in their country of origin, and therefore their emigration may have long-term benefits. It could potentially break the cycle between lack of understanding, lack of demand for mental health services and lack of training. It should therefore be an ethical obligation of UK employers to offer migrant psychiatrists time and support to facilitate these contributions.

Natural disasters can result in a range of mental health outcomes among the affected population. Appropriate mental health interventions are required to promote recovery. In the aftermath of the 2009 bushfires in Victoria, Australia, a collaboration of trauma experts, the Australian and Victorian state governments and health professional associations developed an evidence-informed three-level framework outlining recommended levels of care. The framework was underpinned by an education and training agenda for mental health professionals. This framework has been successfully applied after further natural disasters in Australia. This paper outlines the steps included in each of the levels.

Traditional healers' centres may constitute community resources for people with a mental illness. Many low-income countries are seeking to integrate mental health into their mainstream health services and primary healthcare, so as to decrease the duration of untreated illness. Traditional healers can help to meet these needs. A series of four studies has been conducted in central Sudan. In-patients with mental disorders undergoing treatment with traditional healers were recruited, as well as some of the healers themselves. The resulting observations should help practitioners trained in Western psychiatry to better understand traditional healing as an alternative healthcare system. The results should contribute to current debates on whether or not traditional healers in Africa should be officially recognised as healthcare providers. They should also deepen social scientists' understanding of the role of culture in mental health and help policy makers to improve mental health services.

In the aftermath of the major earthquake that hit Pakistan in 2005, there appeared to be a paucity of psychometric tools validated in Urdu. It was decided to translate the Impact of Event Scale - Revised (IES-R) so as to obtain an internationally validated and recognised psychometric tool for use in research into post-traumatic stress disorder. The resulting Urdu and English versions of the IES-R were compared for linguistic, conceptual and scale equivalence. The Urdu version of the IES-R (UIES-R) can be used for clinical, psychological trauma populations in Pakistan with evidence of good reliability and satisfactory validity. In trauma research in Pakistan the UIES-R will be an extremely useful psychometric tool.