There are striking and significant differences in psychiatric training across Europe and procedures for the assessment of trainees vary widely (Strachan, 2007). The introduction of competency-based training represents a major shift in medical education and a challenge to harmonising psychiatric training in Europe. This paper discusses the development and implementation of competency-based training in the Netherlands and the UK and focuses on its effects on trainees.

Henderson and Andrews have written a timely paper to examine the yield from national surveys, and pose questions of value for money, survey methods, delineation of pathology by categorical boundaries rather than dimensions, and breadth of risk factors examined. We would like to address the points they raise, exemplified by the purposes (Jenkins et al, 1997) and yield of the British survey programme.

The use of complementary and alternative medicine is increasing among psychiatric populations. Herbal medications are a form of alternative and complementary medicine whose use has increased over the last decade. Two studies done among Western out-patient groups have reported rates of use of herbal medicine at 15% (‘current use’; Matthews et al, 2003) and 24% (Knaudt et al, 1999).

The prevalence of psychiatric morbidity among rural and urban Kenyan primary care attenders has been reported to be as high as 63% (Ndetei & Muhangi, 1979; Dhapdale & Ellison, 1983; Dhapdale et al, 1989; Sebit, 1996). For its population of 32 million, Kenya has only 16 psychiatrists and 200–300 psychiatric nurses, but there are just over 2000 primary healthcare centres, staffed by general nurses and clinical officers, and the main burden for assessing and caring for people with mental disorders falls upon members of the primary care teams. However, mental disorders are poorly recognised (Dhapdale & Ellison, 1983) and inadequately treated in primary care (Muluka & Dhapdale, 1986). Moreover, Kenyan primary care workers often lack training in mental health (Dhapdale et al, 1989; see also Ndetei, this issue, p. 31).

Previous Presidents wrote Council reports of their overseas visits and one wonders how wide an audience their reflections actually reached. What good fortune for me, then, that I can share my reflections in the pages of International Psychiatry. The title of this paper was given to me by a disgruntled senior member of the College working in England, who felt that I was paying far too much attention to international matters, and so I thought I should explain further why I consider the international role of the College to be so important.

Sir: We read the article by Pi & Zhu (2007) with interest, as this topic is particularly important to psychiatrists practising in countries like Sri Lanka, where, because of the lack of local prescribing guidelines, the dosing of medication is generally determined by guidelines developed for patients in the West, such as those from the National Institute for Health and Clinical Excellence (NICE) and the British National Formulary.

Sir: The Iraq Subcommittee (ISC) of the Board of International Affairs organised a visit to Iraqi Kurdistan to help support mental health services within the province. Four members of the Subcommittee took part in the visit, on 8–15 June 2007. Our official meetings started on the day of our arrival. We met with the dean of Hawler Medical School, the president of Hawler Medical University and the dean of Hawler Nursing School, as well as the Minister of Health and the Minister of Higher Education (Hawler is the Kurdish name for Erbil, capital of the province). We also visited the mental health unit in Hawler Hospital and met with the consultants, psychiatric trainees and other staff. We also visited a newly commissioned long-stay psychiatric facility.

Sir: At the annual meeting of the Royal College in July, British psychiatrists were treated to a taste of the trainee's lot in France, the Czech Republic and the USA. It was reassuring to hear that UK training often compares favourably with that overseas.

Sir: The editorial by George Christodoulou et al (2008) on ‘Psychiatry for the person’ and the response by Jeremy Holmes (2008) have been read with avid interest on this side of the globe. Listening to previous presentations on this topic at Asian meetings of the World Psychiatric Association (WPA), we were often left with a sinking feeling that they resonate well with our work but could be better. For the Institutional Programme on Psychiatry for the Person (IPPP) to succeed, there should be more participation from developing countries. The marketplace of ideas should not be confined to academics in Europe and North America and ignoring the rich experience of clinicians in Chennai, Singapore or Batu Pahat.

Sir: At its 2006 annual forum in Riga, the European Federation for Psychiatric Trainees (EFPT) issued its first statement on competency-based training and assessment in psychiatry. The EFPT, which represents national associations of psychiatric trainees from across Europe, is broadly in favour of competency-based training if it improves the standard of psychiatric education and is not overly bureaucratic.