There is now an increased awareness of the high rates of depression among women with young children in impoverished communities. Poor maternal mental health affects the home environment, family life, child care and parenting. This paper summarises some of the issues related to the determinants, consequences and management of maternal mental health during and after pregnancy in Pakistan, a low-income country.

In late 2008, the Regional Office for Europe of the World Health Organization (WHO, 2008) issued a report based on a survey of the policies and practices for mental health within its area of operation. Forty-two European states were examined and a great diversity in practice was recorded. Almost everywhere, the report suggested, policy making and legislative initiatives were seen; since 2005, some 57% of the countries studied had adopted new mental health policies and 48% had introduced new legislation. Many countries were reported to be closing mental hospital beds and replacing them with community-based services. In some countries, however, the report suggested, desks in ministries were collapsing under the weight of policies that had never been implemented, and compliance with legislation by planners and psychiatrists was distinctly variable. The WHO felt that even the role that general practitioners played in treating people with mental illness was limited in many European states and that the availability of home treatment options, assertive outreach for people with complex mental health needs and community-based early intervention was not only variable but often severely limited. Given the wide discrepancies of procedure and practice, it was difficult for the WHO to gain any clear perspective on such legislative matters as arrangements for compulsory care in the community.

Ukraine is a newly independent state with a population of about 48 million. It inherited its national health system from the USSR. The Soviet system was conceived as part of a massively expensive socialist planning economy that was generally delivering poor value for money. Some aspects of the Soviet health system were, however, undoubtedly sound and certain public health measures were superior to those in the West. For example, infant mortality, despite possible underreporting, was probably lower in the USSR than in many Western countries (Anderson & Silver, 1986). The health system became increasingly corrupt and inefficient during the final years of the USSR's existence. Since independence, the health system has not been a state priority and has been chronically under-funded. In the past few years of rapid economic development in Ukraine, the share of the state budget allocated to the health system has remained static, leaving Ukraine in a disadvantaged state compared with other European countries (United Nations, 2007).

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.

It is widely known that Africans and especially Nigerians place much emphasis on childbearing. It has been said that the effect of childbirth relates to the society and culture's response to parenthood and the existing family structure. Many rituals exist in African societies to signify the changes in women's identity, roles and status during pregnancy and following childbirth. Earlier studies have suggested that perinatal emotional distress is rare among women in sub-Saharan Africa, with the supposed intact family structure in the region acting as a protective factor.

Compulsory admission to and treatment in psychiatric facilities have recently been brought into the spotlight by both psychiatrists and the media in Egypt. Interventions of this kind have always inherently involved deprivations of liberty and infringements on privacy. The debate around this issue acquired considerable heat after it was joined by the legislatures during the discussion of a Bill in Parliament. The Parliamentary Committee for Constitutional and Legislative Affairs questioned the constitutionality of the process of compulsory detention and requested more robust safeguards to protect the rights of persons with mental illness. The new Bill was passed by the Egyptian Parliament on 26 April 2009 and was due to come into force once ratified by the President and published in the Egyptian Gazette, expected in May.

Ukraine, with a population of 46.2 million, is the second largest country in Europe, with an area of 603 700 km2. It is still recovering from the collapse of the Soviet Union in 1991, following the Soviet stagnation era (since the mid-1960s) and perestroika (from 1986), as well as the 1998 Russian financial crisis and Ukraine's 2004 Orange Revolution. These events have resulted in high levels of socio-economic disparity, political instability and a degraded healthcare infrastructure. These issues, in addition to traditionally high levels of alcohol consumption, have made binge drinking and alcoholism, among other addictions, major problems in Ukrainian society (Voloshin et al, 2003).

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).

Many legal mechanisms can be used to authorise compulsory community mental healthcare: leave or conditional discharge for compulsory in-patients; adult guardianship (or incapacity) legislation; treatment as a condition of a community-based criminal sentence, like probation, or of parole from imprisonment; or a full-fledged community treatment order (CTO) scheme. It is the specific mix of mechanisms employed in a particular jurisdiction that will characterise how that legal system manages the delivery of compulsory (or quasi-consensual) community psychiatric care.

Mental healthcare in the countries of the former Soviet Union faces considerable challenges as result of the socio-economic transition. In this article we look at the changes in the Republic of Moldova. We identify weaknesses and strengths in the traditional hospital-based system and describe examples of the successful implementation of modern mental health services. We follow the reform process in mental health law and service provision in view of the recommendations from the Council of Europe (2004) for the protection of human rights of persons with mental disorder. Some of the information in this article was gathered during official visits to mental healthcare institutions in the Republic of Moldova in 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.

Gynaecological complaints have long been associated with poor mental health, in particular depression and anxiety, in higher-income countries. Lower abdominal pain (both menstrual and non-menstrual) and pelvic pain are considered the hallmark gynaecological symptoms associated with somatoform, stress-related and neurotic disorders (the ‘common mental disorders', CMDs). Cultural and social factors heavily influence the expression of somatic symptoms and metaphors for emotional distress, but little is known about gynaecological psychosomatic clinical syndromes in non-Western cultures, despite the enormous global health significance of gynaecological symptoms. This paper considers the specific example of the syndrome of abnormal vaginal discharge (AVD) in India.