A set of principles which might underpin mental health law across the world is discussed, and one particular difficulty is highlighted.

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 global economic downturn seems to be associated with a rise in suicide rates in many countries but we should not assume that this is a social rather than a clinical phenomenon. Mental health patients may be particularly vulnerable to unemployment and other hardships and to cuts in the care they receive. There is now no shortage of evidence on how clinical services and health policies can reduce suicide, and in England a new suicide prevention strategy was recently launched for public consultation. What we lack is an effective forum where a rigorous examination of international evidence can take place, with the findings translated into actions.

The increasing evidence base for cost-effective interventions and a fledgling advocacy effort have given momentum to mental health becoming a global priority. The contention of this editorial is that we are at a tipping point if we can exploit the opportunities that will be afforded to mental health professionals and advocates in the next year or two. The missing links are the development of consensus among mental health stakeholders, the formation of coalitions and partnerships with both advocates and policy-makers, and the mobilisation of a stronger advocacy effort built around consumer and family member ‘voice’ and empowerment.

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.

We asked the programme managers for mental health at the World Health Organization's Regional Offices for Europe, the Eastern Mediterranean and South-East Asia to provide an account of developments in the provision of mental health services within their regions.

We are very fortunate that these busy and influential individuals were able to set aside the time to prepare articles that shed a fascinating light on strategic thinking within the World Health Organization.

There has been considerable publicity recently in the UK concerning the threatened contraction of the country's pharmaceutical industry. The UK currently has the third highest share of global pharmaceutical research and development expenditure (after the USA and Japan), but the costs of conducting research in the UK are rising.

For the past decade, overt unrest and danger have typified daily life for many families in Iraq and Afghanistan, while in Egypt under the former regime a superficial appearance of political stability lay over a sense of deep discontentment. What impact does living in those circumstances have on mental health? We asked psychiatrists with personal knowledge of events in three countries that have recently been riven by war and revolution to discuss their experiences. Because so few objective data are available on the impact of stress in any of the three regions reviewed, the authors have inevitably relied in large part upon anecdote and upon news reports from the internet.

Mental health and psychiatric services in Afghanistan have gone through various stages of development and crisis but the long-term impact of recent wars and conflict on the country's mental health services has not been evaluated. What is obvious is the shortage of trained mental health professionals in the country.

Clinical trials have been conducted almost wholly in high-income countries until recently, yet their results may not always be valid or applicable in middle- and low-income countries. Clinical trials are now, though, increasingly being done in less wealthy countries. While this is welcome, there is a need to ensure the profit motive does not override the benefits. Partnership with local counterparts while adhering to international standards should help to maintain high-quality output from clinical trials.

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.

Over the past decade, attention has increasingly focused on the need to increase the capacity of mental health services. The World Health Report 2001 – Mental Health: New Understanding, New Hope (World Health Organization, 2001) set the agenda, advocating the development of community-based mental health services. The case for scaling up, inspired by the World Health Organization's vision of ‘no health without mental health’, was powerfully argued first in the Lancet series in 2007 (Prince et al, 2007) and again in the Lancet in 2011 (Eaton et al, 2011). The forthcoming Global Mental Health Action Plan, requested in a resolution by member states of the World Health Organization at the 2012 World Health Assembly, is a great opportunity to formulate objectives and targets for countries, and to analyse experiences from around the world. The forthcoming European Action Plan builds on this, customising actions for European countries.

There is a trend for pharmaceutical companies to contract third parties to conduct the clinical trials that are needed to test their drugs. This trend is referred to as outsourcing, and the companies that carry out the work are called contract research organisations. In addition, clinical trials are increasingly conducted in non-traditional trial regions, which are mainly low-and middle-income countries. This trend is called offshoring. The combination of outsourcing and offshoring poses serious risks for the ethical treatment of participants in clinical trials.

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 Eastern Mediterranean Region of the World Health Organization has recently developed a comprehensive strategy and action plan to promote mental health and provide for the integrated prevention, treatment and rehabilitation of mental, neurological and substance use disorders. By strengthening national mental health policies, plans and legislation, scaling up integrated services, capacity-building, promoting human rights and prioritising vulnerable groups, the strategy aims to improve mental health and to help countries achieve their national development objectives.

Since 2003 Iraq has experienced significant challenges in reforming and rebuilding its health services. A national mental health survey reported a high level of mental health problems consistent with a country that has experienced widespread violence and trauma. The survey also highlighted limited access to services. This paper outlines developments in and plans for mental health services in Iraq.

This commentary highlights the poor availability of essential psychiatric medicines at public sector facilities in India and illustrates why even a flourishing generics industry does not assure access to affordable psychiatric medicines for most Indian patients. The paper outlines the Indian government's pricing regulations and then enumerates recommendations for reform.

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.

Traditionally, care for mental and neurological disorders has been concentrated in tertiary care hospitals located in large cities. These custodial types of facility were designed to ‘protect’ the community from patients with a mental illness, as such persons were considered dangerous and a threat to the community. Given the state of medical knowledge in the 19th and 20th centuries, this mode of care was considered appropriate. However, in recent decades more humane and effective concepts of care have evolved. These concepts recognise the stigma attached to hospital-based care and also its limited outreach to the community, leaving out the vast majority of people living in rural and remote areas. Violation of human rights, sometimes seen in mental hospitals, has also been of concern.

The 2011–12 Egyptian revolution (thawret 25 yanãyir, revolution of 25 January) took place following a popular uprising that began on Tuesday 25 January 2011 and is still continuing. The uprising was mainly a campaign of nonviolent civil resistance. In this revolution the participants have proved that if resistance begins with sincerity and unity, it may yet achieve victory.