Just as in the 19th century, when it was realised that public health — or ill health — was often the product of poor social conditions requiring municipal and national action to address it, so in the 21st century it is evident that many of the factors that determine health now require international action. The immediate threats to global health include over-consumption, environmental damage and misuse of medicines, and many international forums have focused on the consequences for physical health. However, as countries address these more tangible problems and improve the physical health of their population, their mental health needs become more apparent and more pressing. In many countries these needs are acknowledged and appropriate training for health care professionals is provided and/or is being developed. However, with the growing gulf in prosperity between rich countries and poor, it is important that mental health services in the latter do not become — or do not continue to be — the Cinderella services that they were for so many years in the UK.

Our College, with its tradition and reputation of experience in postgraduate education and its historical links with many countries, is well placed to play a role in the direct provision of training that should be appropriate to the needs of the country concerned and should not seek to exploit its workforce to remedy service deficiencies in the UK.

A continuing contribution to international education, although an important responsibility, should be seen as the starting point for the College's future global role, rather than an end-point. As a starting point it allows the development of relationships with the people likely to become leaders of the discipline within different countries, and it also offers the College — and through the College, the profession as a whole — the opportunity to learn from other countries' experiences about cultural differences, different pathologies, different treatment approaches and so on. This development of genuine partnerships between equals, benefiting all parties, is of fundamental importance for the College's international role. The decline in the number of overseas trainees in recent years is evidence and warning that the old ways are no longer sufficient.

Instead, the College must reach out and become involved not just with the English-speaking Commonwealth countries, but increasingly with the countries in the European Economic Area. This will require the College to be wholeheartedly committed to organisations such as the World Psychiatric Association, the Association of European Psychiatrists and the World Health Organization, as well as developing strong links with sister organisations in other countries.

We appreciate that any such efforts require significant investment of precious time and money. This investment is essential, not just for the College's continued international prestige, but also because of our responsibility to advocate actively equality of mental health worldwide. Our concern must be for the mental health of all the world's citizens, not just the ‘mental health of the nation’.

Finally, remembering the not too distant history of the use of psychiatry for political purposes, the Royal College of Psychiatrists should lead the way in advocacy of human rights, individual freedom and ethical and moral issues, which are fundamental to good mental health.