Poverty and income inequality have increased in the UK since the 1970s. Poverty and mental ill-health are closely associated and disadvantage can have long-term consequences. In addition, the recent recession and austerity measures have had a detrimental effect on people with mental health problems and the mental health of the population. Mental health services can play a role in addressing the problems of poverty and inequality.

The mental health effects of climate change are significant and highly concerning, yet little is known about the magnitude of these effects or how best to manage them. This introduction to the thematic papers in this issue explains why climate change is an increasingly important matter for all health services.

Some fear that provoking widespread worry about climate change may harm mental health. The Regional Wellbeing Survey, a large study of health, well-being and life in rural and regional Australia, examined climate change worry and attitudes. Most respondents were worried about climate change and agreed that fossil fuel use causes global warming, but there was no evidence to suggest that worry about climate change is linked to mental health in the general population. Respectful, calm, considered public debate about how to respond to climate change is unlikely to be harmful to population mental health. Individually focused clinical approaches are unlikely to be effective as a primary approach in managing the mental health impacts of climate change. Instead, collective, systems-based approaches will be needed.

‘Photovoice’, a community-based participatory research methodology, uses images as a tool to deconstruct problems by posing meaningful questions in a community to find actionable solutions. This community-enhancing technique was used to elicit experiences of climate change among women in rural Nepal. The current analysis employs mixed methods to explore the subjective mental health experience of participating in a 4- to 5-day photovoice process focused on climate change. A secondary objective of this work was to explore whether or not photovoice training, as a one-time 4-to 5-day intensive intervention, can mobilise people to be more aware of environmental changes related to climate change and to be more resilient to these changes, while providing positive mental health outcomes.

Non-attendance at mental health clinics is an international problem. A survey was conducted in the UK investigating communication methods used by staff to inform and remind patients about appointments. Increased number of communication methods used was associated with a reduced non-attendance rate. A care modelling analysis is provided that explores the healthcare use of three hypothetical patients following clinic non-attendance. The financial and environmental costs of each are then calculated and results discussed. Reducing non-attendance is achievable through the use of multiple communication methods. This small change can improve the sustainability of mental healthcare in different countries by improving quality of care and reducing financial and environmental costs.

The Malaysian Mental Health Act 2001 did not come into effect until the Mental Health Regulations 2010 came into force. The Act provides a framework for the delivery of comprehensive care, treatment, control, protection and rehabilitation of those with mental disorders. The Act governs the establishment of private and government psychiatric hospitals, psychiatric nursing homes and community mental health centres. This paper outlines the provisions of the Act and the Regulations.

This article summarises the development of mental health legislation in Singapore in three distinctive periods: pre-1965; 1965–2007 and 2007 onwards. It highlights the origin of mental health legislation and the relationship between mental health services and legislation in Singapore. The Mental Health (Care and Treatment) Act 2008 and Mental Capacity Act 2008 are described in detail.

After a large-scale humanitarian disaster, 30–50% of victims develop moderate or severe psychological distress. Rates of mild and moderate mental disorders increase by 5–10% and severe disorders by 1–2%. Those with such disorders need access to mental healthcare. Primary care clinics are appropriate due to their easy accessibility and the non-stigmatising environment. There is a consensus among experts that the mental health effects of disaster are best addressed by existing services, that is, through capacity building rather than by establishing parallel systems. Mental health interventions in emergencies should begin with a clear vision for the long-term advancement of community services.

In South Asia, general hospital psychiatric units (GHPUs) have developed as an alternative to mental hospitals for the provision of comprehensive mental health services, training and research. GHPUs provide clinical care for all types of patients, including those with severe mental illnesses (SMIs). However, psychosocial rehabilitation is often neglected in GHPUs, partly because of the predominance of the medical model in routine clinical care and a lack of resources. This paper discusses the challenges in the management of SMIs in GHPUs and proposes a model of psychosocial rehabilitation which could be used in such settings.

Some 40 years ago I was at a loss when I was summoned as an expert witness in an indigenous tribal court to defend a witness accused of witchcraft. The experience shows how the psychiatrist's work requires knowledge of an individual's spiritual framework.