Shopping on the internet has become routine for many people and covers a wide range of products and services. It is therefore unsurprising that, in some countries, medical and pharmaceutical services can also be bought. This has clear advantages in countries such as Australia, where some communities are isolated by huge distances (or other geographical circumstances) but are able to access the internet. However, shopping for psychotropic substances is not quite the same as shopping for toothpaste or televisions. These drugs are subject to strict controls, including the requirement for prescription by a qualified medical practitioner. It is possible to implement systems so that internet shopping for and mail delivery of psychotropic substances conform to regulatory requirements; if this is done, internet pharmacies can be valuable in ensuring an adequate supply of medical provisions to all citizens, wherever they live (US General Accounting Office, 2000). However, these same sales opportunities can easily be exploited by unlicensed internet pharmacies and it is the problems caused by these illicit ‘cyber-pharmacies’ that are now the cause of grave concern.

Suicide, especially among young people, appears to be increasing in prevalence in diverse countries and cultures. The reasons for this worrying trend remain obscure. Here we present commentaries on suicidal trends in three countries.

In recent years, the number of suicides in Japan has increased dramatically, particularly among middle-aged men. According to the Brief Report on Suicides in 2001 by the National Police Agency of Japan (NPA, 2002), the number of suicides in Japan was 31 042, and the national suicide rate was 24.4/100 000. Akita is an agricultural prefecture with a population of approximately 1 200 000. According to the Akita Prefectural Police (APP), the number of suicides in Akita Prefecture was 457 (299 males, 158 females) in 2001. Akita Prefecture currently has the highest rate of suicide in Japan. The identification of strategies for suicide prevention is therefore imperative.

Brazil is the largest and most populous country in South America (in 2002 the population was approximately 175 million). Although life expectancy in Brazil has increased, suicide and other forms of injury-related mortality, such as homicide and accident, have increased as a proportion of overall mortality (Oswaldo Cruz Foundation, 1984; Brazil Ministry of Health, 2001). The suicide rate in Brazil (3.0–4.0 per 100 000 inhabitants) is not considered high in global terms (World Health Organization, 1999). Nevertheless, it has followed the world tendency towards growth: during 1980–2000, the suicide rate in Brazil increased by 21%. Elderly people present the highest suicide rates in absolute numbers, but the alarming finding in the Brazilian data is that the youth population is increasingly dying by suicide (Mello-Santos et al, 2005). This statistic partially confirms a forecast by Diekstra & Guilbinat (1993) that the number of deaths by suicide would dramatically increase over the next decades, mainly in developing countries, including Latin America. In these regions, socio-economic factors (such as an increase in divorce and unemployment and a decrease in religiosity) increase the risk of self-harm. We discuss the reasons for the low suicide rate in Brazil and highlight the socio-economic factors affecting its increase among the youth population in particular.

Suicide is a serious worldwide health problem, particularly among youths. It is defined as the intentional act of killing oneself. Analytically, the suicidal act entails: the wish to kill, the wish to be killed and the wish to die. People who die by suicide know what they are doing and are aware of the consequences of their actions. A completed suicidal act is a complex phenomenon associated with psychological, biological and social factors. It follows severe exhaustion under a continuing assault of stressors when the suicidal individual is no longer able to cope with and to restore homeostasis. In order to categorise a case as a suicide, legal authorities demand unequivocal evidence of intent.

With an area of 450 000 km2, Sweden is one of the largest countries in Western Europe. It is 1500 km from north to south. It has nearly 9 million inhabitants (20 per km2). It is a constitutional, hereditary monarchy with a parliamentary government. Sweden is highly dependent on international trade to maintain its high productivity and good living standards. Many public services are provided by Sweden's 289 municipalities and 21 county councils. Municipal responsibilities include schools, child care and care of the elderly, as well as social support for people with a chronic mental illness. The county councils are mainly responsible for healthcare, including psychiatric care, and public transport at the regional level. Sweden is characterised by an even distribution of incomes and wealth. This is partly a result of the comparatively large role of the public sector.

The prevalence of mental illnesses in Finland generally reflects global trends, with a clear increase in the occurrence of depression and anxiety. At any time, between 4% and 9% of the population of 5.2 million suffer from major depressive disorders. Some 10–20% of the population experience depression during their lifetime. Bipolar depressive disorders affect 1–2% and schizophrenia 0.5–1.5% of the population. The prevalence of alcoholism is 4–8%.

French psychiatry is currently facing a period of profound change, as many of what were considered its most specific characteristics and traditions have been called into question. It is therefore difficult to draw a profile of French psychiatry, because it has to take into account a radical splitting between, on the one hand, what is still the common profile of most French psychiatrists and, on the other, the new model imposed by stakeholders and policy makers who want French psychiatry to take on a more Anglo-Saxon profile, with evidence-based practice coming to the fore, for instance.

On the morning of 8 October 2005, Pakistan and Pakistani-controlled Kashmir were hit by an earthquake that measured 7.6 on the Richter scale. Within 5 seconds, almost all buildings in two major cities of the north were destroyed: the capital of Pakistani-controlled Kashmir, Muzaffarabad, and Balakot, a picturesque mountain city. This was about 9 a.m. Children were in classrooms and mothers were doing household chores. Many men were in the fields. Therefore, when houses and buildings collapsed, thousands of young children and women were killed, as a result of falling roofs and walls. All government buildings, universities and colleges were destroyed and thousands of students died. In one town there were no children left alive: a generation had been wiped out. In two schools alone people were trying to retrieve 600 bodies of young girls. The earthquake hit hardest in difficult mountainous terrain. Even under normal conditions, four-wheel-drive vehicles are required to travel in this area; after the earthquake, landslides had blocked access to large villages. Many small villages were buried.

The Board of International Affairs of the Royal College of Psychiatrists initiated the Senior Volunteers Programme in 2004 following discussion at the Board and planning in a subgroup over the preceding year. The aim was to match requests from other countries for specific psychiatric teaching with the services of senior psychiatrists in Britain. The College has acted as intermediary, inviting requests from countries, Members and Fellows overseas, and setting up a database of psychiatrists offering a range of skills. The concept is simple but all the skill and hard work lies in the detail!

The recent controversy surrounding the National Health Service (NHS) International Fellowship Programme (IFP) for consultant psychiatrists (Patel, 2003) has raised a number of important issues. In particular, the issue of recruiting in an under-resourced developing country, where skilled and trained professionals are in short supply but where demand is huge, has exposed the duplicity with which many developed countries interact with developing countries. Although countries such as the UK are forever talking about strengthening the research and training capacity of these countries, they have no qualms about taking trained professionals for their own needs (Goldberg, 2003). Holsgrove (2005) has defended the IFP and tried to counter many of the arguments raised by those opposing it (Patel, 2003; Khan, 2004; Ndeiti et al, 2004).

The debate on international recruitment gained significant momentum after the International Fellowship Programme (IFP) was set up by the Department of Health. This article summarises some of the issues regarding the policy of the National Health Service (NHS) on the international recruitment of psychiatrists that were raised at the Royal College of Psychiatrists' annual general meeting last summer.