bluuebunny/crossref_metadata_2025 huggingface dataset:
Prison is not the right place for people with mental disorders: the Brazilian case
Authors: dos Santos Maíra Mendes , Inoue Silvia Regina Viodres , Quintana Maria Ines , Blay Sergio Luiz , de Jesus Mari Jair , Andreoli Sergio Baxter
Published: January 2018

The large number of individuals with severe mental disorders in prisons worldwide has alarming implications, which leads to the question of the appropriateness of the prison system for people with this type of morbidity. This article discusses these implications, the problems in therapeutic approaches and the legal aspects in the Brazilian context.
A new Mental Health Act for Malta
Authors: Zahra Anthony , Camilleri Miriam , Cachia John
Published: January 2018

Until recently, the care of persons with mental disorder in Malta was regulated by mental health legislation enacted in 1976. This was closely modelled on the 1959 British Mental Health Act. Now, the Mental Health Act 2012 is being implemented in two steps, in 2013 and 2014. The paper reviews its provisions.
A survey of the mental healthcare systems in five Francophone countries in West Africa: Bénin, Burkina Faso, Côte d'Ivoire, Niger and Togo
Authors: Maiga Djibo Douma , Eaton Julian
Published: January 2018

Sub-Saharan Africa has a wide mental health treatment gap, with low levels of access to mental health services. This paper presents the findings of systematic situation analyses carried out in five Francophone countries in West Africa, which are among the poorest in the world. The findings showed low levels of budgetary allocation to mental health, poor health infrastructure (especially at primary level) and unequal distribution of human and financial resources. In this challenging context, there are signs of reform of services, based on international best-practice guidelines and practical considerations such as decentralisation of services, task-sharing and strengthening stakeholder skills to advocate for change.
What's so special about military veterans?
Authors: Greenberg Neil
Published: January 2018

The mental health of military veterans has been, and continues to be, a topic of heated political and journalistic debate. There is a well-documented impact of conflict upon the mental health of service personnel, and most nations have aimed to provide effective care for individuals who have fought for their country. However, as the three thematic papers in this issue demonstrate, the realities of service-related mental health are rather more complex than they initially appear.
Ten months on: qualitative assessment of psychosocial issues in northern Sri Lanka following the tsunami
Authors: Danvers K. , Sivayokan S. , Somasundaram D. J. , Sivashankar R.
Published: January 2018

The tsunami which affected South Asia on 26 December 2004 caused over 41 000 deaths in Sri Lanka, representing 0.2% of the total population, and displaced over 880 000 people from their homes and livelihoods (World Health Organization, 2004). Kilinochchi, Jaffna and Mullativu districts in the Northern Province of Sri Lanka were affected by the tsunami and, as of April 2005, in the whole province, 6200 people had lost their lives, 961 were still missing, 19 618 were still housed in welfare centres and 45 548 were housed with relatives and friends (Government of Sri Lanka, 2005).
Psychiatry in Papua New Guinea
Authors: Muga Florence
Published: January 2018

Papua New Guinea is an independent commonwealth in the South Pacific, lying just north of Australia and sharing its western border with Indonesia. The population of Papua New Guinea is 5.2 million, of whom 87% live in rural areas (2000 census) (National Statistics Office, 2003). The country has a very rich culture; for example, there are over 800 distinct language groups (although Papua New Guinea has less than 0.1% of the world's population, it is home to over 10% of the world's languages).
Earthquake 2005: challenges for Pakistani psychiatry
Authors: Khan Murad M.
Published: January 2018

At 8.52 a.m. on 8 October 2005 an earthquake measuring 7.6 on the Richter scale struck the northern part of Pakistan and devastated large areas of North West Frontier Province and Azad Kashmir. Almost 90 000 people died and many thousands were reported missing. Half the dead were estimated to be children, killed in their classrooms. Some 3.5 million people were rendered homeless. The mountainous terrain made relief work a logistical nightmare.
Dementia care in Latin America — country profiles from Venezuela and Argentina
Authors: Salas Aquiles , Arizaga Raul L.
Published: January 2018

Demographic ageing is proceeding especially rapidly in Latin America. Those aged 65 years and over will increase from 33.3 million (6% of the total population) in 2005 to 56.3 million (8.5%) in 2020 and 110.2 million (14.7%) in 2040. A recent review drew attention to the relatively small number of population-based studies of dementia in Latin American countries (Ferri et al, 2005). Estimates based on the literature suggested 1.8 million people with dementia in 2001 increasing to 4.1 million by 2020 and 9.1 million by 2040. The increase, more than a doubling of the number of people with dementia between 2000 and 2020, was the most marked for any world region. Arguably, health and social finance systems are not well placed to meet the needs of the growing numbers of frail and dependent elderly people.
Alzheimer's Disease International
Authors: Rimmer Elizabeth
Published: January 2018

Alzheimer's Disease International (ADI) is the international federation of 75 Alzheimer associations throughout the world and is in official relations with the World Health Organization. ADI was established to raise awareness about dementia, strengthen Alzheimer associations and provide a platform for the exchange of knowledge with the ultimate goal of improving the quality of life of people with dementia and their families.
Nosology and modalities for deciding on the management of patients with psychiatric illness among traditional healers in Lagos, Nigeria
Authors: Olugbile Olufemi , Zachariah N. P. , Isichei B.
Published: January 2018

Many patients in Nigeria consult traditional healers before, or in parallel with, modern psychiatric services. Part of the attraction of traditional medicine for the populace, apart from its lower cost and easier accessibility, may lie in its ‘cultural’ explanatory concepts of the nature and course of mental disorder.
Psychiatry in Austria
Authors: Fleischhacker W. Wolfgang , Wancata Johannes
Published: January 2018

Austria covers an area of some 84000 km2 and has a population of 8.1 million. According to World Bank criteria, Austria is a high-income country. The overall health budget represents 8% of gross domestic product (World Health Organization, 2005). The state of Austria is divided into nine federal provinces, which have significant legislative rights, including in healthcare provision.
Mental healthcare in Laos
Authors: Courtenay Ken , Choulamany Chantharavady
Published: January 2018

Laos (officially the Lao People's Democratic Republic) is a land-locked country in South East Asia, and one of the three former French colonies of Indochina. Since 1989, when it was opened to foreigners, there has been an influx of non-governmental organisations (NGOs) and tourists. From 1998 tourist numbers have increased every year, and Laos has become the ‘must see’ destination in a travel industry that craves the exotic. It has an old and rich culture with a diverse population. The climate is tropical, with a cool dry season and a hot wet season, when temperatures reach 38°C.
Mental health legislation in contemporary India: the need for inter-sectoral dialogue
Authors: Goel D. S.
Published: January 2018

It is said that war is far too serious a matter to be left to the generals alone. The same could be said for the interface between law and mental health. With our narrow, and sometimes myopic, treatment-centric vision we are ill equipped to claim hegemony over the complex domain of legislation as it relates to mental health, even more so in the multicultural Indian subcontinent, where the medieval exists alongside the modern and where abject poverty jostles with ostentatious wealth:

‘The mental health scene in India at the dawn of the twenty-first century is a bewildering mosaic of immense impoverishment, asymmetrical distribution of scarce resources, islands of relative prosperity intermixed with vast areas of deprivation, conflicting interests and the apparent apathy of governments and the governed alike.’ (Goel et al, 2004)
Forced marriage
Authors: Rele Kiran
Published: January 2018

This article examines factors that are salient to understanding forced marriages and provides an overview of the issue. It aims to promote awareness in the UK, where there is a need for services to develop appropriate responses, as primary care and the local psychiatric services are not geared up to tackle such transcultural issues.
The yield from national surveys of mental health
Authors: Henderson Scott , Andrews Gavin
Published: January 2018

At least 21 countries have now carried out national surveys of mental health under the aegis of the World Health Organization's World Mental Health Surveys. This has meant interviewing some 157 000 people in their homes. The countries are as varied as Australia, China, Iran, six continental European nations, Nigeria, the UK and the USA (Andrews et al, 2001; Demyttenaere et al, 2004; Mohammadi et al, 2005). It is therefore timely to consider what this very large body of information has yielded and to what use it can be put, especially in relation to the costs and human resources expended in a field where unmet need is so conspicuous.
Perambulations of a President
Authors: Hollins Sheila
Published: January 2018

Previous Presidents wrote Council reports of their overseas visits and one wonders how wide an audience their reflections actually reached. What good fortune for me, then, that I can share my reflections in the pages of International Psychiatry. The title of this paper was given to me by a disgruntled senior member of the College working in England, who felt that I was paying far too much attention to international matters, and so I thought I should explain further why I consider the international role of the College to be so important.
Management of mental health services in Malawi
Authors: Kauye Felix
Published: January 2018

Malawi is a country in sub-Saharan Africa bordering Mozambique, Tanzania and Zambia. It has an area of approximately 118000 km2 and is divided into northern, central and southern regions. It has an estimated population of 13 million, 47% of whom are under 15 years of age and just 5% over 60 years. Its economy is largely based on agriculture, with tobacco being the main export. The projected growth in gross domestic product (GDP) for 2007 was 8.8%; GDP per capita was $284 per annum.
Mental healthcare programmes in Kenya: challenges and opportunities
Authors: Ndetei David M.
Published: January 2018

The mental healthcare programmes in Kenya fall into four inter-related categories: service provision; training; research; policy and advocacy.
United Arab Emirates (UAE)
Authors: Eapen Valsamma , El-Rufaie Omer
Published: January 2018

This paper will focus on the current state of mental health services in the United Arab Emirates (UAE) and reflect on the various public health, socio-economic and psychosocial factors that have a major impact on the mental health needs of the population. It is to be borne in mind that the services described in this paper are in a state of rapid change, as the country is witnessing one of the fastest rates of development in the world.
The psychological and psychosocial impact of the Pakistan Kashmir earthquake after 8 months: a preliminary evaluation by PACTT
Authors: Rana H. , Ali Sohail , Yusufi Babur , Alexander David A. , Klein Susan , Lee Amanda J. , Jones Gareth T. , Macfarlane Gary
Published: January 2018

Natural disasters are complex events that challenge the coping abilities of individuals and communities (Alexander, 2005). They are characterised by substantial loss, physical injury and economic hardship, as well as by extensive internal displacement and damage to the infrastructure, as exemplified by the Pakistan Kashmir earthquake of 8 October 2005. Measuring 7.6 on the Richter scale, it affected an area of 30000 square miles and a population of 3.6 million. Approximately 90000 were killed, 200000 were injured and 3.5 million were left homeless (Khan, 2006). Based on a literature review and estimates from the World Health Organization (WHO), the National Plan of Action for Mental Health and Psychosocial Relief of Earthquake Survivors anticipated high levels of trauma-related psychopathology (Rana et al, 2006).
Leadership, decision-making and errors: cultural factors
Authors: Bhugra Dinesh , Gupta Susham
Published: January 2018

As clinicians, we are used to making often fast and life-altering decisions. As professionals, the clinical decisions we make depend upon our training, knowledge base, supervision, expertise and experience. Sociodemographic factors such as age, gender, ethnicity and cultural background can also influence our views. However, rarely do we step back to think about the mental processes behind our decision-making. In cognitive–behavioural therapy and in our general dealings with patients, we aim to help them identify their cognitive schema and attribution errors as a way forward; but we rarely reflect on our own cognitive schema and possible misattribution in making decisions. Both patients and healthcare professionals are affected by cultural norms, mores and expectations.
Care for elderly people with mental illness: a global problem
Authors: Skuse David
Published: January 2018

As the median age of populations around the world increases, due to the provision of better diets and better medical care, the number of elderly persons vulnerable to mental illness will inevitably increase too. We are not good at providing high-quality geriatric care, even in high-income countries. For example, Age Concern (a UK-based charity) states on its website: ‘Health and social care services have made some progress in tackling age discrimination, but older people still report feeling that they have had second class treatment and care simply because of their age’ (www.ageconcern.org.uk/AgeConcern/ageism-in-healthcare.asp). How much worse these matters are in low- and middle-income countries is the subject of our theme in this issue. We have drawn articles from three distinct geographic regions: India, Africa and South-East Asia. We often assume that cultural factors in lower-income areas lead to greater respect for, and better care of, the elderly than we experience in many parts of the Western hemisphere. This appears to be a misapprehension, and attitudes towards the elderly are changing as the impact of industrialisation increases.
Twenty-five years of expectation: where are the services for older people with mental illness in Africa?
Authors: Clausen Thomas , Wilson Adrian O.
Published: January 2018

Mental health disorders account for about 14% of the global burden of disease. Neuropsychiatric disorders may be responsible for more than 1.2 million deaths annually (Prince et al, 2007). Around 80% of those affected live in low- and middle-income countries. Yet, despite the fact that older persons carry a disproportionate burden of non-communicable disease and mental disorder, they are not seen as priority issues for healthcare provision in these countries. Logically and ethically, older persons should be prioritised for targeted interventions, alongside the generic strengthening of primary and community health provision. African governments, spurred on by the specific agendas of non-governmental and parastatal organisations, continue with more urgent tasks; their healthcare provision is oriented towards the ‘younger generations’ (maternal and child healthcare, and infection). In most African countries, the expenditure specifically targeted for mental health is below 1% of the total healthcare budget, that is, effectively non-existent (Saxena et al, 2007).
Russian Federation: mental healthcare and reform
Authors: Krasnov Valery , Gurovich Isaak , Bobrov Alexey
Published: January 2018

The Russian Federation is a country with an enormous territory, of over 17 million km2. Its population is 141.9 million (2010 figure). The population was declining, especially at the end of the 1990s, but in more recent years the tendency has been towards stabilisation. Life expectancy has remained relatively low, although it has increased somewhat over the past few years, to reach 67.5 years in 2008 (61.4 for men and 73.9 for women), up from 65.3 years in 2004 (58.9 for men and 72.3 for women).
Mental health in the Democratic Republic of Congo: a post-crisis country challenge
Authors: On'okoko Michel Okitapoy , Jenkins Rachel , Miezi Samuel Mampunza Ma , Andjafono Daniel Okitundu Luwa E , Mushidi Ildephonse Muteba
Published: January 2018

The delivery of mental healthcare in the Democratic Republic of Congo (DRC), formerly Zaire, is influenced by geography, politics, legislation and the structure of the health system, as well as traditional beliefs and culture.
Mental health profile of Greece
Authors: Christodoulou George , Ploumpidis Dimitris , Christodoulou Nikos , Anagnostopoulos Dimitris
Published: January 2018

Since the mid-1980s, a profound reform in the organisation of mental health provision has been taking place in Greece (Madianos & Christodoulou, 2007; Christodoulou, 2009). The aim has been to modernise the outdated system of care (Christodoulou, 1970), which was based on in-patient asylum-like treatment, the beginning of which can be roughly dated to the second half of the 19th century (Christodoulou et al, 2010).
Reproductive risk: its role in maternal mental health
Authors: Henshaw Carol
Published: January 2018

For many women, pregnancy and childbirth are not without substantial risk in terms of new-onset, recurrent or existing mental disorder. This has consequences not only in terms of poor maternal mental health but also in terms of increased pregnancy- and delivery-related morbidity and can have a significant negative impact on the wellbeing of the fetus or neonate. New-onset disorders such as postnatal depression and puerperal psychosis have been recognised for some considerable time but it is also becoming apparent that, with the exception of anorexia nervosa, severe intellectual disability and possibly schizophrenia, conception rates among women with all types of mental disorder are the same as those in the general population. In high-income countries, the widespread use of atypical antipsychotics, most of which do not impair reproductive function, may lead to increased conception rates in women with schizophrenia. In addition, pregnancy and childbirth are multifactorial stressors which may render women with previous mental disorders vulnerable to a recurrence. Hence it is no surprise that studies in urban, low-income and ethnically diverse populations in the USA estimate that around a third of pregnant women are suffering from a mental disorder when substance misuse is included (e.g. Kim et al, 2006).
Alcohol misuse by the young: problems and solutions
Authors: Skuse David
Published: January 2018

Back in April 2006 (vol. 3, no. 2) we published papers on the theme of misuse of alcohol by young people, 3 years after the UK government had introduced the option of 24-hour drinking. The British Medical Association (BMA) subsequently recommended that there should be a programme of research to examine the consequences of this change to our drinking culture. In 2008, it reported on current trends in alcohol misuse (BMA Board of Science, 2008). An appendix to that report summarises the different alcohol control strategies pursued by the governments of England, Wales, Scotland and Northern Ireland in the past few years. These are outlined in the document Safe. Sensible. Social. The Next Steps in the National Alcohol Strategy (HM Government, 2007).
A collaborative community approach to adolescent substance misuse in Iceland
Authors: Sigfusdottir Inga Dora , Kristjansson Alfgeir L. , Gudmunsdottir Margret L. , Allegrante John P.
Published: January 2018

Substance use has become a major threat to health and human development in many European countries. In 23 out of 28 countries participating in the European School Survey Project on Alcohol and Other Drugs (ESPAD), there was a constant and substantial increase in substance use among secondary-school students between the years 1995 and 2003 (Hibell et al, 2003). Iceland experienced a similar upward trend in substance use (Sigfusdottir et al, 2008). Throughout the 1990s, the use of alcohol, tobacco and other drugs increased steadily among 15- and 16-year-olds. In 1998, approximately 17% of 16-year-olds had tried hashish, which was the highest frequency to be measured in Iceland, and over 80% reported that they had used alcohol once or more in their lives (Thorlindsson et al, 1998).
Iraq: children's and adolescents' mental health under conditions of continuous turmoil
Authors: AlObaidi AbdulKareem
Published: January 2018

Children and adolescents constitute half of Iraq's population of over 30 million. Mental health problems experienced by Iraqi children and adolescents are a hidden problem. Many factors contribute to the mental health problems of young Iraqis, including being victims and witnesses to violence, seeing family members become victims, being displaced from their homes, and experiencing the instability that still plagues their nation. Iraqis have experienced severe deprivation caused by many years of war, economic embargoes and civil unrest. Violence, poverty and the failure of the education and health systems have severely undermined the well-being of Iraqis, especially children (AlObaidi et al, 2009).
Mental health in the Dominican Republic
Authors: Hernández Miguel R. , Gibbs Tresha Ann , Gautreaux-Subervi Luisa
Published: January 2018

The Dominican Republic is located in the Caribbean Sea and comprises three-quarters of the island Hispaniola, which it shares with Haiti. According to the 2002 census, approximately 8.5 million people live in the Republic, with 64% residing in urban areas (Oficina Nacional Estadística, n.d.). During 1990 and 2000, the Dominican Republic was a leader in economic development for Latin America and the Caribbean; however, this was not reflected in the areas of human and social development (Pan American Health Organization & World Health Organization, 2007). Less than 1 % of the health budget administered by the Ministry of Public Health and Social Assistance (MISPAS) is allocated to mental health and the public system is generally underfunded (Pan American Health Organization & World Health Organization, 2008). However, there is an array of mental health services within the country when privately funded facilities are taken into account.
A working visit to Chad's refugee camps for the people of Western Darfur
Authors: Rose Nick
Published: January 2018

In 2004 at least 200000 people from Darfur in Western Sudan are thought to have died in a wave of what has been alleged to have been ethnic cleansing (Flint & De Waal, 2008). And in April 2008 it was reported that a total of over 300000 people might have died in the (then) 5-year Darfur conflict. During the period of the alleged genocide, nearly a quarter of a million refugees (Central Intelligence Agency, 2009) crossed the nearby border into Chad, where they remain in a dozen or so camps looked after by the United Nations and international aid organisations. These camps are strung along the frontier, in remote semi-desert locations that are sustainable only with United Nations support. Many of the camps no longer take new refugees, and are in effect transplanted communities from nearby Darfur, their social and leadership structures mirroring those of the communities that were torn apart by war. Even place names have been transplanted, to suggest a kind of normality.
Introduction
Authors: Saxena Shekhar
Published: January 2018

How many members of the College know about the state of psychiatry in Nigeria or Egypt? Perhaps just a few. How many would be interested in knowing more? Perhaps many. The country profiles section of International Psychiatry attempts to narrow this information-and-awareness gap.
Psychiatry in Nigeria
Authors: Gureje Oye
Published: January 2018

Nigeria is a huge country. It covers an area of 924 000 km2 on the west coast of Africa. It has a population of about 110 million, which means that every one in six Africans is a Nigerian. It is a country of diverse ethnicity, with over 200 spoken languages, even though three of those are spoken by about 60% of the population. Administratively, it is divided into 36 states and operates a federal system of government, with constitutional responsibilities allocated to the various tiers of government – central, state and local. There are two main religions, Islam (predominantly in the north) and Christianity (predominantly in the south). However, a large proportion of the people still practise traditional religions exclusively or in addition to either Islam or Christianity.
eHealth and ePsychiatry for Europe
Authors: Richardson Ricky J.
Published: January 2018

The use of the term ‘eHealth’ is gathering momentum across Europe as the wider implications of the health care reforms enabled by information technology become apparent. There is a growing realisation by both health care providers and consumers alike that change in the sector is now imperative and timely. Member states of the European Community are all facing an increase in the requirement for health care provision because of changing demography, in particular ageing populations. In the face of an increasing demand for services, the existing model for health care delivery is arguably inadequate. In many ways it is economically unsustainable, even by the wealthiest countries in Europe.
Mental health services in Azerbaijan
Authors: Ismayilov Fuad
Published: January 2018

Azerbaijan is a nation with a Turkic population which regained its independence after the collapse of the Soviet Union in 1991. It has an area of approximately 86 000 km2. Georgia and Armenia, the other countries comprising the Transcaucasian region, border Azerbaijan to the north and west, respectively. Russia also borders the north, Iran and Turkey the south, and the Caspian Sea borders the east. The total population is about 8 million. The largest ethnic group is Azeri, comprising 90% of the population; Dagestanis comprise 3.2%, Russians 2.5%, Armenians 2% and others 2.3%.
Psychiatry in Ethiopia
Authors: Alem Atalay
Published: January 2018

Ethiopia, in the Horn of Africa, is one of the ancient independent nations of the world and has a rich diversity of peoples and cultures. The country covers 1.1 million km2 (Central Statistical Authority, 2000a). It has a population of about 70 million people (Central Statistical Authority, 2002), 80 different ethnic groups and some 200 dialects. Ethiopia is the second most populous nation in sub-Saharan Africa, after Nigeria (Hailemariam & Kloos, 1993). Forty-eight per cent of the population are under 15 years of age and over 80% live in rural areas (Central Statistical Authority, 1995). Islam and Christianity are the main religions.
Resource allocation for psychosis in Australia
Authors: Carr Vaughan J. , Neil Amanda L. , Lewin Terry J.
Published: January 2018

Using a census-based prevalence survey (Jablensky et al, 2000), we estimated the cost of psychosis in urban Australia at AU$2.25 billion (£0.86 billion) per year when valued at prices pertaining in the year 2000 (Carr et al, 2003). About 40% of these costs were spent on direct mental health care, the remainder being the costs of lost productivity (limited to unemployment in our study). The total costs amounted to AU$46 200 (£17 722) per person per year, 20% higher than the average annual male income. The bulk of the treatment cost was accounted for by in-patient care, which appeared to have become the default option in the absence of adequate levels of supported community accommodation. This was indicated by the fact that after ‘non-discretionary’ treatment costs (42% of direct costs) were accounted for (i.e. visits to a general practitioner, medication, crisis or emergency care, acute hospitalisation), almost three-quarters of the remainder was spent on long-stay hospitalisation (Neil et al, 2003). When patterns of community-based service delivery were examined, we found a marked paucity of delivery of psychosocial treatments, rehabilitation and substance use interventions, reflecting the skewing of expenditure towards long-term hospitalisation and away from community care.
Mental health services in Uganda
Authors: Kigozi Fred
Published: January 2018

Uganda is a landlocked developing country in East Africa with an estimated population of 24.8 million people (2002 census). At independence (in 1962) Uganda was a very prosperous and stable country, with enviable medical services in the region. This, however, was destroyed by a tyrant military regime and the subsequent civil wars up to 1986, when the current government took over the reigns of power.
Alternative routes to healing in Bangladesh
Authors: Radford Michael
Published: January 2018

The mission to find ‘the secret of the village’ is one attraction of engaging in mental health services in Bangladesh. Over the last 15 years much attention in world psychiatry has been given to the fairly robust finding that the prognosis of people with established and severe mental illness is better in ‘developing countries’ than in ‘developed’ ones (e.g. World Health Organization, 1979; Leff et al, 1990; Jablensky et al, 1992). Earlier assumptions that ‘developing’ is a simple variable were almost certainly a result of racist ignorance (Kulhara, 1994). Developing countries are not homogeneous. The variation in mental health outcomes seems to be clearer in more remote villages and tribal areas (Chatterjee et al, 2003), especially those that have less contact with Western (colonial) models of psychiatry and ways of life. More studies on this topic across a wider range of rural and urban settings would have much to offer. Is there something poisonous that comes with lots of expensive services? Or is there something missing?
Mental health in Mongolia
Authors: Byambasuren S. , Tsetsegdary G.
Published: January 2018

Mongolia is a country with an approximate area of 1.5 million km2. Its population is 2.5 million, nearly 90% of whom are ethnically Mongolian. Khalkh Mongols form the largest subgroup (approximately 79% of the population); the next largest subgroup is the Kazakhs (5.3%), followed by smaller groups such as Tuvins, Uzbeks, Uighurs, Russian and Chinese. The population is young, with 35.9% under the age of 15 years. The official language is Mongolian. Just under half the population live in rural areas and around a fifth live a nomadic life. About 80% of the land area is suitable for agriculture, mostly for animal husbandry.
The Royal College of Psychiatrists goes ‘international’: the European International Division
Authors: Douzenis Athanasios , Christodoulou Nikos , Christodoulou George
Published: January 2018

The initiative of the Royal College of Psychiatrists to establish international divisions has created considerable enthusiasm. College members have some common characteristics, mainly their training and success in the Royal College examination. Thus College members share a common approach to the practice of psychiatry as well as some common experiences; it can be argued that they share a common language in psychiatry.
The making of a psychiatrist: an Israeli perspective
Authors: Abramowitz Moshe Z. , Bentov-Gofrit Daphne
Published: January 2018

When medical school educators – polished veteran doctors – review data on their students’ attitudes towards residencies, they remember their own long days in the anatomy dissection room. They recall treating their first teenage patient and comforting a patient seeking solace while succumbing to a fatal illness. They think about why they made their important career choice. Thus the glory days of medical school become a defining and shaping experience for physicians, similar to boot camp for veteran paratroopers.
Attitudes to psychiatry: a comparison of Spanish and US medical students
Authors: Pailhez Guillem , Bulbena Antonio , Balon Richard
Published: January 2018

There is a growing concern in many countries over the low recruitment into psychiatry among medical graduates. This has led to studies that aim: (1) to study the attitudes of medical students towards psychiatry, (2) to determine factors that influence such attitudes, (3) to assess the possible causes of this low recruitment and (4) to try to change students’ views of psychiatry during their medical education to improve recruitment.
International Psychiatry – the way forward
Authors: Ghodse Hamid
Published: January 2018

All psychiatrists would acknowledge that communication between individuals is fundamental to their speciality, but it is perhaps less obvious that the increasing ease and speed of communication worldwide are also having a profound effect on psychiatric practice. With this improved communication comes an awareness of the commonality of many mental health issues and recognition that there is much to learn from others working in very diverse environments. It is also true that many mental health problems have an international dimension, particularly when large numbers of people are displaced by war or other disasters. Increasingly we need to have a better understanding of other cultures and the relationship between culture, mental health and psychiatric disorder.
Mind games: standing by while the world ignores climate change
Authors: Maughan Daniel L. , Berry Helen L.
Published: January 2018

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.
Access to community-based mental healthcare and psychosocial support within a disaster context
Authors: O'Hanlon Katherine P , Budosan Boris
Published: January 2018

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.
Mental health law profile: the United Arab Emirates
Authors: Alhassani Ghanem , Osman Ossama T.
Published: January 2018

There are two federal laws in the UAE from 1981 that are specific to people with mental illnesses and disabilities. Efforts are presently being made to develop other laws addressing the protection of the vulnerable population, including women, children and the elderly. A new updated Mental Health Act is needed to keep in line with the UAE's major leaps achieved in healthcare.
Stigma and psychiatric care in Latin America: its inclusion on the universal health coverage agenda
Authors: Acuña Cecilia , Sepúlveda Rafael , Salgado Osvaldo
Published: January 2018

In 2014, the Pan American Health Organization (PAHO) approved Resolution CP53.R14, which aimed to provide a framework for universal access to health and universal health coverage. It sets the stage for the inclusion of psychiatric practice within the provision of universal healthcare and highlights the fight against stigma. We propose to concentrate our efforts on changing the model of medical management. To that end, we are promoting the inclusion of mental health patients within the daily routine of primary care centres, thus allowing them to interact with other users of health services on a regular basis.
International employment schemes for people with mental health problems
Authors: Grove Bob
Published: January 2018

It has been recognised that work is a positive factor for mental health since the days of Galen (2nd century CE). It was central to the theories and practice of William Tuke at the Retreat in York (founded 1796) and has continued in different forms as a therapy and/or a form of rehabilitation ever since. These forms can be usefully divided into four main categories: sheltered work, vocational training, transitional employment (or work experience) and supported employment. These broad categories have been adapted to different cultures and economic circumstances across the world. There are advantages and disadvantages to all forms, but the burgeoning research literature of the past 20 years does show that when it comes to finding people paid work in the open labour market, supported employment is markedly more successful than other methods.
Rapid tranquillisation: a global perspective
Authors: Nadkarni Pallavi , Jayaram Mahesh , Nadkarni Shailesh , Rattehalli Ranga , Adams Clive E.
Published: January 2018

Violence and aggression among patients suffering from mental health problems undoubtedly pose a challenge to healthcare professionals, families and carers. Aggressive behaviours affect all aspects of clinical care. The goal of professionals is to ensure safety while effectively managing behavioural emergencies. ‘Rapid tranquillisation’ implies prescribing pharmacological agents to manage these behaviours. This article highlights changing prescription trends. Appraisal of global guidelines suggests that factors other than scientific evidence dictate their evolution. High-quality randomised controlled trials are needed to develop a global guideline.
The effect of aerobic exercise in the maintenance treatment of depression
Authors: Majumder P. , Sharma I. , Vostanis P. , Bone C.
Published: January 2018

We investigated the efficacy of aerobic exercise alongside antidepressant medication as an adjuvant maintenance treatment for depression. Fifty patients in remission were randomly assigned to either medication only or medication plus exercise. Assessment of psychopathology was made at 6-weekly intervals (for 24 weeks) using the Hamilton Rating Scale for Depression. The medication-plus-exercise group showed significantly more improvement at 12 and 24 weeks than the medication-only group. This study adds to a growing evidence base that suggests aerobic exercise is worthy of further development in the treatment of depressive disorders.
Mental health e-supervision for primary care doctors in Sudan using the WHO mhGAP Intervention Guide
Authors: Aboaja Anne , Myles Puja , Hughes Peter
Published: January 2018

This paper describes the evaluation of a pilot e-supervision programme, with a focus on feasibility. The findings suggest that e-supervision in mental health using the World Health Organization (WHO) Mental Health Gap Action Programme (mhGAP) Intervention Guide and case-based discussions is valued by participants and can improve the knowledge, confidence and beliefs of primary care doctors in low- and middle-income countries.
The WHO mhGAP Intervention Guide for people with intellectual disability: the Sri Lankan experience
Authors: Gumber Rohit , Gangavati Shweta , Bhaumik Sabyasachi , Cooray Sherva , Purandare Kiran , Mendis Jayan , Abeywickrema Chamila
Published: January 2018

In recognition of the treatment gap in mental health, the World Health Organization (WHO) Mental Health Gap Action Programme (mhGAP) was launched in 2008 and has proved successful. The paper describes the launch of the first mhGAP intellectual disabilities pilot project in Sri Lanka. It reports on the development of the materials and the key lessons learnt.
Acceptability and challenges of implementing the NICE guidelines for schizophrenia in Lagos, Nigeria
Authors: Okewole Adeniran , Dada Mobolaji , Adeoye Adefemi , Lawal Kehinde , Oduguwa Taiwo
Published: January 2018

This study aimed to examine the suitability and challenges of implementing in a Nigerian tertiary mental health facility the guidelines for the management of schizophrenia produced by the UK National Institute for Health and Care Excellence (NICE). The study was based on a group discussion at the Psychiatric Hospital, Yaba, Lagos. A panel of ten individuals (consultants, senior registrars, senior psychologists and senior social workers and nurses) discussed the guidelines, having been given ample time to study the document. Five patients were also interviewed. Some of the recommendations of the NICE guidelines are already being practised in the hospital to various extents. Full implementation would be hampered by a shortage of human resources and financial constraints. The guidelines need to factor in sociocultural differences. The NICE guidelines with modifications are suitable for use in a Nigerian setting.
New global priority for mental health – reasons for optimism and concern
Authors: Crisp Nigel
Published: January 2018

Mental health is a core part of the Sustainable Development Goals (SDGs) agreed by the United Nations General Assembly. This follows on from the World Health Organization's 2013 Global Action Programme. The World Bank is also expected to give mental health greater priority. Moreover, mental health is now seen as essential in disaster relief management. However, although global policy towards mental health has improved, there are only rare examples where this has been translated at scale into action. There are, nonetheless, reasons for optimism in the new policy background, in the many innovative practical developments around the world and in the way that evidence is being gathered and learning shared. The understanding that mental health is intimately connected to physical, social, environmental and economic health – which is so evident in the SDGs – represents a major change in mind-sets globally.
The mental health services for detained asylum seekers in Malta
Authors: Taylor-East Rachel , Rossi Alexia , Caruana Julian , Grech Anton
Published: January 2018

Approximately 17 000 individuals have claimed asylum in Malta over the past 10 years. Maltese law stipulates mandatory detention. Here, we review Malta's asylum procedures and detention policy, and explore the impact of detention on mental health. We review the current mental health services and make recommendations to help fill the gaps.
Brunei Darussalam's new Mental Health Order
Authors: Ho Hilda
Published: January 2018

Brunei's new mental health legislation was implemented on 1 November 2014. This is a much needed and long overdue development which has required significant multi-agency consultation and commitment. This paper describes how the 2014 Mental Health Order was prepared and provides a summary of its contents. The future direction and challenges facing its full implementation are discussed.
Fiji's Mental Health Decree 2010
Authors: Chang Odille
Published: January 2018

Fiji's Mental Treatment Act 1940 had become outdated, in part because it concentrated on treatment within a psychiatric hospital. The Mental Health Decree 2010 covers not only in-patient treatment but also the promotion of mental health, the prevention of mental illness, and the community-based and rehabilitative aspects of mental healthcare, as well as human rights issues.
Child and adolescent mental health in sub-Saharan Africa: a perspective from clinicians and researchers
Authors: Owen Jacqueline Phillips , Baig Benjamin , Abbo Catherine , Baheretibeb Yonas
Published: January 2018

There is a widening mental health treatment gap for children and adolescents in sub-Saharan Africa. The region has few economic or human resources dedicated to the mental health of children and young people. The World Health Organization's Mental Health Gap Action Plan and the push for mental health to be included in the Millennium Development Goals have raised the profile of child mental health but comparatively few studies have estimated prevalence rates or assessed needs or tested interventions in African countries. In most countries there is no clear pathway to access treatment, especially in-patient facilities. This article considers these issues from clinical, educational and research perspectives.
The Young Psychiatrists' Network: between past and future
Authors: Krupchanka D. , Los T.
Published: January 2018

The Young Psychiatrists' Network is a movement of early-career psychiatrists that was established in 2009 with the principles of peer regulation, lack of hierarchy and transparency. From humble beginnings as a small group of professionals in Eastern Europe, the Network is expanding into a globally inclusive platform. Future challenges, such as retention of the Network's core values, are now being debated.
Brain drain: the issues raised for Egypt by the emigration of psychiatrists
Authors: Loza N. , Sorour E.
Published: January 2018

The practice of Egyptian psychiatrists emigrating to high-income countries is not a recent phenomenon. Egyptian doctors have long travelled in search of training and education and to better their standards of living. The debate continues. What effective measures can be taken to reduce the brain drain, or at least its effect on Egyptian mental health services?
Intellectual developmental disorders in Mexico: a call for programmes promoting independence and inclusion
Authors: Katz Gregorio , Corona Edgar , Lazcano-Ponce Eduardo
Published: January 2018

This paper describes an innovative institution, Capacitación y Desarrollo Integral AC (CADI – Comprehensive Training and Development), created in Mexico to develop evidence-based interventions grounded in the principles of inclusion, independence, social and health equity that promote the well-being of persons with intellectual developmental disorder older than 14 years.
Mental health and psychosocial needs of Syrian refugees and the role of Syrian non-governmental organisations
Authors: Almoshmosh Nadim , Mobayed Mamoun , Aljendi Mohammad
Published: January 2018

Almost 5 million Syrians have been registered as refugees since the conflict started in 2011. Their mental health and psychosocial needs continue to grow as the situation at home gets more complicated. Syrian non-governmental organisations (NGOs) and mental health professionals have been offering their support to help meet these needs. They have set up various centres and teams on the ground that focus their efforts on the most needy individuals. They train and supervise healthcare volunteers, encourage self-management and build on people's resilience. These NGOs require support to deal with the consequences of this unprecedented crisis.
Greece and the refugee crisis: mental health context
Authors: Christodoulou George N. , Abou-Saleh Mohammed T.
Published: January 2018

The recent influx of refugees and immigrants to Greece has coincided with the ongoing and deteriorating financial crisis. This situation does not allow the Greek authorities to provide help to the desired extent. Yet, the church, local communities, medical societies and non-governmental organisations are offering good psychosocial support. In parallel with support for refugees it is important to provide support for the citizens of the host country. The rich countries of northern Europe should help the poorer countries of southern Europe cope with the refugees. A number of important declarations on refugee mental health and related issues have been produced recently, including the Anti-war Declaration of Athens.
Involving patients, carers and families: an international perspective on emerging priorities
Authors: Javed Afzal , Herrman Helen
Published: January 2018

This paper focuses on the importance of involving patients, families and other carers when offering and deciding on treatment and care options. It highlights the activities of international and national organisations in facilitating collaboration with patients and families in treatment, research, teaching and training related to mental healthcare.