An understanding of the current state of mental health services in the United Arab Emirates (UAE) from a clinical perspective is an important step in advising government and stakeholders on addressing the mental health needs of the fast-growing population. We conducted a retrospective study of data on all patients admitted to a regional psychiatric in-patient unit between June 2012 and May 2015. More Emiratis (UAE nationals) were admitted compared with expatriates. Emiratis were diagnosed more frequently with substance use disorders and expatriates with stress-related conditions. Psychotic and bipolar disorders were the most common causes for admission and had the longest in-patient stays; advancing age was associated with longer duration of in-patient stay.

I visited Chile for the first time in 2003. Over the course of the 12 months during which the country became my home, I realised there was a secret side to the capital city, Santiago. Never was this clearer than when I witnessed a demonstration to mark the 30th anniversary of the 11 September 1973 coup, when General Pinochet took power. I watched tears stream down the cheeks of men and women as they sang along with the revolutionary Cuban folk singer Silvio Rodriguez, raising their fists in the air. I felt the distrust of and anger towards the police who lined rooftops with snipers and the military units which filled side streets with water cannons. It was a visceral experience, made more so by the contrast with day-to-day life on the city's streets. This was a boom town, proud of its malls and economic growth, and the residents of Santiago made every effort to remark upon their high standards of living.

This article gives a junior psychiatry resident's personal story of burnout during the COVID-19 pandemic: what led to it, what helped her get through it and the continual process of working to avoid burnout in the future.

More than a year ago I was sat in my room watching an American university professor demonstrating a computerised test on a tablet to one of his interns. His name was Matthew Nock and he was a professor of psychology at Harvard University and a world expert on suicide research. The computerised test was and still is called the Suicide Implicit Association Test (S-IAT) and Professor Nock hoped he was on the brink of a breakthrough in suicide risk prediction research. I was sceptical. How could a brief computerised test predict future suicide attempts better than already known suicide risk factors and the expert opinion of a psychiatrist? It was at this moment that I was convinced that I would have to spend some time in Professor Nock's lab at Harvard in order to get the inside story.

Over half of doctors who joined the General Medical Council's (GMC) medical register in the UK in 2020 were from Black, Asian and minority ethnic (BAME) background, and I am one of them. Having experienced clinical settings across three different countries, I think my journey deserves to be shared with others as a unique experience. My story will help medical students and early career doctors have a general idea of different clinical settings and hopefully will encourage them to chase their dreams. I hope to inspire people.

The recent flood crisis in Pakistan has had significant impacts on the physical, mental and socioeconomic fabric of almost 33 million people. Floods in Pakistan are leading to a range of negative impacts on health and major disruptions to healthcare services. The lack of mental health and psychosocial support services (MHPSS) is a significant concern in rural areas of Pakistan in providing support to communities affected by floods. It is important for the government and mental health policymakers to work with academic coalitions and non-governmental organisations to replicate low-resource MHPSS models that will develop and advocate for effective, gender-sensitive mental healthcare throughout the country.

The opioid crisis continues to affect many areas worldwide, raising questions regarding prescribing indications. There is no consensus on negotiating the need for pain relief and the potential for medically prescribed opioid-related harm/addiction. These issues present an enormous educational challenge to physicians in training, particularly those whose mandate is to understand and respond to varying forms of pain. This article examines the perspectives and educational challenges faced by two psychiatry residents from different parts of the globe during the crisis. Is the educational experience of future psychiatrists sufficient to prepare them for the responsibilities that lie ahead?

Gypsy, Roma and Traveller (GRT) communities have considerably worse mental health outcomes than the general population and many other ethnic minority groups. We argue that there is a dynamic, interplaying ‘accessibility mismatch’, resulting in a failure of healthcare services to adequately understand and work with GRT communities in a meaningful way. The consequences are limited engagement and poor health outcomes. Contact with services is often at crisis points, such as in forensic services, which reinforces existing prejudice. Research is limited, and therefore so is the evidence base. It is critical that the UK's National Health Service takes a culturally informed approach to co-produce services that are accessible and responsive to GRT communities. Here we offer practical actions that healthcare organisations can undertake to help redress imbalances and increase equity of healthcare outcomes for these overlooked populations.

This article is a summary of perspectives on training curricula from child and adolescent psychiatry trainees globally. We aimed to identify the relative strengths, weaknesses and gaps in learning needs from a trainee's perspective. The 20 early-career child psychiatrists who contributed are from 16 countries and represent all the five continents. We could identify some global challenges as well as local/regional challenges that need to be addressed to develop competent child psychiatrists.

Primary care is geared to manage patients with mild to moderate presentations of common mental disorders and to refer patients with more severe mental disorders to specialist mental health services. With growing demand for specialty care, the quality of the referral is increasingly important to ensure efficient patient flow across the primary/secondary care interface and appropriate use of secondary services. We report on an initiative in a Qatari mental health clinic to improve the quality of referrals from primary care to specialist mental health services through an educational intervention for family physicians. We highlight the problem, the intervention and the outcome of our initiative, which was the first of its kind in the region. The number of inappropriate referrals fell by 93%, and the number of referrals with inadequate clinical information declined from 15 (January 2019) to 1 (September 2019). Feedback was very positive; respondents reported feeling supported, with better understanding of care pathways, the scope of primary care and mental health services.

The World Psychiatry Exchange Program in Iran is an academic experience we are delighted to share. As two participating early career psychiatrists, a local psychiatry faculty member manager, and the lead founder and international coordinator of the programme, we focus in this article on the unfolding of this new learning experience, the difficulties we encountered and the main lessons learned by the participants: commonalities and differences in training and practice in general adult psychiatry and child psychiatry in Tunisia and Iran, as well as in idioms of distress between the Arab and Persian cultures.

This reflection focuses on research conducted in ‘The Jungle’ in Calais, an informal camp of approximately 6000 refugees (Help Refugees, 2016). My self-designed qualitative study aimed to assess the availability and nature of mental health and psychosocial support (MHPSS) by interviewing service providers about their role in MHPSS. The research questioned whether MHPSS was evidence-based (Tol et al, 2011), what types of MHPSS was available, what service providers envisaged to be the most immediate needs, and barriers and enabling factors in MHPSS.

Balochistan, Pakistan's largest province, faces a concerning rise in self-harm and suicide, exacerbated by socioeconomic challenges, political instability and events such as climate change and recent suicide bombings. Despite the alarming suicide mortality rate, it remains a neglected public health issue. This perspective paper highlights the need for a comprehensive approach, including suicide prevention initiatives, community-based mental health services, education and research. We also suggest establishing a suicide prevention task force, inclusion of life skills and mental health education in school and undergraduate curricula, conducting research into self-harm, and fostering empathetic media reporting. Additionally, suggestions for sustainable economic change include job creation, development of marketable skills and interest-free microfinance initiatives to empower the community economically.

The World Psychiatry Exchange Program offers opportunities overseas for early career psychiatrists (ECPs), fostering immersion in clinical and cultural contexts. In this article, we present the experiences of two Tunisian ECPs in India. Activities included observing interviews, and attending courses and webinars. Challenges and opportunities in perinatal psychiatry and in child psychiatry were observed, emphasising cross-cultural nuances. Language barriers were overcome through translation. Notably, collaboration and proximity between departments countered mental illness stigma among medical professionals. This exchange underscores the importance of cultural awareness, collaboration and contextual adaptation in psychiatry. Lessons from this cross-cultural experience offer insights for enhanced care and research in diverse settings. This exchange also allowed for a rich scientific and cultural experience and brought to light many commonalities between India and Tunisia.

Experiencing life and work in an alien culture initially just felt unsettling, but it also really challenged how I perceived myself and my abilities as a doctor. Being the outsider in a group has the ability to hold an uncomfortable and scrutinising mirror up to yourself. It also offers a unique opportunity to reconsider the skills, attributes and knowledge needed to be a psychiatrist. As psychiatrists, we intellectually know that culture is integral to a person's well-being and the care we deliver will never be truly holistic until we encompass that. However, it was only when I was the fish out of water that I truly began to appreciate its significance.

Having returned from a period of volunteering with a healthcare charity working with the refugee camp population of Lesbos in Greece, a junior doctor reflects on the common presentations he saw and the current state of mental healthcare for these patients. The placement of already-traumatised people in an overcrowded and under-resourced camp environment creates a perfect storm for the emergence of post-traumatic stress disorder, depression and anxiety. With extremely limited psychiatric care in place, he considers the simple interventions he could use to help his patients with their distressing symptoms. This prompts exploration of the importance of giving time to listen as well as encouraging small but significant lifestyle changes. After exploring the ethics of psychiatric diagnosis in this setting, the author concludes that while we must acknowledge the political origins of some of the symptomatology in this population, we must continue to strive to treat psychiatric illness with all the appropriate interventions available to us in order to help those in this patient group recover and move forward.

We are members of Students’ Education, Empowerment and Development in Mental Health, a group of medical students and psychiatrists from around the globe under the Psychiatry, Medicine and Primary Care Section of the World Psychiatric Association. In this article, we put forward recommendations to help improve the mental health response in disaster-prone regions such as Türkiye. We recommend a three-step multi-tiered mental health response system that could significantly help to address the immediate, short-term and long-term mental health needs of communities directly affected by a disaster. The recommendation draws from the relevant literature and, most importantly, from our lived experiences of living in earthquake-prone countries.

Approximately 20% of the adult Indian population are affected by a psychiatric disorder that requires intervention from a mental health professional (Math & Srinivasaraju, 2010). In spite of this, the provision of mental healthcare is poor. Therefore, to learn more, between July and August 2014 I undertook a 4-week elective at the Psychiatry Department of Sawai Man Singh (SMS) Hospital in Jaipur, Rajasthan, India. The Psychiatry Department was founded in 1952. It has a total of 332 beds, with nearly 20 000 patients admitted per year and an attendance of nearly 100 000 annually at the out-patient department.

The article offers a personal memoir of a psychiatric registrar's impressions of daily life while working in a South African mental hospital during the apartheid era in the late 1960s. From the perspective of a trainee psychiatrist, he recalls admission procedures, ward management, patient assessment, and medical and nursing care, including electroconvulsive therapy administration, at that time.