Dr Trevor Turner was asked to provide a commentary on the preceding paper in this issue, ‘“Freedom is more important than health”: Thomas Szasz and the problem of paternalism’, by Joanna Moncrieff.

The Republic of Croatia is in central Europe, on the Mediterranean. A large majority of its 4 440 000 inhabitants are Croats (89.6%). The main religion is Roman Catholicism (88%). Sixteen per cent of the population is aged over 65 years. Croatia was a part of Yugoslavia after the Second World War until 1991, when Croatia declared independence. Following the declaration, Croatia was attacked by the Yugoslav army and by Serbia and suffered a devastating war (1991–95). The transition had consequences for mental health, for example a dramatic rise in the prevalence of post-traumatic stress disorder, especially among soldiers. The majority of soldiers received appropriate psychiatric treatment; there has, however, been an increase in claims motivated by secondary gain, as a result of government policy.

This article provides a brief overview of the legislation that has been enacted in Ireland with respect to mental health, in particular the 2001 Mental Health Act. Although that Act was a positive step towards developing an Irish mental health service that protects the human rights of service users, a number of concerns remain, including issues related to consent and capacity, involuntary out-patient treatment and admission, the adversarial nature and timing of tribunals, and the lack of safeguards for voluntary patients.

Asians represent more than half the world's population but themselves consist of very diverse genetic, ethnic, cultural and linguistic groups. Understanding the role of ethnicity in an individual's response to psychotropic medications is of importance in treating psychiatric disorders among Asians. Recent research has supported the notion that Asians carry distinct genetic profiles that can influence both the pharmacokinetics and the pharmacodynamics of a given medication (Lin & Smith, 2000; Pi & Simpson, 2005). In this brief review, we summarise the research findings in the field, focusing on pharmacogenetic variations between Asians and other ethnic groups.

Malta is an archipelago (with three inhabited islands) in the Mediterranean Sea. According to the 2006 census, Malta has a population of just over 400000 and is the eighth most densely populated country in the world (1272 persons/km2) and the most densely populated of the member states of the European Union (EU). The most densely populated town in Malta is Senglea, with 22744 persons/km2 (situated in the Southern Harbour Area). In comparison, Malta's sister island, Gozo, has a density of 422 persons/km2. Over 92% of the population lives in urban areas.

In the UK, only 13% of people with long-term mental health problems are in employment, compared with 35% generally of people with a disability (Royal College of General Practitioners, 2005). Nearly 2.6 million individuals receive incapacity benefit and/or severe disability allowance and, of these, close to 1 million are claiming incapacity benefit due to mental ill health. The management of this enormous number of people – providing support to them and helping them get back into employment – is an issue that cannot be addressed adequately by our specialist mental health services. Accordingly, other models of service delivery need to be considered. The three thematic papers in this issue look at this issue from the perspective of three highly contrasting societies.

In the past 15 years in Canada, as in other nations, the mental health of veterans has emerged as a key concern for both government and the public. As mental health service enhancement unfolded, the need for wider population studies became apparent. This paper describes the renewal of services and key findings from national surveys of serving personnel and veterans.

The World Health Report 2001, dedicated to mental health, identified several important factors for improving mental health services (World Health Organization, 2001): the policy and legislative framework; community mental health services; provision of mental healthcare within primary care; human resources; public education; links with other sectors; and monitoring and research. Moreover, national mental health policies and national implementation programmes for these policies are vital for the improvement of mental health services (World Health Organization, 2004; Jacob et al, 2007).

Australia has a generally progressive approach to mental health law, reflective of international trends in human rights. Responsibility for most legislation is vested in the six States and two Territories, a total of eight jurisdictions, such that at any given time several new mental health acts are in preparation. In addition there is a model mental health act that promotes common standards. Transfer of orders between jurisdictions relies on Memoranda of Understanding between them, and is patchy. State and Territory legislation is generally cognisant of international treaty obligations, which are themselves the preserve of the Federal Parliament and legislature. UK legislation has had a key influence in Australia, the 1959 Mental Health Act in particular, with its strong emphasis on voluntary hospitalisation, prefacing deinstitutionalisation.

The purpose of this study was to investigate whether the Strengths and Difficulties Questionnaire (SDQ) may be considered a reliable measure of child behaviour, social functioning and adjustment in an Indian Gujarati context. The sample comprised 351 children who were classified as coming from a ‘poverty’ or ‘non-poverty’ background. The means and standard deviations for the SDQ total and five behavioural scales, as rated by children themselves, were first calculated for the entire Gujarati sample, then for the poverty and non-poverty subgroups. The SDQ did prove to be an appropriate measure for behavioural assessment. Its cross-cultural sensitivity was ascertained by comparing it against a British normative population. Small effect sizes were seen in the Emotional subscale scores and scores for total difficulties, and medium and large effect sizes on the Prosocial and Peer subscales, respectively, with greater difficulties experienced by the Indian Gujarati sample than their British counterparts.

Sudan has endured the longest civil war in the history of Africa. The conflict between the northern (mainly Arab) and southern (mainly sub-Saharan African) populations started in 1983, and in its first phase continued for 22 years. The combination of civil war and famine has taken the lives of nearly 2 million people and displaced an estimated 4 million people from their villages and homes. This paper presents some data on the prevalence of mental disorder and the mental health service response to the situation.

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.

This paper focuses on the question of whether separate attention to children who have faced specific conflict-related events is justified, or whether the scarce resources for mental health should be spent on the development of services for children more broadly in low- and middle-income countries (where most contemporary armed conflicts are taking place). It is argued that a systems approach to mental health and psychosocial support for children is warranted.

Psychiatric sequelae may occur following traumatic injury irrespective of whether an insult has been caused to the brain. A range of psychiatric illnesses have been either causative of or associated with road traffic accidents and traumatic injuries, including depression, anxiety, post-traumatic stress disorder, substance use disorder and attention-deficit hyperactivity disorder. Despite literature on such associations, psychiatric intervention in the treatment of patients following traumatic injury is limited. The authors share their experience of challenges in addressing mental health problems in a tertiary care trauma centre located in North India. Steps in overcoming those challenges included: developing a semi-structured form to be completed for referrals and consultations, a psychiatrist attending weekly rounds with the surgeons, and initiating a psychiatry out-patient clinic for patients discharged from the trauma centre. It may be worthwhile in the future to set up a trauma psychiatry unit at the centre, involving a clinical psychologist, a psychiatric social worker and an occupational therapist for the comprehensive care of patients.

Schizophrenia is a chronic illness with a lifetime prevalence of 1% and with serious physical, social and economic consequences. Over the past decade, atypical antipsychotic medications have become the first-line treatment for schizophrenia (Breier et al, 2005).

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.

Commissioning of health services has become an intensely political issue in the UK and there is no reason to believe that the conflicts that have arisen domestically would not be mirrored overseas. A key ideological issue in the UK concerns the relative merits of public and private provision of services. In their guest editorial in this issue, ‘Governance, choice and the global market for mental health’, Sugarman & Kakabadse take a particular ideological stance: they write on the one hand of commercial-style efficiency and on the other of monopoly state provision risking inefficiency and ineffectiveness. This perspective is addressed here.

We aimed to find the depression rating scale with the greatest accuracy when applied by psychiatrists in Iraqi Kurdistan. We recruited 200 patients with primary depression and 200 controls living in the Kurdistan region of Iraq. The Mini International Neuropsychiatry Inventory (MINI) was used as a gold standard for DSM-IV depression. We also used: the two-item and the nine-item versions of the Patient Health Questionnaire (PHQ2, PHQ9), the Hospital Anxiety and Depression Scale (HADS), the Calgary Depression Scale for Schizophrenia (CDSS) and the Centre for Epidemiological Studies Depression (CES-D) scale. Interviews were performed by psychiatrists who also rated their clinical judgement using the Clinical Global Impression (CGI) scale and other mental health practitioners. All scales and tools performed with high accuracy and reliability. The least accurate tool was the PHQ2; however, with only two items it was efficient. Sensitivity and specificity for all tools were above 90%. Clinicians using the CGI were accurate in their clinical judgement. The CDSS appeared to be the most accurate scale for DSM-IV major depression and the PHQ2 the most efficient. However, only the CDSS appeared to offer an advantage over psychiatrists' judgement.

The availability and use of mental health treatments are influenced by many different factors. Prominent among these are scientific evidence, cost, ethics and politics. However, the social sustainability of treatments can also have a considerable influence on their use.

Alcohol use and misuse among young people continue to be a major public health concern, despite decades of initiatives aimed at educating young people about the hazards of alcohol. Yet where do young people learn about alcohol use? How do they form attitudes about the effects and risks of drinking? Increasing evidence suggests that young people learn not only from real people (e.g. peers and parents) in their everyday lives but also from characters whose lives they witness through the media. In fact, the mass media have been recognised as significant sources of information about substance use that can influence young people's beliefs and expectations (Bahk, 2001; Sargent et al, 2002).