The enlargement of the European Union (EU) creates new inspiration and challenges for the Section and Board of Psychiatry of the Union of European Medical Specialists (UEMS). The Section and Board, which have an active history dating back to the early 1990s, aim to promote and harmonise psychiatry throughout Europe, mainly by working to produce standards for training, including conditions for training and continuous professional development (CPD). However, European society is complex and in transition. The move towards a more unified European professional identity first requires the identification and acknowledgement of differences.

Most scientists are now aware of what has been called the 10:90 divide (Saxena et al, 2006): the fact that 90% of the published scientific activity in the world comes from the richest 10% of countries. Many would like to brush off this simple fact as unimportant, but at another level it could be regarded as a scandalous disequilibrium of the planet's resources. One small way of reversing this is for editors to publish more papers from low-income countries and counter what can be described somewhat strongly as editorial racism (Horton, 2003). We have tried to do so in the British Journal of Psychiatry (Tyrer, 2005); this paper describes some of the difficulties.

This paper reflects on the development of a capacity-building programme to support a mental health service modernisation pilot project based in the Lviv region of Western Ukraine. National programmes that aim to modernise mental health services now have the experience of other countries on which to draw. The challenges faced by such modernisers have much in common. Nevertheless, although there are lessons to be learned from what has worked well elsewhere, we caution that the local context can have a profound effect on the successful implementation of plans based on best practice.

In 2014, Brunei implemented the Mental Health Order, which replaced the 1929 Lunacy Act. This new legislation was designed to improve the treatment of mental disorders and to protect the rights and welfare of people with mental disorders. This short report describes the experience and challenge of implementing the new legislation, with a particular focus on the use of involuntary treatment and the restrictions imposed on people with mental disorders despite the new legislative framework.

As part of a pilot programme to scale up community mental health services, local health centre directors, community health workers and key informants were interviewed in two neighbouring political districts of Niger. Major priorities for improving services included training staff on the diagnosis and treatment of mental illness, collaborating with traditional healers, educating the community about the origins of psychiatric illness and building infrastructure for medication delivery. Barriers to care included long distances for travel to the nearest hospital and lack of funding for home-based visits by health workers. This study was the first step in Niger's plan to implement the World Health Organization's Mental Health Gap Action Programme (mhGAP) at a national level.

We used medical record abstraction to conduct research in a psychiatric hospital with paper-based medical records. The challenges we encountered included: the difficulty in retrieving files; the extensive effort and time needed to extract clinical information; the lack of a standardised documentation system of medical records; and the need for advanced computer literacy. To promote future research using electronic medical records, potential solutions include creating a registry of all patients receiving treatment, as well as equipping busy clinicians with computer skills.

The Mental Health Ordinance 2001 was the last comprehensive legislation on mental health policy in Pakistan, replacing the Lunacy Act 1912. Since then, most of the amendments to the act have only delineated the jurisdiction of the provincial governments. Failure to account for mental illness in Pakistan brings with it unique challenges, such as the criminalisation of suicide and exploitation of blasphemy laws. There is a need for organised efforts to promote awareness of mental illness, amend the obsolete legislation in conformity with the scientific evidence, implement mental health policy effectively and deal with sensitive issues that have a strong sociocultural or religious background.

When the world of public health considers the health of women, one tendency is first and foremost to link the well-being of women to that of children and the family, and, legitimately, to the health of society overall. Epidemiological data point to sex differences in the patterns and clusters of psychiatric disorders and psychological distress. The origins of much of the pain and suffering particular to women can be traced to their social circumstances. Depression, hopelessness, exhaustion, anger and fear grow out of hunger, overwork, domestic and civil violence, entrapment and economic dependence. Understanding the sources of women's ill health demands awareness of how cultural and economic forces interact to undermine their social status. This article highlights aspects of social suffering among women in Iran. Self-inflicted burns, a significant indicator of mental health among Iranian women, are discussed in order to increase awareness of the phenomenon among the international community, as a first step towards initiating an improvement in the health of women in Iran.

In-patient treatment is a complex system of recursively interacting components. Patient characteristics interact with caregiver characteristics, home context and ward factors. Quality improvement requires primary focus on the interacting factors over which the ward itself potentially has influence. Ward practice has to integrate the demands of the hospital owner, the legal framework for treatment and what we know facilitates effective treatment plans. We describe how we have implemented a quality improvement system that addresses these interplaying influences in acute adolescent psychiatry in Norway. The process involved with this system (developed in the UK for child and adolescent psychiatric units) is independent of the organisational structure of the department and which alternative resources it has to rely on. It is independent of the characteristics of the patient population, although specific standards can be developed for local requirements.

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.

A questionnaire was sent to all consenting doctors at the University of Ilorin Teaching Hospital, Nigeria. It asked about their management of psychological problems in their clinical practice. Over 90% would welcome more time to talk to patients and agreed that psychological and social factors should be routinely assessed and recorded for patients. Most respondents would refer patients with depression or disturbed behaviours. ‘Ineffective treatment’ and ‘dislike of psychiatric referral’ were not the main reasons for non-referral. A majority of the doctors had initiated treatment for anxiety and insomnia but not for alcohol withdrawal, psychosis, acute confusional state or depression. Doctors' awareness of ‘the impact of psychological factors on the course of physical illness' was high. To sustain this high level of awareness and encourage referral, in-house psychoeducational training of hospital doctors should be intensified. In addition, an increased doctor/patient ratio, public education to reduce stigma and a well developed liaison psychiatric service are imperative.

Further to the publication by the London School of Economics and Political Science of the report Ending the Drug Wars, this editorial focuses on the mental health impact of the ‘war on drugs' and on the need to end such policies in favour of evidence-based interventions to manage drug dependence as a health condition.

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.

Sir: In 2005, the Department of Health for England set a five-year action plan, Delivering Race Equality in Mental Health Care. The aim was to encourage the development of services that were more appropriate and responsive to the needs of both adults and children in Black and minority ethnic communities.

Psychiatry has probably always been the least attractive of the medical specialties. The choice of psychiatry as a career has been consistently low in the English-speaking world over the past 50 years (British Medical Journal, 1973; Feifel et al, 1999; Brockington & Mumford, 2002). Over the past decade there has probably been a further decline in the proportion of medical graduates choosing to train in psychiatry (Sierles & Taylor, 1995; Feifel et al, 1999).