The paper reports a descriptive survey of the referrals received by a new psychiatric liaison service in Rawalpindi in the first 2 years. The survey showed a rapid increase in use of the service, particularly by the emergency department. There was a lower proportion of referrals for self-harm and substance misuse than occurs in similar services in high-income countries but a higher proportion of patients presenting with dissociative (conversion) disorders. The large proportion of patients who had abnormal findings on physical examination remains unexplained and warrants further investigation.

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.

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.

In Malawi, mental health services account for only 2% of the health budget; there are just 4.5 full-time psychiatrists and 433 psychiatric beds. The Scotland Malawi Mental Health Education Project (SMMHEP) aims to provide sustainable support for psychiatric training for healthcare professionals and has increased the number of psychiatrists in the country. There has been a recent change in the educational programme in order to maximise clinical exposure and experience, particularly with the care of in-patients. The new programme has had a positive effect on students' attitudes towards psychiatry and their consideration of psychiatry as a career. This paper supports the ongoing work SMMHEP does in developing psychiatric services through education.

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.