The history of psychiatry and homosexuality illuminates how stigma develops in the professions, how it is linked to cultural values and religious attitudes and how it affects patients. Homosexuality was medicalised as a disorder in the late 19th century and this led to treatments to change it. Same-gender contacts between men were decriminalised in many countries in the 1960s and 1970s, but – as recently as the 1980s – 30% of doctors in the USA did not think that gay students should be admitted to medical school and 40% would not allow gay doctors to specialise in paediatrics or psychiatry. Lesbians and gay men were effectively debarred from training in the main psychoanalytical schools in the USA and the UK. Although mainstream psychological treatments to make gay and bisexual people heterosexual fell into disrepute in the 1980s, so-called conversion or reparative treatments took their place and are still practised today. Transgender people have been the target of similar disapproval and attitudes towards them have been even slower to change than those towards lesbians and gay men. This stigma had consequences on the health, well-being and social inclusion of those who were lesbian, gay, bisexual and transgender (LGBT). This history suggests we need to examine where psychiatry and psychology are making similar mistakes today.

Stress and burnout are major issues affecting medical trainees, especially psychiatry trainees, throughout the world. Stress and burnout were studied using an online survey among psychiatry trainees of the National Institute of Mental Health and Neurosciences (NIMHANS) which is one of the oldest and largest training centers in India. Postgraduate training in academic institutions like NIMHANS, while offering excellent teaching experience, may impact the mental and physical health of trainees due to complex clinical challenges and academic pressure. Measures need to be taken to enhance trainee well-being by ensuring support from colleagues and seniors, allowing for an adequate work–life balance, introducing departmental level committees to address grievances and providing therapy and mentorship. Providing safe and non-stigmatizing spaces to seek help in workplace promotes whole-person growth and well being.

Transcultural observations offer an opportunity to study attitude to mental illness in different societies and family structures. The disparity between industrialised and lower-income societies reflects greater tolerance due to the ability of extended families to compensate for the patient's limitations.

Global mental health (GMH) work reminds us about our professional ideals and mission. GMH specialists conduct research and provide psychosocial and mental health support to populations affected by humanitarian crises around the world. This work exposes these specialists to situations with a high degree of moral ambiguity and no good solutions, where humanitarian accountability takes priority over conflicting values. Self-awareness helps to address the countertransference that confounds complex decision-making and can compromise the health and safety of all involved. The evolving role of GMH as a humanitarian actor underscores the importance of professional competencies in assuring the integrity and standards of practice.

This paper describes the history and current provision of mental healthcare in the Czech Republic. After the political changes in 1989, there was an expansion of out-patient care and several non-governmental organisations began to provide social rehabilitation services, but the main focus of care still rested on mental hospitals. In recent years, mental health reform has been in progress, which has involved expanding community-based services and psychiatric wards of general hospitals, simultaneously with educational and destigmatisation programmes.

The use of community treatment orders (CTOs) is available in more than 70 jurisdictions around the world. Although CTOs are used extensively, their effectiveness remains doubtful. We comment on the existing evidence and focus on components that influence the outcomes of CTOs internationally. It is essential to identify factors that affect the delivery of CTOs, and mixed methodologies may improve our understanding regarding their efficiency.

The history of psychiatry in Malta dates back to the 16th century. In the early 1990s, a detailed account of psychiatry in Malta documented the drive from institutional psychiatry to community psychiatry and outlined the difficulties with subspecialisation, staffing and training. Malta has since set up five community mental health teams, introduced new mental health legislation and introduced full postgraduate psychiatry specialisation. Work is continuing towards improvement of the country's mental health services and towards reducing the stigma associated with mental illness.

In 2013 the Federal Government of Somalia contacted the Mersey Care National Health Service Foundation Trust (MCFT), asking whether they could formulate a teaching programme tailored towards improving mental health provision in Somalia, and the E-learning Mental Health Training Programme (SOM-Health) was eventually conceived. The fundamental aim was to provide mental health awareness to practitioners and trainees in Somalia so that they could deliver mental healthcare services confidently and effectively.

Mental health support in Sierra Leone is sparse, and qualitative research into the feasibility of implementing psychological interventions is equally underdeveloped. Following the 2014 Ebola virus disease outbreak, South London and Maudsley NHS Trust were commissioned to develop a psychological intervention that UK clinicians could train national staff with minimal psychological experience to deliver to their peers. Following the completion of the stepped care, group-based cognitive–behavioural therapy intervention, qualitative interviews were conducted with the national team to identify key barriers and enablers to implementation of and engagement with this intervention. This article describes the key themes that came out of those interviews, and discusses the implications of these findings for future clinical teams.

The main challenges faced by psychiatrists in the Arab world are stigma, shortage of resources, role of the family and effects of conflicts and migration. Psychiatrists practising in this region have to adapt to these challenges and use creative methods to provide a good service to their patients.

A woman in her mid-20s presented to a private psychiatric out-patient clinic with a longstanding obsessive–compulsive disorder of contamination. She had fled her home country with her family because of an ongoing armed conflict. They were under temporary ‘visitor’ visas and the possibility of their stay not being renewed created immense anxiety. The patient was prone to bouts of anger on a regular basis, causing her to shout at her mother and brother. Her mother was concerned that the neighbours might complain, which might get the family into trouble with the police. The family were eager to know if the patient's condition was likely to improve with medication. They also asked if she could be admitted to an in-patient unit for treatment. Unfortunately, the psychiatric in-patient unit was not suitable for her needs and she could not go back to her home country because of safety concerns. The cost of treatment at a private clinic was expensive for the family. She was not eligible for state-funded healthcare.

The psychiatrist had to manage a complex situation created by stigma, effects of war and migration, lack of appropriate resources and the role of family. He maintained a trusting relationship with the patient and made sure no information was given to her family without her consent. Regular contact with the family was maintained to increase awareness about the nature of the patient's symptoms and to support the family in coping with the difficulties mentioned above.

For over a decade, concerted efforts have been made in Europe to reform mental health services and move away from institutions to community-based models of care, supported by international policy statements, good practice examples and research evidence. Progress has been uneven. So what is the status of mental healthcare across the World Health Organization European Region, and what factors support, or detract from, such progress?

There is a longstanding but sometimes controversial belief that a person is not criminally responsible for a crime if they were suffering from a mental illness at the time of the offence. The Queensland Mental Health Court (QMHC) system, in which assisting clinicians have a central role, is underwritten by this belief. This paper describes the QMHC system.

Psychiatry in Greece is undergoing a prolonged reform. Deinstitutionalisation is at an advanced stage and there are active efforts to support primary care and community psychiatry, and to establish local administration of services in each sector of the country (i.e. the equivalent of Mental Health Trusts in the UK). Quality assurance and continuing professional development require further development, as do a series of other issues pertaining to the day-to-day clinical practice of psychiatrists. Recent economic difficulties have undoubtedly affected the mental health of the population, but also mental health services and psychiatrists themselves. These financial difficulties coupled with pre-existing organisational issues present important, yet rectifiable, challenges. We conclude by identifying preventive psychiatry as an especially important target for progress and by advocating for continued support for the public system of mental healthcare as well as for the continued psychiatric reform.

The Lancet Commission summarises some of the history of mental health concepts, recent developments in scientific understanding, mental health programmes and threats to progress, and proposes a way forward. Although ostensibly aiming to reframe global mental health within the paradigm of sustainable development, in practice it has taken a narrower academic perspective rather than a generic approach to health and social sector reform, leading to much less of an integrated implementation focus than would have been useful.

In Eastern Europe, the Swiss Agency for Development and Cooperation is supporting various post-communist states in reforming their mental health systems to ensure equal access to high-quality services in community-based settings. The approach and new care models introduced have proven successful in most of these countries, one of which is Bosnia and Herzegovina.

Sri Lanka ranks highest in the region for human development. Despite producing the first female head of state in the world, the country has failed to achieve substantial gains in the gender inequality indices in the past decade. In recent years, the proportion of females in secondary education has equalled that of males, and young women have become the majority among the university entrants. These educated young women are likely to face psychosocial distress in a patriarchal society where they would be expected to fulfil traditional gender roles. This article describes gender disparities that could affect the mental well-being of young Sri Lankan women and the need for awareness among mental health professionals in the country.