This paper is a British psychiatrist's personal reflection of the treatment of homeless people in American societies. Drawing upon theories of social distance, exclusion, discrimination and internalised stigma, this reflective piece suggests that homelessness is one price that certain societies pay to invest in the notion of individualised success and self-sufficiency. In reflecting on his own dissonance, the author argues that these societal processes exert a powerful influence on us as individuals, even if we as psychiatrists might think that our understanding confers on us a certain level of understanding.

National information on mental health services in the Philippines indicates that there are substantial gaps and inconsistencies in the delivery of mental healthcare. The recently enacted Mental Health Act legislation provides a platform for the delivery of comprehensive and integrated mental health services. However, there remain many challenges in the provision of accessible and affordable mental healthcare.

Globally, established practice in mental health services has tended to be codified into law in ways that are paternalistic, seeking to make decisions for patients that presume ‘best interest’ and which ultimately place power in the hands of medical authority. The United Nations Convention on the Rights of Persons with Disabilities (CRPD) – which has been widely ratified globally – challenges these assumptions, instead placing the expressed will and preference of patients as the most important factor in decision-making, including treatment and consent to admission. The contradictions between these approaches cause profound challenges in legislation reform, but a human rights framework offers the potential for a paradigm shift in the way that people are treated in services, and in exploration of alternative practices that promise a more humane and dignified future for mental health care.

Fiona Martin is a psychiatry trainee who spent 6 months volunteering in a mental health service in Uganda between her core and higher psychiatry training. In this article, she reflects upon this experience, including the challenges and rewards, and in particular the benefits to training of such an experience.

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.

Although significant progress has been made in the peace process, Colombia still experiences high levels of ongoing violence and a legacy of more than five decades of armed conflict. Epidemiological studies show markedly raised levels of mental health problems in people affected by the conflict, with internally displaced people being a large and important group with unmet needs. Provision of mental health services is uneven and subject to significant underinvestment. Priority mental health treatment for victims of the conflict is now established in law, although the effectiveness of these programmes has yet to be established.

The first mental health act legislation in the history of the Philippines has been officially signed into law and was enacted as the Republic Act no. 11036 on 21 June 2018. It provides a rights-based mental health bill and a comprehensive framework for the implementation of optimal mental healthcare in the Philippines. We review the principles and provisions of the Mental Health Act of 2017 and the implications for mental healthcare in the Philippines.

Development of an undergraduate psychiatric teaching programme and curriculum is a challenge in the current atmosphere of increasing knowledge and vast literature. However, the curriculum remains the cornerstone for future doctors' development and career. Doctors need to have the abilities to recognise, assess and manage common psychiatric conditions presenting at different levels of health services. This paper aims to look at the current status of psychiatric teaching and evaluate the curricula through interviews with teaching staff, to make appropriate recommendations for the future. Teaching staff and psychiatrists involved in undergraduate teaching were interviewed using a data collection format.

In Myanmar, a country that has just recently opened up to the international community, Buddhist and traditional healing methods are still widely applied to various diseases and conditions. The aim of this study was to ascertain how professionals from the biomedical healthcare system in Myanmar experience interactions with patients with depression, based on the professionals' conceptualisation of this disorder. Six problem-centred interviews were conducted and analysed with grounded theory methodology. The interviewed professionals conceptualised three ways of understanding depression, including different treatment strategies: a biomedical, a contextual and a Buddhist concept of depression. Concerning the patients' perspective, the professionals mentioned somatic, religious and supernatural explanatory models, as well as corresponding help-seeking behaviour. Our results suggest that by taking a biomedical approach, professionals risk neglecting both the needs and resources of Myanmar patients with depressive symptoms.

Since 2009, Greece has experienced a long-lasting socioeconomic crisis that has had substantial consequences on the health and mental health of the population. Unemployment, financial hardship and income loss constitute the hallmarks of the socioeconomic landscape. Consequently, a substantial decline in health and mental health has been documented. Converging evidence corroborates a deterioration of self-rated health, an alarming rise in suicide rates and a gradual increase in the prevalence of major depression. Concomitantly, the healthcare system is on the verge of collapse and the mental healthcare system is incapable of addressing the emerging needs. Therefore, a multifaceted and concerted effort is urgently needed to mitigate the mental health effects of the recession.

The Mental Disorders Act of 1969 is the primary legislation relating to mental health in Botswana. Despite the country not being a signatory to the United Nations Convention on the Rights of Persons with Disabilities, its Act has a self-rated score of four out of five on compliance to human rights covenants. However, it can be argued that the Act does not adequately espouse a human rights- and patient-centred approach to legislation. It is hoped that ongoing efforts to revise the Act will address the limitations discussed in this article.

Working as a foundation doctor in psychiatry I quickly noted the value of two things: the development of a strong therapeutic relationship and the importance of a detailed history. These two things are made much harder when your patient does not speak English and you do not speak their language. I present a reflection on my experiences with two patients who did not speak English, the role of interpreters and some common pitfalls when working with them.

Mental health service provision for youth within the juvenile justice system remains a topic of contemporary global discourse. To bring perspectives from under-resourced regions, we examine the current limitations of some globalised models for mental health services within the juvenile justice system in Nigeria. The important multi-systemic steps needed to reposition the system for modern mental health promotion and services are highlighted.

Aotearoa New Zealand is a country of just under 5 million people with a diverse population, the main ethnic groups being of European descent and Maori. There are well-developed public and private healthcare systems. As in other countries, Aotearoa New Zealand has closed the large institutions and developed community-based services for people with intellectual disability. Aotearoa New Zealand has specific legislation for people with intellectual disability presenting to the criminal justice system and has unusually and explicitly excluded people with intellectual disability from mental health legislation since 1992. Partly as a result, most health professional training schemes have little focus on issues for people with intellectual and developmental disabilities. Therefore, one of the main challenges over the coming decade will be to ensure there is a sufficient workforce of psychiatrists and other professionals who have the training and expertise to work with people with intellectual disability requiring mental health and forensic services.