The global economic downturn seems to be associated with a rise in suicide rates in many countries but we should not assume that this is a social rather than a clinical phenomenon. Mental health patients may be particularly vulnerable to unemployment and other hardships and to cuts in the care they receive. There is now no shortage of evidence on how clinical services and health policies can reduce suicide, and in England a new suicide prevention strategy was recently launched for public consultation. What we lack is an effective forum where a rigorous examination of international evidence can take place, with the findings translated into actions.

There has been considerable publicity recently in the UK concerning the threatened contraction of the country's pharmaceutical industry. The UK currently has the third highest share of global pharmaceutical research and development expenditure (after the USA and Japan), but the costs of conducting research in the UK are rising.

Clinical trials have been conducted almost wholly in high-income countries until recently, yet their results may not always be valid or applicable in middle- and low-income countries. Clinical trials are now, though, increasingly being done in less wealthy countries. While this is welcome, there is a need to ensure the profit motive does not override the benefits. Partnership with local counterparts while adhering to international standards should help to maintain high-quality output from clinical trials.

There is a trend for pharmaceutical companies to contract third parties to conduct the clinical trials that are needed to test their drugs. This trend is referred to as outsourcing, and the companies that carry out the work are called contract research organisations. In addition, clinical trials are increasingly conducted in non-traditional trial regions, which are mainly low-and middle-income countries. This trend is called offshoring. The combination of outsourcing and offshoring poses serious risks for the ethical treatment of participants in clinical trials.

This commentary highlights the poor availability of essential psychiatric medicines at public sector facilities in India and illustrates why even a flourishing generics industry does not assure access to affordable psychiatric medicines for most Indian patients. The paper outlines the Indian government's pricing regulations and then enumerates recommendations for reform.

Despite attempts made in recent years to address the diagnosis and treatment of mental illness in Mozambique, service provision remains deficient. The present paper focuses on the attitudes to mental illness and its diagnosis and treatment in Mozambique. This paper is based on both a thorough literature search and on the results of qualitative interviews carried out with six individuals of Mozambican origin now living in the UK.

The Republic of The Gambia, on the west coast of Africa, is a narrow enclave into Senegal (which surrounds the nation on three sides), with a coastline on the Atlantic Ocean, enclosing the mouth of the River Gambia. The smallest country on mainland Africa, The Gambia covers 11 295 km2 and has a population of 1705 000. There are five major ethnic groups: Mandinka, Fula, Wolof, Jola and Sarahuleh. Muslims represent 95% of the population. English is the official language but a miscellany of minor languages are also spoken (Serere, Aku, Mandjago, etc.). The Gambia has a history steeped in trade, with records of Arab traders dating back to the ninth century, its river serving as an artery into the continent, reaching as far as Mauritania. Indeed, as many as 3 million slaves were sold from the region during the trans-Atlantic slave trade. The Gambia gained independence from the UK in 1965 and joined the Commonwealth of Nations.

An increased incidence of psychiatric disorders has been reported in homeless young people. These disorders are often related to their childhood experience of trauma, although less is known about how secondary traumatic experiences while being homeless affect psychopathology. The aim of this study was to establish the relationship between life adversities – living on the street, physical and sexual abuse (during both childhood and young adult life) and substance misuse – and depressive symptoms and self-harm among homeless young people.

This paper reports on the training of primary care physicians in the family medicine programme at the University of Gezira, Sudan, using the World Health Organization's Mental Health Gap Action Programme Intervention Guide (mhGAP-IG). The training had a positive impact on their knowledge of and attitudes to mental disorder. More field tests of the mhGAP-IG would be useful to make further recommendations on its cultural relevance and its adaptation for use in low- and middle-income countries. Distance supervision of training of primary care physicians by internal facilitators is seen as critical for the sustainability of the intervention.

The community psychiatry movement started in India in the early 1950s. It has gone through different phases of development, beginning with family care of people who are mentally ill in the campus of the mental hospitals, followed by satellite clinics and a national mental health programme. Other initiatives have included the camp approach, initiatives by non-government organisations and the media, and mental health services for disaster-affected populations. The paper traces the development of community psychiatry in India over the past six decades.