It is perhaps unusual for an academic journal like the Lancet to spearhead a ‘movement’ to advocate the scaling up of mental health services in low-income countries. Yet at the movement's launch in London in November 2007, attended by representatives from World Health Organization (WHO), the World Bank, donor agencies, as well as the World Psychiatric Association (WPA) and the Royal College of Psychiatrists, it was clear that a seminal series of papers, published in September of last year, was of the utmost importance for world psychiatry and for our planet. The five papers in the series ‘Global Mental Health’ had the following titles: ‘No health without mental health’; ‘Resources for mental health: scarcity, equity, and inefficiency’; ‘Treatment and prevention of mental disorders in low-income and middle-income countries’; ‘Mental health systems in countries: where are we now?’; and ‘Barriers to improvement of mental health services in low-income and middle-income countries’ (Lancet, September 2007, vol. 370, nos 9590–9593).

Within the continent of Africa, mental health services are relatively undeveloped. In the sub-Saharan countries of Malawi, Kenya and Nigeria, similar problems are faced by dedicated psychiatrists who are struggling to create and sustain an educational, management and political structure for psychiatry.

Malawi is a country in sub-Saharan Africa bordering Mozambique, Tanzania and Zambia. It has an area of approximately 118000 km2 and is divided into northern, central and southern regions. It has an estimated population of 13 million, 47% of whom are under 15 years of age and just 5% over 60 years. Its economy is largely based on agriculture, with tobacco being the main export. The projected growth in gross domestic product (GDP) for 2007 was 8.8%; GDP per capita was $284 per annum.

The mental healthcare programmes in Kenya fall into four inter-related categories: service provision; training; research; policy and advocacy.

Nigeria, like other African countries, is short of personnel trained in mental healthcare. Efforts to tackle the problem have often focused on increasing the numbers of psychiatrists and nurses in the field. These efforts, over the past 20 years, have not appeared to have greatly improved service delivery at the grass roots. Most of the specialist centres where such highly trained personnel work are in urban areas and for a large part of the population access to them is limited by distance and cost.

Brunei Darussalam occupies a sliver of land on the northwest coast of the island of Borneo with a geographical area of just 5765 km2 (Government of Brunei, 2004). It is divided into the four districts: Brunei-Muara, Temburong, Tutong and Belait. Two-thirds of the land is covered by lush tropical rainforest and the climate is perpetually warm and humid. It is ruled by Sultan Hassan Al-Bolkiah, the head of a dynasty which has governed Brunei for 650 years.

Sandwiched between India and China, Nepal is a small landlocked lower-middle-income country in South Asia. Once a peaceful country, it is striving to overcome the legacy of a 10-year Maoist rebellion, a royal massacre and continuing political chaos. Nepal has been in dispute with neighbouring Bhutan over the repatriation of hundreds of thousands of refugees in several camps in Nepal. In addition, the country experiences frequent natural disasters (floods and landslides) and faces several environmental challenges, including deforestation and a population explosion in southern Nepal.

This paper will focus on the current state of mental health services in the United Arab Emirates (UAE) and reflect on the various public health, socio-economic and psychosocial factors that have a major impact on the mental health needs of the population. It is to be borne in mind that the services described in this paper are in a state of rapid change, as the country is witnessing one of the fastest rates of development in the world.

Over the past two decades, psychiatric services have evolved globally and generally there has been a gradual transition from hospital-based practice to a more community-based approach. The stigma associated with psychiatry has somehow diminished and society in general can now relate better to this field of medicine.

Natural disasters are complex events that challenge the coping abilities of individuals and communities (Alexander, 2005). They are characterised by substantial loss, physical injury and economic hardship, as well as by extensive internal displacement and damage to the infrastructure, as exemplified by the Pakistan Kashmir earthquake of 8 October 2005. Measuring 7.6 on the Richter scale, it affected an area of 30000 square miles and a population of 3.6 million. Approximately 90000 were killed, 200000 were injured and 3.5 million were left homeless (Khan, 2006). Based on a literature review and estimates from the World Health Organization (WHO), the National Plan of Action for Mental Health and Psychosocial Relief of Earthquake Survivors anticipated high levels of trauma-related psychopathology (Rana et al, 2006).

The prevalence of psychiatric morbidity among rural and urban Kenyan primary care attenders has been reported to be as high as 63% (Ndetei & Muhangi, 1979; Dhapdale & Ellison, 1983; Dhapdale et al, 1989; Sebit, 1996). For its population of 32 million, Kenya has only 16 psychiatrists and 200–300 psychiatric nurses, but there are just over 2000 primary healthcare centres, staffed by general nurses and clinical officers, and the main burden for assessing and caring for people with mental disorders falls upon members of the primary care teams. However, mental disorders are poorly recognised (Dhapdale & Ellison, 1983) and inadequately treated in primary care (Muluka & Dhapdale, 1986). Moreover, Kenyan primary care workers often lack training in mental health (Dhapdale et al, 1989; see also Ndetei, this issue, p. 31).