Most scientists are now aware of what has been called the 10:90 divide (Saxena et al, 2006): the fact that 90% of the published scientific activity in the world comes from the richest 10% of countries. Many would like to brush off this simple fact as unimportant, but at another level it could be regarded as a scandalous disequilibrium of the planet's resources. One small way of reversing this is for editors to publish more papers from low-income countries and counter what can be described somewhat strongly as editorial racism (Horton, 2003). We have tried to do so in the British Journal of Psychiatry (Tyrer, 2005); this paper describes some of the difficulties.

The theme in this issue concerns the interface between child psychiatric services in low- and middle-income countries and the availability of such services in higher-income countries. In neither context are such services ideal, and resources are relatively slim when compared with demand. The key issues are discussed in three terms: first, of the need for nations to have a general statement of child and adolescent mental health policy (Shatkin et al); second, of the need to establish inter national child and mental health research networks to foster research in low- and middle-income countries (Erlich & Plener); and third, of the circumstances that exist for providing such support to children in one such country, Pakistan (Khan et al).

Few countries worldwide maintain policies specifically designed to address the mental health needs of children and adolescents. Yet policies are essential to guide the development of systems of care, training programmes for practitioners, and research endeavours. Without policy, there is no clear pathway for programme development, no specific commitment from government, no expression of governance, no guide to support funding, and no clarification of who exactly is responsible for providing services to children and adolescents. In 2004, we published a report aimed at identifying child and adolescent mental health policies worldwide (Shatkin & Belfer, 2004). The present review expands upon that report and provides an up-to-date assessment of these policies.

The International Congress of the International Association of Child and Adolescent Psychiatry and Allied Professions (IACAPAP) takes place every other year. It is an opportunity for specialists from around the world to meet, exchange ideas and plan new projects. Since 2006, the Donald J. Cohen (DJC) Travel Fellowship has been an integral part of the Congress. It aims to foster the professional development of ‘emerging leaders’ in child and adolescent mental health (Adler et al, 2007).

Worldwide, mental disorders are on the increase (Gadit, 2007) and an estimated 10-20% of children have one or more mental or behavioural problems (Park, 2002). There is an urgent and serious need to pay attention to the mental health needs of children in low- and middle-income countries (Rahman et al, 2000). The initial survey for the World Health Organization's Atlas project (Sherer, 2002) showed that 41% of countries surveyed had no mental health policy and 28% had no separate budget for mental health.

The Kingdom of Belgium is a high-income country in northern Europe with an approximate area of 33 000 km2 and a population of 10.5 million. The proportion of the population under the age of 15 years is 17% and the proportion of the population above the age of 60 years is 22%. Life expectancy at birth is 75.2 years for males and 81.5 years for females. As a founding member of what is now the European Union, it hosts the headquarters of the European Commission and the European Parliament, as well as other major organisations, including NATO.

The Republic of Yemen, on the south-western coast of the Arabian Peninsula, was formed in 1990 when North and South Yemen united. Yemen covers 527 970 km2. The capital is Sana'a. The country is divided into 20 governorates and one municipality. It has an elected president, an elected House of Representatives, and an appointed Shura Council. The president is head of state, and the prime minister is head of government. Suffrage is universal for people aged 18 and older. The population of Yemen according to the 2004 census is about 20 million, but recent years have seen the arrival of many refugees.

We assessed the mental and neurological health (MNH) situation of Ecuador in 2006–8, using the Mental and Neurological Health Country Profile (MNHCP) (Gulbinat et al, 2004; Jenkins, 2004; Jenkins et al, 2004), an instrument which helps to develop evidence-based MNH policy and services (Townsend et al, 2004). An extensive review of the literature was undertaken and consultations and consensus meetings (Schilder et al, 2004) were conducted with key mental and neurological health stakeholders, including consumers, carers and clinicians from the government and non- government sectors.

Over the past few decades there has been a growing interest in first-episode psychosis (FEP), help-seeking behaviour and pathways to care. Treating psychotic disorders in their earliest stages has become a key focus for research and clinical care (Yung & McGorry, 2007). FEP studies show that the average time between onset of symptoms and first effective treatment is often 1 year or more (McGlashan, 1987). This long duration of untreated psychosis (DUP) is undesirable. Early treatment helps minimise the risk of the serious consequences of untreated psychosis, in terms of changes in mental state and behaviour (Larsen et al, 1998; Wyatt et al, 1998) and can reduce suffering (Ho et al, 2003). Some early results suggested that an ‘early intervention in psychosis’ (EIP) service is more cost-effective than generic services (Mihalopoulos et al, 1999).

In our age of frequent natural disasters in this increasingly interdependent world, there is a pressing need to understand better the processes of societal adjustment. The Kashmir earthquake of 8 October 2005 brought human suffering on a massive scale. High rates of psychiatric morbidity have been reported (Niaz et al, 2006; see also http://emdrpakistan.com). Whereas the relevance of the application of Western, secularised, psychological treatment models to this group is outside the scope of this paper, survivors have faced catastrophe and destruction of both their internal and external realities.

There are striking and significant differences in psychiatric training across Europe and procedures for the assessment of trainees vary widely (Strachan, 2007). The introduction of competency-based training represents a major shift in medical education and a challenge to harmonising psychiatric training in Europe. This paper discusses the development and implementation of competency-based training in the Netherlands and the UK and focuses on its effects on trainees.

Sir: The Iraq Subcommittee (ISC) of the Board of International Affairs organised a visit to Iraqi Kurdistan to help support mental health services within the province. Four members of the Subcommittee took part in the visit, on 8–15 June 2007. Our official meetings started on the day of our arrival. We met with the dean of Hawler Medical School, the president of Hawler Medical University and the dean of Hawler Nursing School, as well as the Minister of Health and the Minister of Higher Education (Hawler is the Kurdish name for Erbil, capital of the province). We also visited the mental health unit in Hawler Hospital and met with the consultants, psychiatric trainees and other staff. We also visited a newly commissioned long-stay psychiatric facility.

Sir: At the annual meeting of the Royal College in July, British psychiatrists were treated to a taste of the trainee's lot in France, the Czech Republic and the USA. It was reassuring to hear that UK training often compares favourably with that overseas.