This paper provides a six-point definition of what parity of esteem for mental health means in practice. It highlights examples of the current disparity between mental and physical health and the importance of redressing this. The significance of securing a legislative basis for parity in England is discussed. The authors make a call for action, and pose six questions for international readers to consider and respond to.

We are now seeing in clinical practice a generation of young women who are referred for psychiatric treatment by their parents because they are rebelling against society's cultural norms but it is often apparent that women fear their families finding out that they are seeking psychiatric help. Despite improvements in the cultural understanding of women's right to equality, there remain deeply rooted practices and cultural norms that continue to adversely affect women's mental health and well-being. Physical abuse, for instance, is rarely reported, for fear of shaming the family, or of retaliation with further abuse. Mental health services in many countries in the Middle East are undergoing reform, but little research has been done into gender differences in service delivery or needs.

There has been increasing policy interest in the interface between mental and physical health in recent years. One of the key objectives of the current Cross-Government Mental Health Strategy (for England) is to improve the physical health of those who suffer from mental illness. In parallel, people who suffer from long-term physical conditions have very high rates of comorbid mental ill-health, which are associated with worse outcomes, can delay recovery and can lead to longer hospital stays. Therefore there are opportunities for liaison psychiatry to do its part in helping our healthcare systems to deliver better outcomes in an economically challenging environment.

It appears self-evident that psychiatry should be classified as a particular specialty within the broader field of medicine. Psychiatrists, being first and foremost doctors, have undertaken an identical basic training to their physician and surgical peers and, as in general medicine and surgery, the biomedical model is a central pillar of psychiatric practice. Within psychiatry, signs and symptoms are elicited, diagnoses made and very often physical interventions (in the form of psychotropic agents) are employed. However, familiar institutional conventions can conceal the fact that psychiatry suffers from greater uncertainty regarding its conceptual foundations than other fields of medicine. In fact, the conceptual challenges arising within psychiatry are reflected in its thriving field of philosophy, and although there exists a dedicated philosophy of medicine, no other specialty is equal to psychiatry's breadth of conceptual debate.

The recent financial crisis in Greece has affected the mental health of the population as well as mental health service provision and planning. These new adverse circumstances call for the profession's swift response. In this paper we make evidence-based suggestions for urgent, as well as longer-term, mental health reform. We consider psychiatric prevention and mental health promotion to be the central principles to abide by in the long term. We also offer suggestions for important current issues, including the devolution and coordination of decision-making, the further development of community psychiatry and the implementation of sectorisation, support for service user involvement, the reform of psychiatric education and the creative integration of mental health service provision with Greek culture. We conclude that enhanced participation of the profession in decision-making and service planning can result in cost-effective, evidence-based reform.

Decades of neglect have left the mental health system in Libya in bad shape. Services for the entire population are scarce, highly centralised and provided only through two psychiatric hospitals in the two biggest cities of the country. There are virtually no other mental health services anywhere else in Libya. Even the most basic of services, such as the availability of psychotropic medication for people with severe mental illness, are scarce outside Tripoli and Benghazi. This paper reviews the state of the country's mental health services since the civil war of 2011 and highlights a new fourfold approach taken by the management of the psychiatric hospital in Tripoli.

Reported rates of child sexual abuse in China fall at the lower end of the range found in Western studies. However, most of the studies were conducted in only one city or province and thus their results may not be generalisable. Acknowledging the infeasibility of recruiting a truly representative sample, we conducted a survey during 2009–10 using a probability sampling procedure to obtain a large and diverse sample of school-aged adolescents from six regions in China. About one in every 13 children had had experience of sexual abuse. Routine screening in medical and social settings is urged. Efforts should be made to ensure wide awareness of this issue.

The effect, if any, of recent economic problems on mental health in the Republic of Ireland is not fully clear. Rates of suicide increased slightly between 2006 and 2011, and there was a notable increase in 2011 itself. Rates of psychiatric admission continued to fall, however, in line with national mental health policy. Use of sedative and tranquilliser medications (but not antidepressants) increased, although use in the Republic of Ireland remains substantially lower than in Northern Ireland. Mean self-rated happiness in Ireland declined steadily and significantly between 2005 and 2012. In 2009, as economic problems deepened, satisfaction with income replaced satisfaction with health as the strongest correlate of happiness in Ireland. By 2011/12, however, none of the traditional correlates of happiness retained an independent association with happiness. Overall, these trends suggest that suicide prevention strategies will be increasingly important for Ireland in future years. Active labour-market programmes to address unemployment may also play an important role in suicide prevention. Rates of mental illness and medication usage in the community merit further study. The solution to declining happiness levels may elude purposive description but this trend is likely to reverse as Ireland's economic prospects improve.

Data from five waves (2002–10) of the European Social Survey were examined to see the extent to which heterosexual and homosexual couples differ in their health and happiness. Homosexual people had lower levels of self-rated health and happiness. We suggest that those who experience discrimination are more strongly integrated in their gay community, which, in turn, may bring positive effects in terms of happiness due to a sense of belonging, but may be accompanied by the specific health risks associated with this community.

This paper begins by outlining the nature of the present conflict in Syria. It goes on to describe the psychological consequences of this conflict and the present state of the mental health services in the country.

We revisit our previous work on child abuse in Kuwait, with a focus on the sexual abuse data, and discuss the findings in the context of the local culture. In 2006, a nationwide sample of 4467 senior high-school students (mean age 16.9; 48.6% boys) at government secondary schools was studied. Over their lifetime, 8.6% had been sexually attacked, 5.9% had experienced someone threatening to have sex with them, 15.3% had experienced unwanted sexual exposure, and 17.4% had had someone touch their sexual parts (boys 21.1%, girls 14.0%; P < 0.001). Most perpetrators were members of the extended family. The way to assist ‘dysfunctional families’, where ‘family honour’ and the need for peaceful relations with neighbours have priority over the mental health of female victims, is to propagate the finding that child sexual abuse has a wide-ranging deleterious impact on psychosocial functioning.

According to preliminary data, by 2010 the economic crisis in Spain had already led to an increase in the prevalence of anxiety, mood disorders and alcohol misuse, identified in primary care settings, but there had not been an impact on suicide rates. Since then, several indicators suggest that the full impact of the economic crisis on mental health was delayed, until at least the second half of 2011 and even later, to 2012. There is increasing evidence that budget cuts had a particular impact on mental healthcare during this latter period.

This paper reports the results of a cross-sectional survey of 11- to 16-year-old school-going youths in ten southern African countries. The survey instrument recorded both the experience of coerced sex and the perpetration of forced sex. There were prominent school and community risk factors for increased risk-taking behaviours, revictimisation and the perpetration of sexual violence. This supports the idea that the local culture can reinforce the antisocial consequences of sexual abuse of boys and girls. There was a suggestion that the school environment can compound the effects of child sexual abuse in terms of conscious knowledge, high-risk behaviour, the risk of revictimisation and disdain for the safety of others.

Heterosexuality continues to be regarded and adopted as a norm in the majority of Asian societies. In Hong Kong, lesbians and gay men are still encountering unfavourable attitudes from the general public (such as stereotyping and discrimination). This paper briefly reviews the legal and cultural context and notes in particular the situation in schools.

Sudan has endured the longest civil war in the history of Africa. The conflict between the northern (mainly Arab) and southern (mainly sub-Saharan African) populations started in 1983, and in its first phase continued for 22 years. The combination of civil war and famine has taken the lives of nearly 2 million people and displaced an estimated 4 million people from their villages and homes. This paper presents some data on the prevalence of mental disorder and the mental health service response to the situation.