The Roma people are one of the most unknown and interesting nations in Europe. Although they are severely marginalised within European societies, they have greatly influenced European culture. Despite this fact, there is a deep prejudice against them. In the region of East Macedonia and Thrace, a significant proportion of the population are Roma. Their marginalisation leads to many problems and also affects their mental health. Their psychopathological manifestations differ from the majority population. They express more somatic complaints and higher overall stress in a histrionic background. The main obstacles regarding their mental health issues and treatment appear to be the following: gender inequality, illiteracy and lack of cultural sensitivity in healthcare system. Although all of these obstacles must be removed, some are easier to remove than others. Cultural sensitivity could be applied by using more culturally sensitive diagnostic tools, improving overall training for mental health professionals and treating Roma wherever they seek help, because they often have a nomadic style of living. Telemedicine can be quite useful in serving this goal. Improving their educational status and addressing gender inequalities issues, on the other hand, are more difficult and long-term goals.

The Republic of Trinidad and Tobago is the most southerly of the Caribbean island states. Trinidad is just 14 km from the coast of Venezuela. Trinidad covers an area of 4828 km2 while Tobago, the sister isle, has an area of 300 km2. The total population is approximately 1.3 million; 40.3% of the population is of East Indian descent, 39.6% of African descent, 18.4% mixed and 1.7% belong to other ethnic groups (Central Statistical Office, 2001). St Ann's Hospital in Port of Spain, the capital, was established in 1900 and is the country's only psychiatric hospital. There are two general hospitals, one in the north, at Port of Spain, and the other in the south, at San Fernando.

There has been a rapid rise in the number of people with mental disorders. These disorders represent a major challenge to global development. The burden will be higher in developing countries, which have the least resources to respond. World-wide, 450 million people are affected at any given time. No group is immune to mental disorders but the risk is higher among: the poor; children and adolescents; abused women; the unemployed; persons with little education; neglected elderly people; victims of violence; migrants and refugees; and indigenous populations.

The association between mental illness and poor physical health has been known for decades (Philips, 1934). This is not a trivial relationship between mental ill health and minor physical problems but an association with such poor physical health that it results in premature death. For example, a study in the USA showed that the life expectancy of those with schizophrenia or other serious mental illness was 9 years shorter than for the general population (Dembling et al, 1999). Similarly, those with learning disabilities have an increased risk of early death, and this increase is greater in those with severe disability.

In the United States, the patient has emerged as the central focus in evaluations of mental health services (Buckley, 1993). Whereas evaluation research in the 1980s emphasised the structure and process of mental health care, current evaluation research incorporates client-based measurements of treatment outcomes, such as symptom reduction, functional status and quality of life (Chisholm et al, 1997; Campbell, 1998). In addition, patient satisfaction with mental health services is increasingly used as an outcome dimension and an indicator of service quality (Center for Mental Health Services, 1996; Teague et al, 1997; Howard et al, 2003).

The move to provide psychiatric services within the general health care system has resulted in emergency departments becoming the means of access to acute psychiatric care in Australia (Gillette & Bucknell, 1996). Triage within the emergency departments ensures that patients are reviewed and treated in a timely manner, in accordance with the urgency of the presenting problem. The National Triage Scale was developed as a clinical tool for this purpose for use in Australia and New Zealand (Australasian College for Emergency Medicine, 1994). However, this scale tends to attach lower priority to psychiatric issues (Smart et al, 1998).

A woman in the care of the author 40 years ago was reported to have been sleeping for 2 days. We treated her condition as conversion hysteria. Her private psychiatrist was the renowned R. D. Laing; he was unhappy with our line of management, on the grounds of the arbitrariness of the diagnosis, the labelling of the woman with a diagnosis of hysteria and the treatment of the patient without her consent. In retrospect, I wonder if she was in a state of yogic sleep (yoga nidra).

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.

Azerbaijan is a nation with a Turkic population which regained its independence after the collapse of the Soviet Union in 1991. It has an area of approximately 86 000 km2. Georgia and Armenia, the other countries comprising the Transcaucasian region, border Azerbaijan to the north and west, respectively. Russia also borders the north, Iran and Turkey the south, and the Caspian Sea borders the east. The total population is about 8 million. The largest ethnic group is Azeri, comprising 90% of the population; Dagestanis comprise 3.2%, Russians 2.5%, Armenians 2% and others 2.3%.

Indigenous people face numerous challenges to their mental health across the world. We consider the situation in Bangladesh, where those living in the remote hill tracts areas of Eastern Bangladesh experience widespread difficulties. Few seek attention for their problems from professional services, in part because of stigma or a lack of awareness that help could be made available, but also because in these remote areas few resources are available. We make recommendations to improve this situation, which could be implemented with the assistance of primary healthcare services and traditional healers.

This paper describes the evaluation of a pilot e-supervision programme, with a focus on feasibility. The findings suggest that e-supervision in mental health using the World Health Organization (WHO) Mental Health Gap Action Programme (mhGAP) Intervention Guide and case-based discussions is valued by participants and can improve the knowledge, confidence and beliefs of primary care doctors in low- and middle-income countries.

Gypsy, Roma and Traveller (GRT) communities have considerably worse mental health outcomes than the general population and many other ethnic minority groups. We argue that there is a dynamic, interplaying ‘accessibility mismatch’, resulting in a failure of healthcare services to adequately understand and work with GRT communities in a meaningful way. The consequences are limited engagement and poor health outcomes. Contact with services is often at crisis points, such as in forensic services, which reinforces existing prejudice. Research is limited, and therefore so is the evidence base. It is critical that the UK's National Health Service takes a culturally informed approach to co-produce services that are accessible and responsive to GRT communities. Here we offer practical actions that healthcare organisations can undertake to help redress imbalances and increase equity of healthcare outcomes for these overlooked populations.

The Middle East has been in conflict for many decades and wars have become the ‘normative reality’ of children residing in the area. Questions have been raised about children's vulnerability to the stresses that come with living in a war area. Are children more resilient because they are more flexible in their ways of coping? Or are children more vulnerable because their psychological development is influenced by the environment?

Australia was one of the first countries to develop a national mental health strategy. This article reviews the progress of reform, outlining some strengths, weaknesses and prospective challenges.

This article examines factors that are salient to understanding forced marriages and provides an overview of the issue. It aims to promote awareness in the UK, where there is a need for services to develop appropriate responses, as primary care and the local psychiatric services are not geared up to tackle such transcultural issues.

This article aims to explore the barriers and challenges of implementing psychiatric rehabilitation services at a psychiatric hospital in Iran. We performed an internal mixed-methods evaluation by adopting a multi-method approach. The data were organised, analysed and interpreted by the evaluation team. A low participation rate, administrative issues, low fidelity to protocols and incomplete documentation were the main findings.

Implementing and maintaining rehabilitation services in low- and middle-income country settings requires more than a mere transfer of models of psychiatric rehabilitation; it needs adaptation to the local context as well as continuous evaluation and quality improvement in an iterative fashion, given the rapidly changing contexts with scarce resources.