The clinical practice of psychiatry should incorporate a biopsychosocial model of illness, acknowledging both cultural and social influences on the patient's experience. Medical humanities include a number of academic disciplines that complement the clinical practice of psychiatry. The medical profession, including psychiatry, has a social responsibility to study the psychosocial context within which people become ill and have to be treated. Although the biopsychosocial model of illness has strong theoretical foundations, its application in clinical practice is limited. A new approach would be to restructure medical student teaching to include medical humanities in the first year, and to share such education with other professions.

The Sultanate of Oman is located in the south-east of the Arabian Peninsula. It has a distinctive history and subcultures. Its seafaring tradition has endowed the country with various ethnic and linguistic groups, with Arabic being a dominant language and Ibadhi being the dominant sect of Islam (Al-Nami, 1971). Oman in the 1970s saw rapid development, triggered by the discovery of oil, which took place under enlightened new political leadership.

This paper highlights the extent of the brain drain in relation to human resources for health (HRH) that is currently challenging Kenya, and suggests strategies that have the potential to change current working environments and improve HRH retention rates. Governments in partnership with health professional bodies and regulators could improve the working conditions for psychiatrists and mental health nurses: by promoting career choices in mental health; by providing accessible professional development opportunities; and by easing workload pressures by expanding service reach through thoughtfully planned and delivered task-shifting to primary care. While these strategies have the potential to make a significant difference, the evidence suggests a brain drain will continue as long as working conditions remain sub-optimal and global HRH shortages persist.

The Islamic Republic of Iran is located in the Middle East between the Caspian Sea and the Persian Gulf. Iran's total land area is 1 648 000 km2. Its total population in 2003 was about 68 920 000 (UNICEF, 2003). The population growth rate is 1.41%. Of the total population, 60.4% live in urban and 39.6% in rural areas (Yasamy et al, 2001).

Paraguay is a landlocked country in South America. It is a democratic low-middle-income nation, and the Ministry of Public Health and Social Welfare is responsible for its healthcare system. Mental health services receive just 1–2% of healthcare budgets, and there are only 1.6 psychiatrists per 100 000 inhabitants. There are insufficient resources to adequately assess and treat mental disorders in high-risk populations such as children, adolescents and prisoners. Despite several improvements to mental health policies within the past two decades, the nation still lacks a Mental Health Act and specific policies required to optimise the mental health of the population.

Malawi is a country with an approximate area of 118 000 km2. Its population is estimated at 13 million and the gender ratio (men per hundred women) is 98. The proportion of the population under the age of 15 years is 47% and the proportion above the age of 60 years is 5%. The literacy rate is 75.5% for men and 48.7% for women (World Health Organization, 2005).

There is no national mental health law in Germany: the 16 German states are responsible for legislation concerning forced admissions, while the German Civil Code covers non-acute care, in particular for those not able to care for themselves. In forensic psychiatry, both federal and state laws apply. This article describes this situation and provides figures about detentions and other aspects of mental health law in Germany.

Nigeria's current mental health legislation stems from a lunacy ordinance enacted in 1916 that assumed the status of a law in 1958. The most recent attempt to reform the law was with an unsuccessful Mental Health Bill in 2003. Currently, though, efforts are being made to represent it as an executive Bill sponsored by the Federal Ministry of Health. The present paper reviews this Bill, in particular in light of the World Health Organization's recommendations on mental health legislation.

Child soldiers represent a challenging population for mental health and psychosocial support (MHPSS), as we have little evidence regarding their needs or the efficacy of interventions. Despite an increasing breadth of MHPSS interventions for children affected by war, very few are supported by evidence (Jordans et al, 2009). In a recent decade-long conflict, Maoists and the government of Nepal conscripted thousands of children to serve as soldiers, sentries, spies, cooks and porters. After the war ended in 2006, we began a project incorporating research into the development of interventions for former child soldiers. Through this work, conducted with Transcultural Psychosocial Organization (TPO) Nepal, we identified four key principles to guide research and intervention with child soldiers (Fig. 1). We present these principles as location- and context-specific examples of the growing effort to develop guidelines and recommendations for research and intervention in acute post-conflict settings (Inter-Agency Standing Committee, 2007; Allden et al, 2009).

When people living in poverty are asked to describe their living conditions, mental health issues quickly come to mind (grief, sadness, anger, fear, bitterness, frustration, discontent, anxiety, and emotional damage consisting of low mood and depression, fatigue, hypersensitivity, sleep difficulties and physical pain). Although the association between poverty and mental health have been widely demonstrated in the literature, care must be taken to avoid the psychiatrization of poverty. However, how can healthcare be provided to people living in poverty when basic needs are not met? This article explores the global challenge of providing mental health services in impoverished populations, using the example of the poorest country in America: Haiti. It examines the availability of services offered through the Mental Health Centre at Morne Pelé, and the necessity for innovative and comprehensive approaches to provide culturally appropriate care that meets the real needs of populations. It highlights effective measures that policy makers should implement to develop an efficient mental healthcare system based on the lessons of the Mental Health Centre at Morne Pelé.

This paper details the grounds for compulsory treatment, compulsory admissions in an emergency department and compulsory out-patient treatment in Portugal. Portuguese mental health legislation has improved significantly over recent years, with enhanced safeguards, rapid and rigorous review and clear criteria for compulsory treatment, although much remains to be done, especially in relation to the ‘move into the community’.

Mental health problems are almost ignored in Bangladesh, one of the most densely populated countries in the world. The lack of overall health literacy and human resources due to an ineffectively updated legal and regulatory framework, coupled with very limited but misused budget allocation, are some of the factors responsible for this. The country's Constitution recognises the importance of public health and stipulates the improvement of public health as an important primary duty of the state. Nevertheless, it is often compromised or neglected in favour of other socioeconomic development priorities. The Lunacy Act 1912 was recently repealed and substituted by the Mental Health Act 2018 to fill in various gaps in mental health law. This is a welcome development, but there remain limitations and scope for further improvement. We highlight some important provisions of this newly enacted law, identify some limitations and propose some issues for consideration in future policy reform.

Thailand is located in Southeast Asia and covers an area of 513 115 km2. In 2006 its population was approximately 64 million. The major nationality is Thai. About 80% of the total population live in rural areas. The country is composed of 76 provinces, divided into a total of 94 districts and 7159 sub-districts.

Ethiopia, in the Horn of Africa, is one of the ancient independent nations of the world and has a rich diversity of peoples and cultures. The country covers 1.1 million km2 (Central Statistical Authority, 2000a). It has a population of about 70 million people (Central Statistical Authority, 2002), 80 different ethnic groups and some 200 dialects. Ethiopia is the second most populous nation in sub-Saharan Africa, after Nigeria (Hailemariam & Kloos, 1993). Forty-eight per cent of the population are under 15 years of age and over 80% live in rural areas (Central Statistical Authority, 1995). Islam and Christianity are the main religions.

Mental health services and legislation in Brunei Darussalam have undergone a period of development and reform. This paper describes the challenges met, recent innovations and priority areas for the next 10 years.

Primary care is geared to manage patients with mild to moderate presentations of common mental disorders and to refer patients with more severe mental disorders to specialist mental health services. With growing demand for specialty care, the quality of the referral is increasingly important to ensure efficient patient flow across the primary/secondary care interface and appropriate use of secondary services. We report on an initiative in a Qatari mental health clinic to improve the quality of referrals from primary care to specialist mental health services through an educational intervention for family physicians. We highlight the problem, the intervention and the outcome of our initiative, which was the first of its kind in the region. The number of inappropriate referrals fell by 93%, and the number of referrals with inadequate clinical information declined from 15 (January 2019) to 1 (September 2019). Feedback was very positive; respondents reported feeling supported, with better understanding of care pathways, the scope of primary care and mental health services.

The forceful conscription of children (both boys and girls) into armed forces has been documented in at least 86 countries (Coalition to Stop the Use of Child Soldiers, 2008). Research suggests that these children may be at heightened risk of psychological and social problems (Wessells, 2009; Blattman & Annan, 2010). However, there is little information on the long-term effects of child soldiers' wartime experiences.

Compulsory admission to and treatment in psychiatric facilities have recently been brought into the spotlight by both psychiatrists and the media in Egypt. Interventions of this kind have always inherently involved deprivations of liberty and infringements on privacy. The debate around this issue acquired considerable heat after it was joined by the legislatures during the discussion of a Bill in Parliament. The Parliamentary Committee for Constitutional and Legislative Affairs questioned the constitutionality of the process of compulsory detention and requested more robust safeguards to protect the rights of persons with mental illness. The new Bill was passed by the Egyptian Parliament on 26 April 2009 and was due to come into force once ratified by the President and published in the Egyptian Gazette, expected in May.

During the past three decades Nepal has gone through series of reforms to address the mental health needs of the Nepalese population by promulgation of an exclusive National Mental Health Policy and related Strategic Action Plan. Small but significant improvements have been achieved in Nepal with regard to mental health policies and plans. This article discusses the evolution of mental health policies in Nepal and analyses the challenges to be overcome for their effective implementation.