All psychiatrists would acknowledge that communication between individuals is fundamental to their speciality, but it is perhaps less obvious that the increasing ease and speed of communication worldwide are also having a profound effect on psychiatric practice. With this improved communication comes an awareness of the commonality of many mental health issues and recognition that there is much to learn from others working in very diverse environments. It is also true that many mental health problems have an international dimension, particularly when large numbers of people are displaced by war or other disasters. Increasingly we need to have a better understanding of other cultures and the relationship between culture, mental health and psychiatric disorder.

According to the World Health Organization, 450 million people in the world currently suffer from some form of mental or brain disorder, including alcohol and substance misuse. Within this huge number, 121 million people suffer from depression, and more than 800 000 people die by suicide each year, with young people accounting for well over half of these. Projections from 1990 to 2020 suggest that, in future, the proportion of the global burden of all disease accounted for by mental and brain disorders will increase to 15%.

The importance both of undergraduate education in forming the knowledge base for the next generation of doctors and of their continuing professional development is widely acknowledged. The changes that are occurring to the undergraduate medical curriculum in many countries are therefore likely to have a long-term effect, although their specific effect on psychiatric teaching and the future of psychiatry is not yet apparent. This is of particular significance in the context of a continuing crisis in the recruitment and retention of mental health professionals in general, and of psychiatrists in particular, when the need to attract doctors into the specialty has never been greater (Sierles & Taylor, 1995).

In this, the inaugural issue of International Psychiatry, we are highlighting the first of many themes that are of interest and concern to psychiatrists around the globe. Terrorism is both directly and indirectly the predominant topic in our media at present. What impact does living with such a threat, an ‘ever-present danger’, have on our mental health? Even if we are not directly affected by terrorism, psychiatrists cannot ignore the effects such incidents have had on societies in both the developed and the developing world.

Trauma can have both acute and insidious effects upon children's mental health. We present four articles, each of which offers a new perspective on this important topic. As Daniel Pine points out, in the first paper, as many as one in five children in the developed world can expect to experience a truly traumatic event, while half those in developing countries may do so. Such experiences can be either personal – such as emotional or sexual abuse – or impersonal – being shot or blown up in a conflict of which one understands little, except the misery it brings. How do children cope? We know that there are at least two important influences that moderate the impact of trauma on the developing child: the persistence and severity of the experience, and the degree of social support available. Beyond these broad generalisations, little is understood about what should be done or what could be done to minimise the long-term consequences of growing up in an environment characterised by cruelty, exploitation and death.

Modern biomedical psychiatry is the product not only of scientific enterprise but also of the progressive secularisation and medicalisation of moral life in the West (Jimenez, 1987). Psychiatry is an evolving cultural product. Its diagnostic categories represent pathologies rooted in Western notions of self, identity, normality and abnormality (Gaines, 1991). Psychiatric practice in Egypt, on the other hand, is the product of two different and often incompatible world views, namely Western psychiatry and Egyptian concepts of self, identity, normality and abnormality. The task of the psychiatrist in Egypt is to negotiate symptoms and diagnoses in a way that is sensitive to the demands of these two competing cultural streams. Analysis of this process provides a unique view of the ways in which culture can have an impact on professional psychiatry in any society or ethnic context.

Financing is a critical factor in the realisation of a viable mental health system. It is the mechanism by which plans and policies are translated into action through the allocation of resources. Financing is essential for operations and the delivery of services, for the development and deployment of a trained workforce, and for the required infrastructure and technology (Chernichovsky & Chinitz, 1995; World Health Organization, 2003). Financing mechanisms can also be used to facilitate change and introduce innovations in systems (World Health Organization, 2003).

On 11 September 2001, the United States suffered the worst terrorist attacks in its history. In New York City, approximately 3000 persons were killed at the World Trade Center, while many thousands fled for their lives. Millions of other city residents observed the burning towers and breathed the acrid smoke that blanketed the city. Compounding the massive physical destruction and loss of life, the psychological impact of these terrifying events on the populace was profound – there were significant increases in mental distress and symptoms of disorder.

Interest concerning the effects of trauma on the mental health of children has grown markedly during the past few years. At least three factors contribute to this growing concern.

The use of the term ‘eHealth’ is gathering momentum across Europe as the wider implications of the health care reforms enabled by information technology become apparent. There is a growing realisation by both health care providers and consumers alike that change in the sector is now imperative and timely. Member states of the European Community are all facing an increase in the requirement for health care provision because of changing demography, in particular ageing populations. In the face of an increasing demand for services, the existing model for health care delivery is arguably inadequate. In many ways it is economically unsustainable, even by the wealthiest countries in Europe.

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).

Many African countries gained political independence in the 1960s and 1970s and went through difficult times in economic, political and security terms in the 1980s and early 1990s. Mental health services and research were not spared and stagnated or deteriorated during this period. The effects of poor governance, inequitable distribution of resources and environmental degradation conspired with natural and man-made disasters (wars in particular) to drive Africa into an abyss of despair.

Health care will undoubtedly change over the next 20 or 30 years as eHealth technologies become increasingly used and accepted (Treister, 1997; Yellowlees, 1997, 2001). At a global level, the health care system is moving away from episodic care to concentrating on continuity of care, especially for patients with chronic diseases (Yack, 2000), who will give rise to the greatest disease burden in the future (Murray & Lopez, 1999). Many countries are gradually moving away from a focus on the service provider to a focus on the informed patient, and from an individual approach to treatment to a team approach. Increasingly there is a concern less with the treatment of illness and more with the need for wellness promotion and illness prevention, which, of course, parallels a shift away from traditional care to community care.