Since 1994, child and adolescent psychiatry has been a distinct specialty, separate from psychiatry, within the Union of European Medical Specialists (UEMS). It has a slightly curious title, of which more later. It has proved a successful arena for promoting training, and this in turn has led to a developing European view of what exactly child and adolescent psychiatry is, and how it can be practised. This article tries to reflect this.

I greatly welcome this opportunity to contribute to the first edition of International Psychiatry and to wish it well on its maiden voyage; the aim of this contribution is to outline those structures and objectives of the World Psychiatric Association (WPA) that are relevant to members of the Royal College of Psychiatrists.

According to the most recent data provided by the World Health Organization (2001), there are presently in Europe more than 77 000 psychiatrists, more than 46 000 clinical psychologists active in the mental health field, more than 285 000 psychiatric nurses, and more than 91 000 social workers operating in the mental health sector. Are these professionals being adequately updated on recent clinical and service developments in mental health? What is the role of international channels (in particular, those of international professional associations) in this process? These are difficult questions to answer, in the absence of a European systematic survey (which, of course, would be a very worthwhile initiative). I try, however, to provide here a framework for a discussion of these issues, as a background to the presentation of the programme of itinerant educational courses run by the Association of European Psychiatrists (AEP).

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.

In the early 1980s, when the first cases of AIDS were being reported in the gay population and among intravenous drug users, epidemiological research indicated that the disease was both blood-borne and sexually transmitted. Mental health care workers had little concern about infection among people with serious and persistent mental illness, because this population was felt to be too disabled to engage in the sexual or needle-sharing behaviours that put one at risk. Yet the first case of AIDS in a US state psychiatric facility was diagnosed in 1983, when a woman in her mid-20s, who had been hospitalised for several months, developed Pneumocystis carinii pneumonia (Cournos et al, 1989). This case was quite shocking to the treatment team, for two reasons: first, AIDS had unexpectedly entered the psychiatric population; and second, the person infected was a woman, when the disease was being reported almost exclusively in men in the United States.

The World Association for Psychosocial Rehabilitation (WAPR) could be considered as a newcomer among scientific societies in the mental health field, because it was established in 1986 in France, when about 100 professionals from 35 countries met at its founding congress. That congress was preceded by an extensive international planning process, which began with the First World Congress on Rehabilitation for the Mentally Ill in Helsinki, in 1970. Subsequent meetings of key professionals and agency representatives from various countries, mainly supported by the World Health Organization (WHO) and the International Labour Office, resulted in the formation, in 1980, of a promoting group which planned, through its international secretariat, the foundation of the WAPR. Therefore, close links with the mental health programme of the WHO have been maintained by the WAPR since its beginnings.