Some principles of psychiatric practice are applicable across all healthcare settings and epochs, whereas other issues are more specific to one healthcare model and/or time. The increasing divergence of service models and underlying policies in the four UK devolved jurisdictions (England, Northern Ireland, Scotland and Wales) means that this distinction between general and specific issues has increasing relevance to the College. There are many benefits in identifying, and being strong advocates for, the generic principles of excellent psychiatric care, which are transferable across settings and relatively stable over time. These are also, of course, the principles that will have the most relevance in a broad international perspective that goes far beyond the UK.

In early 1933, the members of the British Federation of University Women (BFUW), an organisation which was established in 1907 to provide a supportive network for the growing number of academic women, embarked upon a unique humanitarian mission to aid their counterparts in Europe (Sondheimer, 1957; Dyhouse, 1995). This remarkable undertaking, which came to provide academic women refugees with professional, financial and practical support, was in direct response to the growing threat from Fascism and Nazism. Almost from the moment that Hitler came to power in Germany in January 1933, the BFUW Executive Committee began to receive a steady stream of calls from German members of the International Federation of University Women (IFUW), whose lives and careers were affected by restrictions imposed upon them by the Nazi regime. Some were seeking help finding work and settling in Britain, while others were looking for temporary help as trans-migrants on their way to the USA, New Zealand or Australia.

In Hong Kong, it is estimated that there are 1.2 million people with different types of mental illness, comprising one-sixth of the total population (Rehabilitation Division, Health and Welfare Bureau, 1999). Hong Kong has a well established mental health service and community support, yet many people still hold a biased view of psychiatry.

For many women, pregnancy and childbirth are not without substantial risk in terms of new-onset, recurrent or existing mental disorder. This has consequences not only in terms of poor maternal mental health but also in terms of increased pregnancy- and delivery-related morbidity and can have a significant negative impact on the wellbeing of the fetus or neonate. New-onset disorders such as postnatal depression and puerperal psychosis have been recognised for some considerable time but it is also becoming apparent that, with the exception of anorexia nervosa, severe intellectual disability and possibly schizophrenia, conception rates among women with all types of mental disorder are the same as those in the general population. In high-income countries, the widespread use of atypical antipsychotics, most of which do not impair reproductive function, may lead to increased conception rates in women with schizophrenia. In addition, pregnancy and childbirth are multifactorial stressors which may render women with previous mental disorders vulnerable to a recurrence. Hence it is no surprise that studies in urban, low-income and ethnically diverse populations in the USA estimate that around a third of pregnant women are suffering from a mental disorder when substance misuse is included (e.g. Kim et al, 2006).

Sir: In 2005, the Department of Health for England set a five-year action plan, Delivering Race Equality in Mental Health Care. The aim was to encourage the development of services that were more appropriate and responsive to the needs of both adults and children in Black and minority ethnic communities.

Sir: The article by Zigmond (2009) made for interesting reading. Mental health law is about balancing the need to detain people in order to protect them or other people from harm and the need to respect people's human rights and autonomy. In the UK, there was much concern during the development of recent mental health legislation, in particular the Mental Capacity Act 2005, that the government had got this balance wrong. Many of these concerns have been addressed in the updated Code of Practice to the 1983 Mental Health Act, which is an essential guide to practising under the Act (Department of Health, 2008). There is no legal duty to comply with the Code, but professionals must have regard to it and record the reason for any departure from the guidance (which can be subject to legal challenge).

Sir: Tony Zigmond's editorial is categorical in condemning the detention of people who are competent but mentally ill (Zigmond, 2009). He notes that the driver for this is risk, in both UK and international legislation. He contrasts this with physical treatment, for which he, and the judicial authority he quotes, believe competency gives an absolute right to refuse.