Psychiatry has probably always been the least attractive of the medical specialties. The choice of psychiatry as a career has been consistently low in the English-speaking world over the past 50 years (British Medical Journal, 1973; Feifel et al, 1999; Brockington & Mumford, 2002). Over the past decade there has probably been a further decline in the proportion of medical graduates choosing to train in psychiatry (Sierles & Taylor, 1995; Feifel et al, 1999).

At a workshop in 2012 in Khartoum, attended by Sudanese psychiatrists based in both the UK and Sudan, as well as psychologists, social workers and lawyers from Sudan and elsewhere, a draft Mental Health Act for Sudan was approved; it is due to be submitted to the Sudanese Parliament. We give a summary of the draft Act and outline some of the areas that need further discussion.

Mental health is a core part of the Sustainable Development Goals (SDGs) agreed by the United Nations General Assembly. This follows on from the World Health Organization's 2013 Global Action Programme. The World Bank is also expected to give mental health greater priority. Moreover, mental health is now seen as essential in disaster relief management. However, although global policy towards mental health has improved, there are only rare examples where this has been translated at scale into action. There are, nonetheless, reasons for optimism in the new policy background, in the many innovative practical developments around the world and in the way that evidence is being gathered and learning shared. The understanding that mental health is intimately connected to physical, social, environmental and economic health – which is so evident in the SDGs – represents a major change in mind-sets globally.

In-patient treatment is a complex system of recursively interacting components. Patient characteristics interact with caregiver characteristics, home context and ward factors. Quality improvement requires primary focus on the interacting factors over which the ward itself potentially has influence. Ward practice has to integrate the demands of the hospital owner, the legal framework for treatment and what we know facilitates effective treatment plans. We describe how we have implemented a quality improvement system that addresses these interplaying influences in acute adolescent psychiatry in Norway. The process involved with this system (developed in the UK for child and adolescent psychiatric units) is independent of the organisational structure of the department and which alternative resources it has to rely on. It is independent of the characteristics of the patient population, although specific standards can be developed for local requirements.

Amidst the current global surge in physician burnout, a compelling need arises for precisely targeted research and interventions that cater to specific contexts, illuminating a path towards professional well-being. This brief communication analyses recent studies on physician burnout in Oman, critically evaluating the findings, cultural factors, methodological limitations and future growth opportunities. Distinct elements of Omani culture, encompassing attitudes towards mental illness, gender roles and patient expectations, can distinctly influence how burnout presents in this population. Advanced mixed-methods research integrating cultural insights, biomarkers and longitudinal tracking is needed to characterise burnout in Omani physicians. The findings can play a significant role in developing comprehensive interventions, at both a systemic and an individual level, that promote well-being of physicians while specifically aligning with the cultural values of Oman.

To address the growing need for good-quality mental health service provision to patients in Iraq, mhGAP-IG 2.0 training in mental, neurological and substance use (MNS) disorders was delivered for primary care physicians in May–June 2022 by the Royal College of Psychiatrists (RCPsych) volunteers scheme. An innovative hybrid model was used to deliver this training to improve engagement compared with virtual training alone. Pre- and post-training assessment tools showed a significant improvement in participants knowledge of MNS disorders. Follow-up fortnightly supervision sessions by RCPsych volunteers were planned to help participants consolidate their learning in managing MNS disorders.

The authors wanted to learn whether it was possible to deliver cognitive-behavioural therapy (CBT) in a low-income country where English is neither the first nor the preferred spoken language and to evaluate the effectiveness of the training in terms of skills acquisition. Twenty participants attended a 3-day workshop on the technique. All had experience of communicating in Hindi with patients, although their medical training was in English. There is no manual for CBT in Hindi. Role-plays focused on basic CBT skills such as Socratic dialogue, the ‘five area’ approach, the use of the ‘downward arrow’, developing an automatic negative thought record and devising behavioural experiments, in Hindi. The findings suggested that it is feasible to train mental health professionals in CBT where English is not the first language.

Ireland is the third largest island in Europe and the twentieth largest island in the world, with an area of 86 576 km2; it has a total population of slightly under 6 million. It lies to the north-west of continental Europe and to the west of Great Britain. The Republic of Ireland covers five-sixths of the island; Northern Ireland, which is part of the United Kingdom, is in the north-east. Twenty-six of the 32 counties are in the Republic of Ireland, which has a population of 4.2 million, and its capital is Dublin. The other six counties are in Northern Ireland, which has a population of 1.75 million, and its capital is Belfast. In 1973 both parts of Ireland joined the European Economic Community. This article looks at psychiatry in the Republic of Ireland.

At 8.52 a.m. on 8 October 2005 an earthquake measuring 7.6 on the Richter scale struck the northern part of Pakistan and devastated large areas of North West Frontier Province and Azad Kashmir. Almost 90 000 people died and many thousands were reported missing. Half the dead were estimated to be children, killed in their classrooms. Some 3.5 million people were rendered homeless. The mountainous terrain made relief work a logistical nightmare.

The increasing evidence base for cost-effective interventions and a fledgling advocacy effort have given momentum to mental health becoming a global priority. The contention of this editorial is that we are at a tipping point if we can exploit the opportunities that will be afforded to mental health professionals and advocates in the next year or two. The missing links are the development of consensus among mental health stakeholders, the formation of coalitions and partnerships with both advocates and policy-makers, and the mobilisation of a stronger advocacy effort built around consumer and family member ‘voice’ and empowerment.

Misinterpretation in major surveys of alcohol use disorder as described by DSM-IV (Hasin et al, 2007) has raised serious questions regarding the extent of alcohol use disorder, and the relationship between alcohol abuse and alcohol dependence. While the adverse social, physical and mental effects of alcohol misuse are well known (Council on Scientific Affairs, 1996), there is little information on the determinants of alcohol abuse (societal impact) and alcohol dependence (physiological impact). We therefore examined their separate and combined associations with demographic, social and health characteristics in a representative community-resident sample aged 60 years and over. We hypothesised that, while for each of the three groups (those with alcohol abuse, those with alcohol dependence, and those with both) there would be associated demographic characteristics, abuse would be more closely associated with social characteristics, dependence with health characteristics, and the combined presence of abuse and dependence with both social and health characteristics.

Globally, poverty has been noted to be a high risk factor for mental disorder. Although there is limited information on the baseline prevalence of mental disorders in low- and middle-income countries, the known risk factors for poor mental health, such as poverty and violence, afflict many of these areas (Miller, 2006). It is clear that poverty and the mental health consequences of war and displacement significantly hinder the achievement of the Millennium Development Goals (Njenga et al, 2006).

This paper describes the historical background, development and current status of psychiatric services in Kuwait. In addition, present practices and the outlook for further development of services are outlined.

Bulgaria has never had a separate law on mental health. Issues such as mandatory treatment, guardianship and legal capacity were regulated in the People's Health Act, which was in force until 2005, when it was replaced by a new Health Act. That Act has a chapter relating specifically to mental health, and this article describes its provisions.

Oman has been recognised as the leading country in terms of recent developments in public health. However, there is a shortage of mental health services, which poses challenges for people seeking such services, particularly those from rural areas. This often results in delayed treatment and longer periods of untreated mental illness.

This is a reappraisal of psychiatric morbidity in North Americans from Indigenous backgrounds, or those from longstanding minority communities. Psychiatric morbidity is often no higher when compared with controls that are similar in other sociodemographic features. Interventions should therefore take into account that disadvantage is rarely from one cause.

Exploring traditional healing practices in the Arab world unveils a diverse range of methods deeply rooted in ancient beliefs. Traditional healing practices encompass natural remedies, spiritual rituals and physical treatments. These historical practices persist today, reflecting their enduring relevance in Arab culture and their influence on healthcare approaches. Factors such as accessibility to traditional healing services, a lack of affordable medical treatment, cultural familiarity and a strong belief in the efficacy of traditional healing methods in treating mental problems contribute to their continued use. However, potential challenges arise when an exclusive reliance on traditional methods might hinder access to critical medical interventions. Thus, the need for further documentation and research into these deeply ingrained healing traditions is emphasised. Some research has focused on integrating these traditional approaches with the modern medical system, recognising their combined value in healthcare. This balanced approach holds the potential to bridge the gap between culturally informed traditional practices and contemporary medical treatments.