In this issue, three papers discuss the issue of the brain drain: of psychiatrists from Egypt and Nigeria, and of nurses from East Africa. They explore the complexities of professional migration and its impact on the health of populations in source and recipient countries; they also review how recommendations for changes in policy and practice might influence the so-called ‘push’ and ‘pull’ factors that aggravate the brain drain.

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 practice of Egyptian psychiatrists emigrating to high-income countries is not a recent phenomenon. Egyptian doctors have long travelled in search of training and education and to better their standards of living. The debate continues. What effective measures can be taken to reduce the brain drain, or at least its effect on Egyptian mental health services?

The brain drain of medical professionals from lower-income to higher-income countries contributes to the current inequity that characterises access to mental healthcare by those in need across the world and hinders efforts to scale up mental health services in resource-constrained settings, especially in Nigeria and other West African countries. The migration of skilled workers is driven by a combination of the globalisation of the labour market and the ability of highly resourced countries to attract and retain specialists from poorer countries. If we are to ameliorate the worldwide shortage of mental health professionals, we need to find innovative ways of attracting young doctors into psychiatric training in all countries. We must also introduce measures to improve health worker retention in low- and middle-income countries.

Although mental health legislation has existed in India since the mid-19th century, it has gone through various changes over the years and the Mental Health Care Bill 2013 has generated a lot of debate and criticism. Despite its shortcomings, the general expectation is that this bill will usher in a new era of proper care and allow people with mental disorders to lead a dignified life.

Continued efforts to produce appropriate mental health legislation in Pakistan led to the Mental Health Ordinance of 2001. However, with the 18th amendment to the constitution and devolution of health responsibilities to the provincial governments, it became the task of the provinces to pass appropriate mental health legislation through their respective assemblies. Currently the mental health legislative picture is fragmented and unsatisfactory. Only the provinces of Sindh and Punjab have a mental health act in place and there is an urgent need for similar legislative frameworks in other provinces to protect the rights of those with mental illness.

Despite all the internal and external criticisms of mental health services in Libya, they remain underdeveloped across the country. The World Health Organization has made efforts to improve the country's mental health services; however, until a stable government is formed, patients with mental illness will continue to be deprived of their basic needs.

This paper describes the challenges in starting a service for the diagnosis of and intensive therapeutic intervention for children with autism in a provincial town in western Greece (Messolonghi). Personnel had to be trained, the community had to be educated to accept and use the new service, and stigma had to be dealt with. Currently, fully developed 10 years after the beginning of the effort, in any one week the Day Centre serves on average 35 children with autism and 20 children with specific language impairment. The treatment programme runs along behavioural lines and the results are presently encouraging. Of 32 children referred consecutively to the Centre, after 5 years eight (25%) were attending regular school classes without a diagnosis of autism and eight (25%) with milder symptoms were attending classes with academic assistance. The limited impact of the Centre on the wider community is discussed.

This paper describes an innovative institution, Capacitación y Desarrollo Integral AC (CADI – Comprehensive Training and Development), created in Mexico to develop evidence-based interventions grounded in the principles of inclusion, independence, social and health equity that promote the well-being of persons with intellectual developmental disorder older than 14 years.