The 2013 report from the Intergovernmental Panel on Climate Change has caused renewed concern among both clinicians and health policy makers. Climate change is continuing at an increasing rate. This guest editorial describes how climate change might affect global mental health and proposes three things that psychiatrists from every country could implement to respond appropriately to this urgent and severe global threat. These responses are mitigation and adaptation strategies for mental health services, and the integration of sustainability into training.

There is a clear interest in many countries in improving education, training and academic opportunities in mental health. The goal of SUD World Project is to create links between South America and Europe that will actively enhance education and training in mental health.

The landscape of some low- and middle-income countries is sadly all too often littered with the remains of well intentioned health development projects that have failed. The Kintampo Project in Ghana is an education intervention that is set to achieve the most elusive of outcomes in development work, namely genuine sustainability. This article focuses on the challenges faced by the project and the factors that have allowed it to reach its targets.

Fiji inherited a British colonial healthcare system. In 2010 the long dormant mental health law was replaced by the Mental Health Decree (MHD), which set up divisional mental health units for the purpose of managing mental health problems outside of the old asylum. The Ministry of Health recruited an overseas consultant to help improve training. Under the MHD, stress management wards, stress management clinics and stress management day centres have been set up, to decentralise and deinstitutionalise psychiatric care. These are on the whole doing reasonably well and have good client acceptance.

Ugandan mental health legislation, which dates from 1964, principally aims to remove persons with mental disorders from the community but also to protect their safety, by keeping them in confinement, although this has been without consideration for clinical care. In response to criticism from various stakeholders and advocates and the need to reflect modern clinical care, Uganda undertook to review and amend the mental health legislation, as part of the Mental Health and Poverty Project (MHaPP). We report on work in progress advancing new legislation.

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.

This study compared beliefs about and attitudes to mental illness among medical and nursing students at two teaching hospitals in Nigeria with very different levels of psychiatric instructional capacity. Factor analysis of responses to a 43-item self-report questionnaire identified three domains: social acceptance of people with mental illness; belief in non-superstitious causation of mental illness; and stress, trauma and poverty as external causes of mental illness, with entitlement to employment rights. Students at the hospital with a larger, functioning psychiatry department had significantly higher scores on all three factors. Culturally enshrined beliefs and attitudes about mental illness are not uncommon among medical trainees. The availability of psychiatric education and services may have a positive effect on beliefs and attitudes.

When Thomas Szasz summed up his philosophical principles at the Royal College of Psychiatrists' annual meeting in Edinburgh in 2010, he declared that ‘freedom is more important than health’. Psychiatry is the arena in which the conflict between freedom and health comes most sharply into focus, according to Szasz. This paper proposes some parallels with medicine in low-income countries for pointers towards a resolution of this conflict.

Dr Trevor Turner was asked to provide a commentary on the preceding paper in this issue, ‘“Freedom is more important than health”: Thomas Szasz and the problem of paternalism’, by Joanna Moncrieff.