Stress and burnout are major issues affecting medical trainees, especially psychiatry trainees, throughout the world. Stress and burnout were studied using an online survey among psychiatry trainees of the National Institute of Mental Health and Neurosciences (NIMHANS) which is one of the oldest and largest training centers in India. Postgraduate training in academic institutions like NIMHANS, while offering excellent teaching experience, may impact the mental and physical health of trainees due to complex clinical challenges and academic pressure. Measures need to be taken to enhance trainee well-being by ensuring support from colleagues and seniors, allowing for an adequate work–life balance, introducing departmental level committees to address grievances and providing therapy and mentorship. Providing safe and non-stigmatizing spaces to seek help in workplace promotes whole-person growth and well being.

The history of psychiatry in Malta dates back to the 16th century. In the early 1990s, a detailed account of psychiatry in Malta documented the drive from institutional psychiatry to community psychiatry and outlined the difficulties with subspecialisation, staffing and training. Malta has since set up five community mental health teams, introduced new mental health legislation and introduced full postgraduate psychiatry specialisation. Work is continuing towards improvement of the country's mental health services and towards reducing the stigma associated with mental illness.

The main challenges faced by psychiatrists in the Arab world are stigma, shortage of resources, role of the family and effects of conflicts and migration. Psychiatrists practising in this region have to adapt to these challenges and use creative methods to provide a good service to their patients.

A woman in her mid-20s presented to a private psychiatric out-patient clinic with a longstanding obsessive–compulsive disorder of contamination. She had fled her home country with her family because of an ongoing armed conflict. They were under temporary ‘visitor’ visas and the possibility of their stay not being renewed created immense anxiety. The patient was prone to bouts of anger on a regular basis, causing her to shout at her mother and brother. Her mother was concerned that the neighbours might complain, which might get the family into trouble with the police. The family were eager to know if the patient's condition was likely to improve with medication. They also asked if she could be admitted to an in-patient unit for treatment. Unfortunately, the psychiatric in-patient unit was not suitable for her needs and she could not go back to her home country because of safety concerns. The cost of treatment at a private clinic was expensive for the family. She was not eligible for state-funded healthcare.

The psychiatrist had to manage a complex situation created by stigma, effects of war and migration, lack of appropriate resources and the role of family. He maintained a trusting relationship with the patient and made sure no information was given to her family without her consent. Regular contact with the family was maintained to increase awareness about the nature of the patient's symptoms and to support the family in coping with the difficulties mentioned above.

Psychiatry in Greece is undergoing a prolonged reform. Deinstitutionalisation is at an advanced stage and there are active efforts to support primary care and community psychiatry, and to establish local administration of services in each sector of the country (i.e. the equivalent of Mental Health Trusts in the UK). Quality assurance and continuing professional development require further development, as do a series of other issues pertaining to the day-to-day clinical practice of psychiatrists. Recent economic difficulties have undoubtedly affected the mental health of the population, but also mental health services and psychiatrists themselves. These financial difficulties coupled with pre-existing organisational issues present important, yet rectifiable, challenges. We conclude by identifying preventive psychiatry as an especially important target for progress and by advocating for continued support for the public system of mental healthcare as well as for the continued psychiatric reform.

National information on mental health services in the Philippines indicates that there are substantial gaps and inconsistencies in the delivery of mental healthcare. The recently enacted Mental Health Act legislation provides a platform for the delivery of comprehensive and integrated mental health services. However, there remain many challenges in the provision of accessible and affordable mental healthcare.

The first mental health act legislation in the history of the Philippines has been officially signed into law and was enacted as the Republic Act no. 11036 on 21 June 2018. It provides a rights-based mental health bill and a comprehensive framework for the implementation of optimal mental healthcare in the Philippines. We review the principles and provisions of the Mental Health Act of 2017 and the implications for mental healthcare in the Philippines.

The Mental Disorders Act of 1969 is the primary legislation relating to mental health in Botswana. Despite the country not being a signatory to the United Nations Convention on the Rights of Persons with Disabilities, its Act has a self-rated score of four out of five on compliance to human rights covenants. However, it can be argued that the Act does not adequately espouse a human rights- and patient-centred approach to legislation. It is hoped that ongoing efforts to revise the Act will address the limitations discussed in this article.

Aotearoa New Zealand is a country of just under 5 million people with a diverse population, the main ethnic groups being of European descent and Maori. There are well-developed public and private healthcare systems. As in other countries, Aotearoa New Zealand has closed the large institutions and developed community-based services for people with intellectual disability. Aotearoa New Zealand has specific legislation for people with intellectual disability presenting to the criminal justice system and has unusually and explicitly excluded people with intellectual disability from mental health legislation since 1992. Partly as a result, most health professional training schemes have little focus on issues for people with intellectual and developmental disabilities. Therefore, one of the main challenges over the coming decade will be to ensure there is a sufficient workforce of psychiatrists and other professionals who have the training and expertise to work with people with intellectual disability requiring mental health and forensic services.