The World Health Organization has made concerted efforts to scale up mental health services in low- and middle-income countries through the Mental Health Gap Action Programme (mhGAP) initiative. However, an overreliance on scaling up services based on those used in high-income countries may risk causing more harm than good.

How to respond optimally following traumatic events remains a Holy Grail. A number of early interventions lack evidence of effect. Practical, pragmatic support provided in an empathic manner is likely to be an appropriate initial response and complement the high levels of resilience shown by individuals exposed to traumatic events.

Prevention of mental disorders can be effective, but is rarely implementedin routine settings. Here we propose a matrix to show how different aspectsof stigma, discrimination and lack of knowledge can hinder different typesof prevention, including early intervention. Programmes to reduce stigma'simpact and so to facilitate prevention are needed.

Psychological medicine (liaison psychiatry) aims to integrate psychiatryinto other areas of medicine. It is currently enjoying considerableexpansion. The degree to which it can take advantage of this opportunitywill be important not only for its own future, but also for the survival ofpsychiatry as a medical discipline.

There is increasing concern that a reliance on the descriptive,syndrome-based diagnostic criteria of ICD and DSM is impeding progress inresearch. The USA's major funder of psychiatric research, the NationalInstitute of Mental Health (NIMH), have stated their intention to encouragemore research across diagnostic categories using a novel framework based onfindings in neuroscience.

Current capacity-based legislation and practice overvalues autonomy to the detriment of other ethical principles. A balanced ethical approach would consider the patient's right to treatment, their relationships and interactions with society and not solely the patient's right to liberty and autonomous decision-making.

The creation, in DSM-III, of the category ‘major depression’ can be linked to the launch, and success, of Prozac. The consequences of creating this broad diagnostic category are of concern in relation to the treatment of individuals with a diverse variety of depressive disorders.