Rachel Jenkins

This paper describes a project to facilitate mental health reform in one Russian oblast (region) using systematic approaches to policy design and implementation. The author led a multidisciplinary team which undertook a three-year action-research programme across three pilot sites, comprising a multifaceted set of interventions combining situation appraisal to inform planning, sustained policy dialogue at federal and regional levels to catalyse change, introduction of multidisciplinary and intersectoral-working at all levels, skills-based training for professionals, and support for nongovernmental organizations (NGOs) to develop new care models. Training programmes developed in this process have been adopted into routine curricula with measurable changes in staff skills. Approaches to care improved through multidisciplinary and multisectoral service delivery, with an increase in NGO activities, user involvement in care planning and delivery in all pilot sites. Hospital admissions at start and end of the study fell in two pilot sites, while the rate of readmissions in all three pilot sites by 2006 was below that for the region as a whole. Lessons learned have informed the development of regional and federal mental health policies. It is concluded that a multifaceted and comprehensive programme can be effective in overcoming organizational barriers to the introduction of evidence-based multisectoral interventions in one Russian region. This can help facilitate significant and sustainable changes in policy and reduce institutionalization.

Climate change is closely linked to rising levels of atmospheric carbon dioxide and methane due to human activities, and soaring temperatures might themselves pose a risk to natural carbon sequestration in the land. This editorial introduces three papers in the current issue exploring the adverse effects on mental health of climate-related loss of biodiversity and cultural heritage markers and the beneficial effects of adopting a plant-based diet. It also suggest three simple steps that clinicians can themselves take to act against climate change: choosing and recommending a plant-based diet, reducing personal use of fossil fuels and integrating climate change in discourse in all areas of their professional work.

The Lancet Commission summarises some of the history of mental health concepts, recent developments in scientific understanding, mental health programmes and threats to progress, and proposes a way forward. Although ostensibly aiming to reframe global mental health within the paradigm of sustainable development, in practice it has taken a narrower academic perspective rather than a generic approach to health and social sector reform, leading to much less of an integrated implementation focus than would have been useful.

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.