Children and adolescents in low and middle income countries (LAMIC) constitute 35-50% of the population. Although the population in many such countries is predominantly rural, rapid urbanisation and social change is under way, with an increase in urban poverty and unemployment, which are risk factors for poor child and adolescent mental health (CAMH). There is a vast gap between CAMH needs (as measured through burden of disease estimates) and the availability of CAMH resources. The role of CAMH promotion and prevention can thus not be overestimated. However, the evidence base for affordable and effective interventions for promotion and prevention in LAMIC is limited. In this review, we briefly review the public health importance of CAM disorders in LAMIC and the specific issues related to risk and protective factors for these disorders. We describe a number of potential strategies for CAMH promotion which focus on building capacity in children and adolescents, in parents and families, in the school and health systems, and in the wider community, including structural interventions. Building capacity in CAMH must also focus on the detection and treatment of disorders for which the evidence base is somewhat stronger, and on wider public health strategies for prevention and promotion. In particular, capacity needs to be built across the health system, with particular foci on low-cost, universally available and accessible resources, and on empowerment of families and children. We also consider the role of formal teaching and training programmes, and the role for specialists in CAMH promotion.

Child psychiatry in developing countries has recently attained the status of an established specialty. This review looks at available epidemiological data, and factors contributing to similarities and differences in rates of disorder. The relevance of child psychiatry to child health in these countries has service, training and research implications.

Aims and MethodTo improve liaison between local schools and child and adolescent mental health services (CAMHS) by exploring teachers' experiences and perceptions of CAMHS. Semi-structured interviews were carried out with 25 volunteer primary school teachers.ResultsTeachers reported exhausting education-based resources before seeking external advice. Most had positive experiences of child mental health services and were keen to be more involved. They favoured a service that provided rapid advice and ongoing support. Many complained about problems in communication.Clinical ImplicationsChild psychiatrists should collaborate more effectively with teachers to promote mental health and manage children with behavioural and psychological problems.

Children and adolescents are one of the very vulnerable groups in any disaster situation. Not only did around 10,000 children die in the tsunami in Sri Lanka, but the survivors experienced a number of symptoms. Children and adolescents were often not allowed to grieve, as information on their parents' and family members' deaths were withheld from them in order to protect them. Fear of recurrence and separation anxiety was related to school refusal. In addition, displacement and within-country migration led to increased demands and pressure on extended family and in some cases led to child sexual abuse. In this paper, lessons from observation of the aftermath of the disaster are described. For health care professionals as well as for lay volunteers, some factors have to be contextualized within the cultural context.

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