Sir: In 2005, the Department of Health for England set a five-year action plan, Delivering Race Equality in Mental Health Care. The aim was to encourage the development of services that were more appropriate and responsive to the needs of both adults and children in Black and minority ethnic communities.The Chinese community is the third largest immigrant group in the UK. Despite this there are few existing data concerning the mental health of Britain’s Chinese population and a recent systematic review concluded that there was insufficient evidence to make any meaningful comment on the prevalence of common mental health disorders in Chinese children and adolescents in the UK (Goodman et al, 2008).Why do we know so little about this significant population of children? First, it is difficult to collect information from the Chinese community. In contrast to other ethnic minority groups, which often coalesce in urban areas, resulting in a high population density, the dispersed nature of the Chinese population makes data-gathering difficult (Cowan, 2001). Moreover, many data were collected via Chinese community organisations and may have therefore been subject to many different forms of bias (e.g. some people who identify themselves as Chinese may never attend community activities).Paradoxically, although Chinese children are educationally among the highest achievers in the UK, many of their parents have limited literary skills and some of them are working unsociable hours in the catering business, which further limits their opportunities to develop their English language skills. This language barrier could impair the ability of Chinese children to receive input from health professionals. For example, some Chinese parents may not feel confident in bringing a young person with a suspected mental health difficulty to see a general practitioner, and Chinese carers may find it difficult to understand concerns regarding their child’s emotional well-being as communicated to them by professionals such as teachers. Furthermore, systemic (e.g. family therapy) or parenting-based work may be difficult, especially in the absence of an independent (non-family) interpreter.In addition to language issues, cultural factors may also shape help-seeking behaviour. Although present across cultures, the problem of stigma remains prominent among the Chinese population. For example, a preliminary assessment of the mental health needs of Chinese young people in Birmingham revealed that the majority of them perceived mental illness as being ‘crazy’ and ‘associated with violence’ (Fung, 2005). Such cultural and individual attitudes could serve to prevent or at least delay young people and their families from engaging with mental health services.Research is urgently needed in order to develop an understanding of the mental health needs of Chinese children in the UK. This should feed into developing programmes of public education and more culturally acceptable services in order to increase the Chinese community’s access to timely help for young people. Without this, UK health services will find it difficult to meet agreed racial equality goals.Sir: The article by Zigmond (2009) made for interesting reading. Mental health law is about balancing the need to detain people in order to protect them or other people from harm and the need to respect people’s human rights and autonomy. In the UK, there was much concern during the development of recent mental health legislation, in particular the Mental Capacity Act 2005, that the government had got this balance wrong. Many of these concerns have been addressed in the updated Code of Practice to the 1983 Mental Health Act, which is an essential guide to practising under the Act (Department of Health, 2008). There is no legal duty to comply with the Code, but professionals must have regard to it and record the reason for any departure from the guidance (which can be subject to legal challenge).Safeguards regarding deprivation of liberty, which address the ‘Bournewood gap’ concerning the detention of compliant incapacitous individuals, in the Mental Capacity Act have been one of the highlights of the changes introduced (Hall & Ali, 2009). The mental health legislation in England and Wales is based on risk. One of the arguments for having risk as the main focus is the fact that mental illness leads to loss of insight, which makes it impossible for the sufferer to make an informed decision. The proponents of the other view argue that having a different criterion for compulsory treatment (risk rather than capacity) for mental illness results in further discrimination against people who are mentally ill and can only help to enhance stigma.The European Court of Human Rights has had some impact on the Mental Health Act 1983 and its interpretation; it has not, however, set a high standard for modern mental health services. Some judgements may strike present-day clinicians not so much as protecting patients’ rights but as permitting undesirable practices. This is perhaps not surprising when it is considered that the European Convention on Human Rights, signed in 1950, harbours old prejudices against those with mental illness (Bindman et al, 2003). These are apparent in the language of Article 5, which groups persons of ‘unsound mind’ with ‘vagrants’ and ‘drug addicts’ as being exempted from the protections afforded to others. In incorporating the European Convention on Human Rights, the UK Human Rights Act 1998 perpetuates rather than challenges the lesser regard for the autonomy of patients with mental illness than of other medical patients, which is at the heart of conventional mental health legislation (Szmukler & Holloway, 2000). If the courts do begin to scrutinise the proportionality of clinical decisions – a function currently carried out only haphazardly by mental health review tribunals (Perkins, 2000) – the impact could be considerable. Many of the cases involving the European Convention on Human Rights to date have concerned patients in maximum security settings or with significant forensic histories, and it is not surprising that compulsory treatment is often found to be justified or the infringement of rights to be proportionate. However, a decision, for example, to compel a ‘revolving door’ patient without a history of offending to accept community treatment might be judged to be disproportionate if founded on weak scientific evidence of risk or benefit.Sir: Tony Zigmond’s editorial is categorical in condemning the detention of people who are competent but mentally ill (Zigmond, 2009). He notes that the driver for this is risk, in both UK and international legislation. He contrasts this with physical treatment, for which he, and the judicial authority he quotes, believe competency gives an absolute right to refuse.I would point out that this overlooks the widespread international use of public health legislation to detain, and even treat, individuals with infectious diseases, on the basis of risk to others. Consequently, Dr Zigmond is wrong, in part, that there is discrimination here. Where they pose a risk to others, physical and mental health patients are both liable to detention. A more interesting question is whether risk of suicide is a sufficient reason to override competency.Sir: I am a little surprised by Professor Sugarman’s letter, as my editorial does not condemn, categorically or otherwise, the detention of people who are competent but mentally ill. Furthermore, I am not aware (I accept this may be my ignorance) of any country having a law which permits treatment of, to use Professor Sugarman’s example, infectious diseases, in the face of capacitous refusal (my editorial refers, at this point, to treatment rather than detention). It is certainly not permitted in England and Wales.I have merely asked why we need different laws for the two populations of ill people. There may be good reasons. I really want to know.Sir: In psychiatry as in politics, it is important to use terms correctly, to be precise. One sentence, one phrase or sometimes even one word can destroy a doctor–patient relationship, or can cause a war between two countries.I have no intention to start a verbal war or an endless discussion, but in the January 2009 issue of International Psychiatry I came across one term which made me think again about the importance of using terms correctly. I am referring to the term ‘former Soviet Union’, which was used for the ‘Thematic papers’ section (‘Mental health services in the former Soviet Union’, vol. 6, pp. 2–10).On 10 March 1997, the then British Foreign Secretary, Malcolm Rifkind, speaking in Washington, DC, to the Carnegie Endowment for International Peace, said that Western leaders should stop referring to the group of countries that emerged from the collapse of the USSR as the ‘former Soviet Union’. Rifkind argued that such references are ‘unwise’ because they carry with them ‘the unconscious legitimation’ of the possible return of Russian rule there in the future (Ziugzda, 1999).The problem is that some people see ‘former Soviet Union’ not only as a term but also as an idea. Moreover, when people write ‘former Soviet Union’, I am not sure if that is intended to include my country (Lithuania) and the other two Baltic states. Yes, the Baltic states were occupied by the Soviet Union on the basis of the secret protocols of the Molotov–Ribbentrop Pact (Visulis, 1990). However, the UK (along with other countries) did not recognise de jure the incorporation of the Baltic states into the Soviet Union (UK Foreign and Commonwealth Office, 2009). Thus the term ‘former Soviet Union’ is even more confusing and in my personal opinion politically incorrect.Why we should look at the complicated history when we want to name those countries? Why we should bring more confusion and maybe even mislead our younger colleagues? I would recommend that authors follow the international media and use terms which are based on the countries’ geographical locations, such as the Baltic states (Estonia, Latvia and Lithuania), trans-Caucasian (Armenia, Azerbaijan and Georgia) or Central Asian (Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan).