LETTER TO THE EDITOR Culture and mental health education: Implications for mental health resources in the Pacific Rim DOI:10.1111/j.1758-5872.2009.00026.x Dear Editor, The article by Tasman et al. (2009) comes at an opportune time to help administrators and clinicians alike to take stock of efforts in this region to improve mental health. This article gives a comprehensive overview of the stark resource limitations in Pacific Rim countries. Only patients seem to be in abundance, potentially threatening to overwhelm the psychia- trists, beds and medications available to them. The effect of stigma in limiting resources is also summar- ized. While these points are not new, the article high- lights two other points influencing resourcing that are relatively neglected: the effect of culture on localizing Western models of care and mental health training. Culture affects the prevalence, presentation, per- ception and ultimately prognosis of mental illness. The complex and interdependent relationship between cul- ture, stigma, resource allocation and accessibility of care by the mentally ill is elegantly discussed. The authors are to be commended for tantalizing us with this important topic. However, in a region with develop- ment dating back 8,000 years, history hangs heavily over everything. One wishes that they also touched on the effects of colonialism on the development of mental health services (Shinfuku 1998) and how to reconcile the colonial mental health legacy with current cultural sensitivities and realities in the region. Mental health education is marginalized in this region and the downstream effects are protean. The visible effects are under diagnosis and treatment of mental illness at every level of medical care. The less visible effects include a vicious cycle of stigmatization, inadequate resources for mental health and poor advocacy for mental health. These topics are well elaborated in the article. Change is required and culture and training are essential enablers. Fortunately the authors are good psychiatrists and leave the readers with hope. They describe a new collaborative model of care that empowers the clini- cians with the greatest potential to improve mental health: primary care physicians. The new generation of mental health leaders also brings with them much hope and promise if the results of a recent survey are reflective of a more regional attitudinal shift. Trainee psychiatrists in Singapore rated cultural aspects of psychiatry, research and basic neuroscience higher than psychiatrists (Tor et al., in press). As the authors state, culture is dynamic and change is constant. We have much to look forward to. P.C. Tor Department of Psychological Medicine, National University Hospital, Singapore References Shinfuku N. (1998) Mental health services in Asia: International perspective and challenge for the coming years. Psychiatr. Clin. Neurosci., 52, 269–274. Tasman A., Sartorius N., Saraceno B. (2009) Addressing mental health resources deficiencies in Pacific Rim countries. Asia-Pacific Psychiatr., 1, 3–8. Tor P.C., Ng T.P., Kua E.H. (In press) Adequacy of psychiatric training: A Singaporean perspective. Academic Psychiatry (in press). Asia-Pacific Psychiatry 1 (2009) 109 c  2009 Blackwell Publishing Asia Pty Ltd 109 Asia-Pacific Psychiatry ISSN 1758-5864