This overview of Czech psychiatry begins with a brief review of its history; outlines its social, political and economic determinants and then describes the field itself. Both epidemiological and service-related information are discussed, together with the issues for mental health personnel, education and research. The heavy burden of communist history pervades most areas and must be taken into account in the specific characteristics that influence both the current situation and future prospects of Czech psychiatry. This consideration is essential for orientation in the field and to understand Czech particularities. The greatest challenges, however, originate from the fundamental changes that are going on in the world today. These challenges reach beyond national boundaries and include such phenomena as globalization, migration, ageing population, growing burden of mental ill health, the still prevailing stigma towards psychiatry, and the psychological roots and consequences of current financial and societal crises.