To evaluate whether and how drafting psychiatric advance directives (PADs) with the support of a peer worker improves recovery outcomes for individuals with severe mental illness.

A mixed-methods design was employed, combining quantitative data from a randomized trial with qualitative interviews. The trial included adults with schizophrenia, bipolar I disorder, or schizoaffective disorder who had experienced involuntary hospitalization in the past year. Participants either completed PADs with peer worker support or without specific facilitation. Recovery was assessed longitudinally using the Recovery Assessment Scale. Thematic analysis of interviews explored mechanisms underpinning the effectiveness of peer facilitation.

A total of 118 participants completed PADs, 84 with peer support. Mixed-effects regression analysis revealed significantly higher recovery scores for those supported by peer workers (coefficient = 4.77, p = 0.03). Qualitative findings highlighted two key mechanisms: peer workers’ boundary role fostering trust and relational symmetry and their facilitation practices promoting critical reflexivity and addressing past psychiatric trauma. Participants emphasized the flexibility and empathy of peer workers, which enabled deeper reflection and empowerment.

Peer facilitation enhances the drafting of PADs, significantly contributing to recovery through trust, critical reflection, and trauma-informed approaches. These findings support the integration of peer workers into PAD frameworks and emphasize the need for tailored training and systemic reforms to maximize their impact.

Methylphenidate (MPH), a commonly used stimulant for the treatment of attention deficit and hyperactivity disorder (ADHD) in children and adolescents, has been associated with adverse effects on weight, height, blood pressure (BP) and heart rate (HR). This study aimed to investigate whether children with ADHD prescribed MPH by a specialist ADHD service showed a change in health data percentiles compared to their pre-treatment measures, and to investigate for any correlation with MPH dose, years prescribed MPH and gender.

In this retrospective observational study health data percentiles (weight, height, BP and HR) were analysed for change between two timepoints: prior to MPH initiation (T1) and at the most recent clinic appointment (T2). Correlations between health data percentile changes and MPH dose, treatment duration, baseline growth centiles and gender were studied.

The cohort consisted of 123 youth (age 5-17.5 years) prescribed MPH (mean dose 0.67 ± 0.32 mg/Kg). Over the treatment period (2.5 ± 2.1 years) weight (P = 0.001) and height (P = 0.007) centiles significantly reduced, BP centiles did not change, while HR centiles increased (P < 0.0001). Weight centile reduction was correlated with higher MPH dose (P < 0.0001) and this effect attenuated with longer duration of MPH treatment (P = 0.005). Height centile reduction was more pronounced in the taller cohort (P = 0.008).

This study supports international guidelines for physical health monitoring of young people prescribed MPH, specifically the conversion of health data to percentiles for accurate monitoring and early identification of concerning trends. Future integration of digital approaches are necessary for rapid and accurate physical health monitoring.

The Collaborative Assessment and Management of Suicidality (CAMS) framework is an evidence-based approach to treating individuals with suicidality. It involves collaboration between patients and clinicians to assess, plan and treat suicidal risk, using the Suicide Status Form. This study applies the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to explore the experiences of Irish higher education counselling staff in implementing CAMS, providing insight into the factors that influence its successful integration into student mental health services.

A mixed-methods approach was adopted, via an online survey and follow-up interviews with student counselling staff to explore the implementation of the CAMS framework. Sixty-four staff members from student counselling services in Irish higher education institutions completed the online survey. Ten participants engaged in follow-up interviews to further explore survey findings. Data on reach, effectiveness, adoption, implementation and maintenance were gathered through the RE-AIM framework.

Survey respondents report treating approximately 44% of individuals presenting with suicidal risk using the CAMS framework. The majority (88.1%) of respondents reported positive outcomes for suicidal patients. Most respondents (91%) found the training beneficial and had ‘definitely’ or ‘somewhat’ incorporated CAMS into their management of suicidal patients. There were three main themes identified from interview data: diverse approaches to implementation, the value of CAMS in practice and challenges in implementing CAMS.

CAMS has provided a strong toolkit for improving suicide-specific skills, communication and collaboration, but fidelity varies due to resource and support limitations. Additional resourcing, increased staff buy-in and further research could lead to smoother implementation in student counselling services.

The COVID-19 pandemic and associated lockdowns raised concerns about their impact on substance use among young people.

The aim of this study is to investigate the potential changes in alcohol and drug-related medical hospital admissions during the pandemic compared to pre and post pandemic years among individuals aged 15–24 in Ireland.

Data from the Hospital Inpatient Enquiry (HIPE) database, covering emergency hospital admissions from 2017 to 2022, were analysed. Lockdown and control periods were identified, and admission rates for drug-related hospital admissions (DRHA) were calculated per population and per 100 all-cause admissions. The study also examined changes in alcohol-related hospital admissions (ARHA) and explored the contribution of different drug categories to DRHA during lockdowns.

We found that there was an increase in drug-related hospital admissions (DRHA) among individuals aged 15–24 years during the periods of hard lockdowns, comparing the three periods of hard lockdown from 2020 to 2021 with corresponding weeks in control years. The median rate of DRHA per million per week during the lockdowns was 23.8 (inter-quartile range [IQR] 19.0 – 29.9) while it was 18.2 (IQR 13.7–22.2) during the control weeks (p<0.001). DRHA accounted for a median 3.81% of admissions during lockdown weeks while they comprised 2.16% during the control weeks.

Our findings suggest that an adverse effect of pandemic restrictions appears to be increased acute drug-related problems requiring medical management among youth aged 15–24 years.

Mentalization-based treatment (MBT) has promising transdiagnostic applications. The evidence base for its application in non-specialist settings, including general adult community mental health services requires further evaluation. This study explores the implementation of an MBT introductory (MBTi) group in an Irish secondary mental health service.

Two online MBTi groups were delivered between 2020 and 2021. A concurrent mixed-methods design was engaged. Qualitative pre- and post-intervention measures include the Clinical Outcomes in Routine Evaluation (CORE) scale, the World Health Organization Quality-of-Life (WHOQoL-BREF) scale and the Reflective Functioning Questionnaire (RFQ). Paired sample t-test was employed to analyse change. Interviews were conducted with seven participants post-intervention and inductive thematic analysis was utilised to identify themes.

Participants exhibited hypomentalizing tendencies, which improved following the delivery of the intervention (RFQu: MD = 0.54, p = 0.032, Cohen’s d = 0.71). There were improvements across the wellbeing, problems and functioning subscales of the CORE. There was no change in the risk domain, which was low at baseline. Improvements were observed in the WHOQoL-BREF subscale of psychological health and social relationships. Five main themes emerged from post-intervention interviews: barriers and facilitators; attitudes to design and delivery; perceived intervention effectiveness; intervention coherence; COVID-19 specific issues.

MBTi delivered in a non-specialist setting is associated with improvements in mentalizing capacity. The intervention is perceived as relevant and useful by participants, although the psychoeducation and online format conferred specific limitations. The findings support the role of MBTi as a feasible transdiagnostic intervention in general adult services, as part of a range of interventions.

We aimed to present the hospital presented age-specific rate ratio of Traveller women with self-harm or suicide-related ideation and further explore their experiences when attending hospitals in Ireland with thoughts of suicide.

A sequential mixed method analysis was adopted. National presentation data from 24 Irish Emergency Departments (EDs) for suicidal thoughts or self-harm, between 2018–2022 and qualitative interviews were conducted. Descriptive statistics, Poisson regression and rate ratios (95% confidence intervals), were used. Interpretative Phenomenological Analysis (IPA) was conducted on interviews with Traveller women presenting to EDs with suicidal thoughts in 2023. We involved lived experience women in the research.

693 Traveller women presentations were assessed in the 5-year period. Traveller women between 40–49 years of age had 7·81 (95% CI 6·39– 9·55) times higher risk of ideation presentation and those 50+ had 6·41 (95% CI 5·04–8·15) times higher risk of self-harm, when compared to White Irish females. One in four Traveller female presentations, requested no next of kin involvement when discharged. The ‘Power of human connection’ theme emerged from two Traveller women interviewed, reflecting the powerfulness of support in the participants experiences of suicidal ideation.

Results highlight the potential suicide risk of Traveller women over the age of 40 and the significant issue of social isolation when all forms of interpersonal support – family, Traveller organisations, and public health services – are lacking, but crucial for a collaborative safety plan upon ED discharge.

This study explores psychiatrists’ perceptions of Attention-Deficit Hyperactivity Disorder (ADHD) through the lens of evolutionary psychiatry, a growing field that reframes mental disorders in the context of adaptation and survival. Evolutionary theories suggest that traits associated with ADHD, such as impulsivity, hypercuriosity and novelty-seeking, may have been adaptive in ancestral environments, though they manifest as maladaptive in structured modern contexts.

A bespoke 10-item questionnaire was developed to assess psychiatrists’ attitudes following a presentation on evolutionary perspectives of ADHD by an expert. The questionnaire allowed rating in 5-point Likert fashion and was followed by a free text box for qualitative analysis. Basic descriptive statistics and One-Way ANOVA pairwise comparisons between groups was used to test for statistical significance. A p value of <0.05 was deemed statistically significant.

Forty-two participants, including 21 consultants and 19 psychiatry trainees completed the questionnaire. All participants rated their comprehension of the presentation as high/very high. Most strongly agreed that the information presented could improve psychiatry and therapeutic outcomes. However, consultants with more than 10 years of experience were less likely than trainees to report optimism about the practical applications of evolutionary frameworks. Qualitative feedback emphasized the relevance of evolutionary perspectives in clinical practice, particularly in reducing stigma and enhancing therapeutic engagement with patients and families.

While the results from this study were positive, limitations include the small sample size and lack of prepresentation baseline data. However, this study has formed part of the first step in investigating the perceptions and attitudes of psychiatrists on evolutionary perspectives on ADHD.

Psychiatric advance directives (PADs) are documents enabling individuals with mental health conditions to specify their treatment preferences for future mental health crises. Despite the benefits of PADs, their implementation has progressed slowly. Concerns about PADs among professionals seem to be part of the explanation. A commonly reported concern is that service users will use PADs to document extensive treatment refusals. Research has not yet explored professionals’ views on ethical conflicts arising from such refusals.

The objective of this study was to explore professionals’ perspectives on ethical conflicts arising from treatment refusals in legally binding PADs.

We carried out semi-structured interviews with 14 mental health professionals working in Germany with professional experience with PADs. We prompted discussions using a case report of an ethical conflict arising from a treatment refusal documented in a PAD. We analyzed the data thematically.

Professionals described the case as extreme yet not unfamiliar. While many felt obligated to respect the PAD, they also felt inclined to override it to promote service user well-being, restore service user autonomy, and protect others. Those inclined to override the PAD focused on scrutinizing its validity and applicability, raising doubts about information disclosure, voluntariness, decision-making capacity, and PAD irrevocability. Professionals believed ethics consultation would help address the ethical conflict.

Legally binding PADs can create ethical conflicts when they include treatment refusals. While the best policy response remains unclear, professionals can help prevent such conflicts by supporting service users in drafting PADs.