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The Resilience Hub was established to support people in need of psychological/psychosocial support following the 2017 Manchester Arena terrorist attack.
Aims
To use mental health screening measures over 3 years following the Arena event to examine the variation in symptoms reported by adults registered with the Hub, and whether this was associated with treatment access characteristics.
Method
Adults engaging with Hub services were separated into eight cohorts depending on when they registered post-incident. Participants completed screening measures for symptoms of trauma, depression, generalised anxiety and work/social functioning. Baseline and follow-up scores over 3 years were compared among the eight admission groups. All types of appointment were recorded in terms of the number of minutes of clinical ‘contact time’ involved, to explore associations with time taken to register.
Results
Overall, baseline screening scores increased as time to register post-event increased. Over the 3 years of follow-up, a decrease in scores was observed for all 4 screening measures, indicating improvement in mental well-being. Those taking longer to register had higher follow-up scores. However, they showed a slightly stronger decrease in average change of score per follow-up month. Mean contact time per month was greater (apart from the 18-months admission group) in individuals delaying registration. Increased contact time was associated with decreased follow-up screening scores for depression and anxiety.
Conclusions
People who registered earlier were less symptomatic, suggesting there may be a potential beneficial impact of early engagement with support services following traumatic events. All who registered showed improvement in symptoms, including those delaying registration, with increased contact time being beneficial. This reinforces the benefits of encouraging early and sustained engagement with services as soon as possible post-incident.
The NHS 2025 Health Plan aims for radical reform but overlooks people with intellectual disability. This editorial highlights critical omissions in policy, services, research and rights protections. Without intentional inclusion, digital and community shifts risk deepening inequality. True progress demands co-produced strategies to ensure equitable care for this vulnerable population.
There is a great potential for carefully designed economic empowerment programmes to improve mental health in recipients and their significant others. Onono and colleagues interviewed 62 caregiver-adolescent dyads on the effect of an economic empowerment intervention consisting of microcredits to purchase farming implements and a water pump to irrigate crops throughout the year combined with agricultural and financial training. Their intersectoral economic empowerment intervention decreased parental stress, parental absenteeism as well as harsh parenting and disciplining practices. This translated to better caregiver-adolescent communication and improved household dynamics, thus increasing the psychological well-being of adolescents. The research contributes to a growing evidence base on the importance of economic empowerment interventions for mental health by generating hypotheses on mechanisms of action.
Attention to human rights as a central pillar of global mental health work has shifted from a focus on the right to healthcare to a deeper examination of the quality of care received, and to the way in which people with mental health conditions are treated in all aspects of life. The QualityRights programme is the World Health Organization’s flagship guidance for promotion of rights-based approaches to mental healthcare, and a means of holding service providers to account for quality of care provided. A recent evaluation of the QualityRights e-training package demonstrates promising impact on attitude change of participants, raising the prospect of an efficient scale-up of efforts to improve dignity in services and reduce stigma and discrimination.
Consistent with many countries in the region, the Republic of Guatemala likely has a high level of mental health need. However, with high poverty rates and workforce deficits, Guatemala faces challenges in providing accessible mental healthcare across the nation. We describe examples of interventions that have been developed to reduce this mental health gap by addressing the existing barriers to accessing mental healthcare. Within this country profile, we identify further opportunities, such as future mental health legislation, to improve access to services across the human lifespan, especially for at-risk and underserved communities.
Attitudes of mental health professionals toward coercion are a potential tool in reducing the use of coercive measures in psychiatry.
Aims
This study, part of the nationwide Attitudes toward Coercion (AttCo) project, aimed to assess staff attitudes on a nationwide and multiprofessional scale across adult, child and adolescent, and forensic psychiatric departments.
Method
During 9 weeks in 2023, 1702 psychiatric staff members across Germany filled out a survey including gender, age, profession, work experience and setting, and the validated Staff Attitude to Coercion Scale (SACS). Analyses of variance and multivariate regression analysis for SACS mean overall score were computed to assess group differences.
Results
Participants largely supported that coercion could be reduced with more time and personal contact (mean 4.20, range 1–5), and that coercion can harm the therapeutic relationship (mean 4.08); however, they acknowledged that coercion sometimes needs to be used for security reasons (mean 4.10). Regarding group differences, specialisation (P < 0.001) and professional affiliation (P = 0.008) remained significantly associated with SACS mean score (with a higher score in forensic psychiatric staff compared with staff in adult and child and adolescent psychiatry), when controlling for gender, age and work experience.
Conclusions
Differences in attitudes are predominantly linked to professional training and structural surroundings. Professionals in adult psychiatry and child and adolescent psychiatry are more critical than staff in forensic settings, with an emphasis on patients’ rights and individuals’ integrity. Further studies are needed on how mental health professionals view coercion, and how actual use of coercion is influenced by staff attitudes.
This paper examines rates of physical restraint and seclusion under the Mental Health Act 2001 in acute adult psychiatry inpatient facilities (“approved centres”) in Ireland.
Methods:
Analysis of rates of physical restraint and seclusion in acute adult approved centres in Ireland in 2023, based on data made publicly available by the Mental Health Commission, Health Research Board, and Central Statistics Office.
Results:
Rates of physical restraint vary 16-fold between approved centres, ranging from 116 episodes of physical restraint per 100,000 population per year to 7 per 100,000 population, with a national rate of 39 per 100,000 population. Among the six approved centres with the highest rates of physical restraint, five are in Dublin (i.e. urban). Among approved centres that use seclusion, rates vary 19-fold, ranging from 38 episodes of seclusion per 100,000 population to 2 per 100,000 population, with a national rate of 15 per 100,000 population.
Conclusions:
There are within-country variations in rates of physical restraint and seclusion in Ireland, but these are of a lesser magnitude than between-country variations. Overall, Ireland’s rates of restrictive practices are lower than those in other jurisdictions, consistent with Ireland’s low rate of involuntary admission. Future research could usefully focus on the relationship between restrictive practices and urbanicity, among other themes.
This article provides the general psychiatrist with a pragmatic guide to working confidently and productively in the emergency department (ED). The focus is on effectively navigating the distinctive physical environment, personnel, systems, time pressures, legal boundaries, special challenges and broad scope of practice applicable to this setting to maximally support both patients and staff. It brings to the reader’s attention special considerations at all stages of workflow, including pre-assessment preparations, the assessment process and ongoing planning. It considers common requests and the application of mental health law (in England and Wales) associated with both capacity assessment and involuntary care. Finally, it explores unique challenges associated with risk assessment, physical health advocacy and management of conflict in the ED setting. The specific systems described are those of the UK’s National Health Service, but the principles involved are universal.
Emergency mental healthcare for young people in the UK has been described as fragmented, risk-driven and under-resourced. Drawing on insights from Australian service models, this editorial explores how timely, integrated and relational care can improve outcomes and reduce harm. Key innovations, including early intervention hubs, assertive aftercare, outreach models and telehealth, are examined through a realist lens to explain how and why they work. Recommendations are offered for rethinking the strategy and provision of youth crisis care in the UK, centred on developmental need, relational continuity and a departure from risk assessment tools that lack an evidence base.
Despite worldwide uptake, there has been little published evaluation of actually delivering the World Health Organization (WHO) Mental Health Gap Action Programme (mhGAP) in typical low- and middle-income countries (LMICs). This paper aims to evaluate the impact of a pilot study in which mhGAP guidelines for mental health sensitisation of community leaders were implemented in 1-day training events across 25 urban and rural health facilities (n = 1004 community leaders) in Uganda. A multiple choice mental health questionnaire was used to assess the community leaders’ mental health knowledge before and after completing the training. Training was evaluated across multiple sites and qualitative feedback comments were used to identify key themes on the impact of the training. The sensitisation training was found to be affordable, accessible and effective, and could be replicated in other LMICs and settings with local adaptations.
The medical workforce in psychiatry is increasingly diverse, but not necessarily in its senior leadership in the UK’s National Health Service (NHS). We aimed to describe the characteristics of psychiatrists with board-level responsibility in mental health trusts in England in 2024, comparing the current picture with that of 2016 and 2020, using publicly available data.
Results
The proportion of medical directors who are female has not changed, so women remain underrepresented, while the proportion who are international medical graduates has increased substantially, so they are no longer underrepresented. Although fewer in number, intellectual disability psychiatrists are underrepresented.
Clinical implications
Greater attention will need to be paid to developing female medical leaders if representative leadership is to be achieved.
The perinatal period is an important time for infant and parent. Vulnerable parents with pre-existing challenges, such as adverse experiences in their own childhood, might find the transition to parenthood particularly hard. The Cochrane Review considered here sought to assess the effectiveness of parenting interventions provided to parents with symptoms of complex post-traumatic stress disorder and/or a history of childhood maltreatment, with the aim of improving the parents’ well-being or parenting capacity. In this commentary we focus on how the limited evidence base, along with some key aspects of the review’s methodology, might have influenced its finding that such interventions showed little or no benefit.
Barricaded incidents, hostage-taking and sieges occur in the community, where police negotiators are usually called on to bring about a peaceful resolution. They occur also in prisons and psychiatric hospitals, where they will be managed by the institution’s staff, with police support if needed. Psychiatrists and other mental health professionals have been involved in providing training and on-call support for negotiators and decision makers in these crisis situations. This article describes definitions and goals in relation to such incidents, and outlines a five-phase framework for their management (training; first responders, preliminary interventions and inquiries; negotiations; resolution; aftercare), indicating the psychiatrist’s role during each phase. Ethical issues are also discussed.
Chronic pain and depression are common in older people, and creative activities may lower the perceived impact and distress related to the symptoms.
Aims
This study describes the co-development of a creative arts and crafts protocol for older people with chronic pain and depressive symptoms, and investigates its feasibility and potential effects.
Method
This study had two phases. In phase 1, a multidisciplinary expert panel (n = 10), consisting of professionals, patients and researchers, underwent iterative rounds to co-develop the protocol. In phase 2, a pilot study was conducted among 12 older adults (mean age 71.4 years). Mixed methods were used, including questionnaires at baseline, post-intervention and 3-month follow-up, assessing pain intensity and interference, depressive symptoms and quality of life; observational notes and focus groups. Descriptive and Wilcoxon signed-rank tests were applied to analyse quantitative data, and thematic analysis was used for qualitative data.
Results
Qualitative findings supported the programme’s feasibility. Participants reflected that the process was engaging and empowering and brought them a sense of achievement and recognition. The quantitative findings evidenced the programme’s potential effects in reducing depressive symptoms (Z = −2.60, P < 0.01) and improving mental health-related quality of life (Z = −2.67, P < 0.01) at 3-month follow-up.
Conclusions
Our results support the feasibility of a creative arts and crafts programme and provide preliminary evidence of its impact on reducing depressive symptoms and improving mental health-related quality of life. Given the promising results, a definitive trial is needed to reveal the effectiveness of creative activities in pain management.
The transfer from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) can be challenging, particularly for adolescents with neurodevelopmental disorders (NDDs) requiring long-term follow-up.
Aims
To examine the transfer process from CAMHS to AMHS in a university hospital in Türkiye, focusing on challenges, service gaps and barriers to transfer for individuals with NDDs.
Method
Hospital records of children with NDDs followed in CAMHS for at least 5 years were reviewed. Children with at least one annual admission until 2017–2018 were included. A total of 211 patients were categorised into two groups: those who transferred to AMHS by 2018–2019 (transferred group, 81 patients) and those who did not transfer (non-transferred group, 130 patients). Clinical features, such as primary diagnosis and treatments, were compared, and parental views on the transfer process were collected via telephone interviews.
Results
The transferred group included 81 patients (38.4%), whereas the non-transferred group had 130 patients (61.6%). Of the total sample, 55 (26.1%) were female, and 156 (73.9%) were male. Primary diagnoses were similar between groups; however, the transferred group had more comorbidities (P < 0.001) and more frequent antipsychotic prescriptions (P = 0.006). Proactive information from CAMHS doctors (B = 2.46, s.e. = 0.68, P < 0.001) and psychiatric comorbidities predicted transfer. In addition, attention-deficit hyperactivity disorder diagnoses changed during transfer in the transferred group (P = 0.002).
Conclusion
These findings emphasise the need for tailored transition support to enhance mental healthcare for NDD patients and indicate areas where further research is required to address healthcare barriers.