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In this paper we respond to this special issue's critical focus on mental health in education by considering the medicalised and homogenising approaches to the mental health of young people and the severely negative consequences for young people. Our argument is underpinned by the need to destabilise the hegemony of the current dominant discourses and practices of mental health used in education. The problem with these discourses and practices, informed by particular forms of psychiatry and psychology, is precisely their dominance and their popularised proxy take-up of these. We firstly outline this problem, explore the emergence and saturation of a 'damaged self' in education and consider the impact on young people. We offer counter-narratives that involve a reframing of the self in relation to ethics, politics, capability and the arts and can assist in countering the psy-dominance in education. The paper concludes with some reflections on how teachers might work against the damaging effects of the psy-disciplines and instead support young people in finding their counter-narrative selves.

The globalization of biomedicine poses the problem of finding cross-culturally valid criteria for mental health. Undue pathologization is a major risk for global health, especially when diagnoses rely exclusively on Western nosology. This article focuses on the clinical conflation between involuntary mass possession and conversion disorder. Originally, the diagnosis of "conversion disorder" evolved from the notion of hysteria. Even though the category of hysteria disappeared from psychiatry many decades ago, some of its undergirding assumptions have survived under the new label of conversion. Namely, the assumption that hysteria/conversion is caused by repressed sexual desire is still implicit in widespread explanatory models for mass possession worldwide. Drawing upon an ethnography of demonic possession (grisi siknis) among the Afro-Indigenous Miskitos of Nicaragua, I argue that (1) the label of conversion is eurocentric and inappropriate for mass possession; and (2) emic perspectives on mass possession offer a critical counterpoint to rethink Euro-American and globalized understandings of embodiment and desire., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

This paper examines the changes in infant homes for children under the age of three in West Germany after the Second World War by combining two research perspectives. First, it will show that the increase in institutional care in the decade after 1945 was not simply dictated by a growing number of orphans. Instead, it primarily resulted from the way how authorities dealt with single mothers and their children. In a second step, the adverse influence of "Maternal Care and Mental Health," the WHO report by British psychiatrist and psychoanalyst John Bowlby, will be analysed. It will become clear that this monograph from 1951 was enormously influential within West German infant home education, such that institutional care for children under the age of three was almost completely abolished only a few years later. Thus, the paper contributes to the historization of residential childcare and of attachment theory.

Perinatal mental illness is associated with considerable maternal and infant morbidity and mortality. However, there are currently no specific guidelines on the standards and structure of postgraduate perinatal psychiatric training in Europe. We describe the characteristics of available and desired specialist perinatal psychiatry training from the perspective of European psychiatrists in training. An online survey was conducted among 34 national psychiatric trainee association representatives of the European Federation of Psychiatric Trainees (EFPT). Participants from the countries in which perinatal psychiatry training was available were invited to participate in in-depth follow-up interviews. Six countries out of 34 (18%) reported that specialist training in perinatal mental health was available (Finland, France, Germany, Ireland, Malta, and the UK). The nature of available training varied in duration, the supervision and assessment model employed, and the training scheme context. Of the 28 countries where specialist perinatal psychiatry training was unavailable, the majority of national representatives (22 countries, 76%) wanted specialist perinatal psychiatry training to be included in their national training curricula. There is a gap between the expected skills and the available training for psychiatrists to meet the mental healthcare needs of women in the perinatal period. Given the prevalence and impact of perinatal mental illness and the expressed desires of trainees themselves for specialist training, this finding should prompt urgent action., (© 2022. The Author(s).)

Abstract: Supervision of nonspecialist clinicians by trained mental health professionals is integral to developing capacity for providing mental health care in low-resource settings. Current supervision efforts in low-resource settings, however, are often variable in quality. Scant published literature addresses how supervision practices affect treatment outcomes; only a few studies have been published on evidence-based supervision methods. Additionally, in low-resource settings many systems-level obstacles exist in providing adequate mental health supervision to nonspecialist clinicians. This article seeks to address psychiatrists' role in providing supervision and promoting quality of care in low-resource settings. We review the literature on evidence-based supervision practices, address obstacles and current practices of providing high-quality mental health supervision in low-resource settings, and weave this knowledge with our experiences learning from the clinicians at Partners in Health in Haiti. We also discuss feasible strategies and provide recommendations for strengthening the supervision process in resource-limited settings., (Copyright © 2021 President and Fellows of Harvard College.)

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Mental health professionals who both provide services and effectively make use of them to address their own emotional or psychiatric challenges are called wounded healers. Despite the potential benefits of lived experience, these professionals often must contend with institutions and systems that are discriminatory. The authors use life-writing to address challenges -- stigma, disclosure, and role fluidity -- faced by wounded healers within educational and work environments.

The term "digital phenotype" refers to the digital footprint left by patient-environment interactions. It has potential for both research and clinical applications but challenges our conception of health care by opposing 2 distinct approaches to medicine: one centered on illness with the aim of classifying and curing disease, and the other centered on patients, their personal distress, and their lived experiences. In the context of mental health and psychiatry, the potential benefits of digital phenotyping include creating new avenues for treatment and enabling patients to take control of their own well-being. However, this comes at the cost of sacrificing the fundamental human element of psychotherapy, which is crucial to addressing patients' distress. In this viewpoint paper, we discuss the advances rendered possible by digital phenotyping and highlight the risk that this technology may pose by partially excluding health care professionals from the diagnosis and therapeutic process, thereby foregoing an essential dimension of care. We conclude by setting out concrete recommendations on how to improve current digital phenotyping technology so that it can be harnessed to redefine mental health by empowering patients without alienating them., (©Antoine Oudin, Redwan Maatoug, Alexis Bourla, Florian Ferreri, Olivier Bonnot, Bruno Millet, Félix Schoeller, Stéphane Mouchabac, Vladimir Adrien. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 04.10.2023.)

Psychiatry and anthropology have a long relationship, and it is worth examining aspects of how that relation is carried over into the developing field of Global Mental Health (GMH). One place at which the two disciplines overlap significantly is in addressing religious phenomena and ritual performance in relation to mental health, and one of the greatest challenges for GMH is how productively to take into account forms of indigenous healing based on religion and ritual. In this paper I compare recent texts in GMH written from the standpoint of psychiatry and anthropology, observing that the psychiatric texts emphasize evidence-based determination of treatment efficacy, while the anthropological texts emphasize ethnographic understanding of treatment experience. Reconciling these two emphases constitutes a challenge to the field, attending to contextual variations in treatment events, illness episodes, phenomenological factors both endogenous and intersubjective, and sociopolitical factors both interpersonal and structural. In addressing this challenge, I propose an approach to therapeutic process that on the empirical level can facilitate comparison across the diversity of healing forms, and on the conceptual level can constitute a bridge between efficacy and experience. This approach is predicated on a rhetorical model of therapeutic process including components of disposition, experience of the sacred, elaboration of alternatives, and actualization of change that highlights experiential specificity and incremental change. Deploying this model can help meet the challenge of understanding efficacy and experience in indigenous healing, and prepare the ground for the further challenge of how practitioners of GMH relate to and interact with such forms of healing.

John Werry completed training in child and adolescent psychiatry at McGill University in Montreal, and has been a world renowned leader in children's mental health. Drawing on a half century of work in Canada, the United States, and his native New Zealand, he shares his reflections and vision for the future in the interview given for this article. The interview was conducted by Larry K. Brendtro, who was a colleague of Werry's when both were on the faculty at the University of Illinois.

The paper gives an account of psychiatric services in Dubai (U.A.E). It describes the unique demographic constitution of Dubai and its complex health system. It also discusses the reasons behind the primitiveness of psychiatry in comparison to other medical specialties and services, especially considering the wealth of Dubai. The paper then goes on to mention the available psychiatric services and the environment of the psychiatric department in Rashid Hospital in Dubai. Finally, the report touches on areas of mental health legislation, education, training and research in the field of mental health in Dubai.

Watters questions the universality of mental illness and warns of the harms that accompany the exportation of Western typologies to non-Western cultures. He is particularly concerned that these effects will be exacerbated by the upcoming revisions of the "Diagnostic and Statistical Manual of Mental Disorders" ("DSM-V"). Building on his examination of non-Western practices, Watters exposes the historical instability of mental health classifications in North America to question the validity of current "DSM" categories. Although Watters' warnings about the dangers of the globalisation of the "DSM" are persuasive, they may be overreaching as our examination of the successful incorporation of Western created autism services, information, and interventions in the developing world suggests. (Contains 25 footnotes.)

Service users and their families have raised concerns about safety in current acute mental health service delivery. Restrictive interventions are routinely used across mental health settings despite increasing awareness of the negative impacts. Underfunding and risk-averse management practices are implicated as key challenges. Utilizing a scoping review and thematic analysis method, this review explored the existing literature of mental health staff perspectives across various settings (including psychiatric wards and emergency departments), focusing on their experience of restrictive interventions. Four themes were developed: 1. Safety (both staff and patient); 2. Barriers to staff reducing their restrictive interventions; 3. Strength in current practice; 4. Recommendations for change. Key gaps in the literature were the limited perspectives of emergency and crisis clinicians (despite these areas being settings where restrictive interventions are utilized) and limited perspectives from allied health disciplines (despite their employment as clinicians in these settings). It also noted a divide between staff and patient safety, as though these concerns are mutually exclusive rather than cooccurring, which is the experienced reality. Advocacy bodies, governments and the media are calling for a reduction in restrictive interventions in crisis settings. This research synthesis proposes that, to achieve this, clinical staff must be involved in the process and their perspectives actively sought and drawn upon to enable reform. [ABSTRACT FROM AUTHOR]

In addition to contemporary boundaries and identities of educational psychology is the historiography of progressive education. Historians have too readily played into the hands of practitioners, accepting antagonisms between Freud and Thorndike, psychoanalysis and behaviorism, liberty and discipline. In its final analysis, this article embraces revisionism. Rather than antagonists, psychoanalysis and behaviorism are complementary and consolidated, working in tandem to individualize students within the confines of mass education. In this article, the author argues by presenting descriptions of Luella W. Cole and Sidney L. Pressey's work at Ohio State University (OSU). By 1931, Cole and Pressey were well recognized in educational psychology and OSU was a powerhouse in both education and psychology. Exemplifying the hybrid nature of educational psychology, these two psychologists' practices at OSU were nonetheless common and indicative of relations between education and psychology at the time. If psychoanalysis was primarily oriented toward personality and counseling, and behaviorism toward performance and testing, Cole and Pressey thoroughly mixed the two in practice. They recognized that personality was inseparable from mundane educational practices--personality was normalized in the minutiae of everyday schooling. They denoted educational psychology as a psychotherapeutic practice in regulating normal, scholastic conduct and thought. They practiced child guidance, mental hygiene, common and special education as well as abnormal, clinical, educational, experimental, individual, and social psychologies. Their practices had as much to do with behaviorism and abnormality as with psychoanalysis and normality. At this same time, abnormal, clinical, and educational psychologists became increasingly interested in the maintenance of normality. From a base of attention to abnormality, Cole and Pressey defined educational psychology as a practice attending to normality through a regulation of healthy, normal scholastic conduct and thought. Furthermore, educational psychology focuses on the eradication of the scholastic errors and personality quirks of individual students, through the use of remedial apparatus and through counseling. (Contains 1 table and 61 footnotes.)

Psychologists and psychiatrists have long been aware that individuals differ in their response to environmental stressors. It is equally apparent that whilst positive or corrective environmental factors help some individuals, others seem to benefit little, if at all. To make the matters even more interesting (at least for a researcher who is hoping for a long and painstaking road of scientific discovery), it is not safe to assume that environments operate entirely independently of the study participants.

Notes that low Medicare reimbursement rates are already causing some mental health professionals to turn away elderly patients. Considers baby boomer cohort who, unlike elders today, have high rates of psychiatric illness and are more likely to seek mental health services. Projects increasing gap over next 25 years between need and availability of geriatric mental health services. (Author/NB)

People with intellectual disability (ID) were once considered immune to developing psychopathology, including affective disorders such as depression. Now research has shown that people with ID do suffer from depression, and the focus is on understanding how to best diagnose and provide treatment. Research has come a long way in adapting the diagnostic process for people with mild/moderate deficits in intellectual functioning and communication abilities. However, there is a lack of research and clinical understanding regarding how to assess depression in people who lack communication skills and function with severe or profound deficits in intellectual functioning. This paper reviews the available literature on the occurrence of depression in people with ID, specifically those with more significant deficits, and discusses the difficulties that arise in trying to determine a diagnosis of depression for this population.

This issue's "Voices of Pioneers" segment features the work of Karl Menninger, pre-eminent psychiatrist, and his contributions to prison reform, mental health, and child care systems. Notes many of Menninger's books and writings, including relevant quotes throughout the article. Also describes Menninger's concern over the plight of Native Americans. (NB)

As someone who has been involved in college mental health in three different roles, the author would say those who work in this field inhabit a strange space. College mental health centers are generally seen as somewhat peripheral to the core mission of universities by upper administration. Counseling centers do not reside within academic departments of social work, psychology or psychiatry. The result is that while they may know how hard they work and how essential they are to the success of the students they treat and help, they are often left feeling less than valued by their administrations and disconnected from many of their clinical colleagues who work in more standard settings such as hospitals, community clinics or private practice. Most of their clinical colleagues do not realize that their college counseling services are responsible for the care and safety of approximately 20 million (mostly young) people in the United States. While college counseling centers have in the past received unfortunate attention around campus tragedies and disasters, they should recognize that their work is being noticed and valued in some pretty disparate and surprising arenas. They may not realize it and take enough credit, but is seems they just may be the "cutting edge" of health and mental health care. (Contains 1 note.)

Background: As many as 20 % of children have diagnosable mental health conditions and nearly all of them receive pediatric primary health care. However, most children with serious mental health concerns do not receive mental health services. This study tested hypotheses that pediatric primary care providers (PPCPs) in relationships with mental health providers would differ in their care of patients with mental health concerns when compared to PPCPs not in such relationships. Objective: To explore differences between PPCPs who have relationships with mental health care providers and those who do not with regard to their care of children with mental health concerns. Methods: Seventy-two PPCPs completed a mailed survey addressing topics such as comfort levels diagnosing and managing patients with behavioral health disorders, perceived barriers to care, activity related to prescribing psychotropic medications, and availability of consultation with mental health specialists. More than one-third (19 providers) of providers reported no specialized training in behavioral pediatrics and nearly 45% (32 providers) indicated having a relationship or partnership with a mental health specialist. Results: Those providers who reported relationships indicated greater availability of consultation and communication with psychiatric providers as well as telephone consultation with non-psychiatric mental health providers. All providers were more comfortable assessing as opposed to treating children with disorders, with the exception of attention disorders, which providers were comfortable with both treating and assessing. For all conditions, there was no main effect for partnership. Conclusion: While partnerships may be associated with greater availability of consultation and communication, for this sample of PPCPs there was no evidence of advantage with respect to diagnosis and management. The paper concludes with a discussion of study limitations, the need for further research, and suggestions for practice.

Background: The rapid integration of Artificial Intelligence (AI) into the healthcare field has occurred with little communication between computer scientists and doctors. The impact of AI on health outcomes and inequalities calls for health professionals and data scientists to make a collaborative effort to ensure historic health disparities are not encoded into the future. We present a study that evaluates bias in existing Natural Language Processing (NLP) models used in psychiatry and discuss how these biases may widen health inequalities. Our approach systematically evaluates each stage of model development to explore how biases arise from a clinical, data science and linguistic perspective., Design/methods: A literature review of the uses of NLP in mental health was carried out across multiple disciplinary databases with defined Mesh terms and keywords. Our primary analysis evaluated biases within 'GloVe' and 'Word2Vec' word embeddings. Euclidean distances were measured to assess relationships between psychiatric terms and demographic labels, and vector similarity functions were used to solve analogy questions relating to mental health., Results: Our primary analysis of mental health terminology in GloVe and Word2Vec embeddings demonstrated significant biases with respect to religion, race, gender, nationality, sexuality and age. Our literature review returned 52 papers, of which none addressed all the areas of possible bias that we identify in model development. In addition, only one article existed on more than one research database, demonstrating the isolation of research within disciplinary silos and inhibiting cross-disciplinary collaboration or communication., Conclusion: Our findings are relevant to professionals who wish to minimize the health inequalities that may arise as a result of AI and data-driven algorithms. We offer primary research identifying biases within these technologies and provide recommendations for avoiding these harms in the future., Competing Interests: Chris Callison-Burch declares no competing interests. Isabel Straw has been an unpaid intern with the e-Health company "Neuroflow" as part of her Masters in Public Health (MPH) Program. While this has been entirely separate from this research project, the timing of the internship overlaps with the period of time taken to write this article. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Background: The psychometric properties of an online test are not necessarily identical to its paper and pencil original. The aim of this study is to test whether the factor structure of the Community Assessment of Psychic Experiences (CAPE) is measurement invariant with respect to online vs. paper and pencil assessment. Method: The factor structure of CAPE items assessed by paper and pencil (N = 796) was compared with the factor structure of CAPE items assessed by the Internet (N = 21,590) using formal tests for Measurement Invariance (MI). The effect size was calculated by estimating the Signed Item Difference in the Sample (SIDS) index and the Signed Test Difference in the Sample (STDS) for a hypothetical subject who scores 2 standard deviations above average on the latent dimensions. Results: The more restricted Metric Invariance model showed a significantly worse fit compared to the less restricted Configural Invariance model (χ2(23) = 152.75, p<0.001). However, the SIDS indices appear to be small, with an average of −0.11. A STDS of −4.80 indicates that Internet sample members who score 2 standard deviations above average would be expected to score 4.80 points lower on the CAPE total scale (ranging from 42 to 114 points) than would members of the Paper sample with the same latent trait score. Conclusions: Our findings did not support measurement invariance with respect to assessment method. Because of the small effect sizes, the measurement differences between the online assessed CAPE and its paper and pencil original can be neglected without major consequences for research purposes. However, a person with a high vulnerability for psychotic symptoms would score 4.80 points lower on the total scale if the CAPE is assessed online compared to paper and pencil assessment. Therefore, for clinical purposes, one should be cautious with online assessment of the CAPE. [ABSTRACT FROM AUTHOR]

Despite the continuing interests in political, economic, and public health issues of North Korea, little is known about mental health problems in North Korea. To gain a glimpse into this area of interest, we aimed to explore the characteristics of mental health research in North Korea and to identify the emphasis therein. In this context, four North Korean medical journals were selected from the Information Center on North Korea, with publication dates 2006-2017 (inclusive). For this bibliographic study's scope, we targeted studies on psychiatric problems in humans. We first selected articles based on their titles, and then finalized the study sample after reviewing the full text of primary sample articles. For main outcome measures, we used the absolute number and proportion of mental health research articles relative to total publications and the distribution of papers by research themes as defined by ICD-10 categories. Collectively, four journals published 162 mental health research articles from 2006 to 2017. The yearly volume and proportion varied between two and twenty-four and between 0.3 % and 2.7 %, respectively. The most frequently addressed ICD-10 category was F40-48, namely 'Neurotic, stress-related and somatoform disorders,' and the most frequently investigated condition was somatoform disorders. In conclusion, there has been a slow but steady increase in the research volume of psychiatry and mental health problems since 2011. The finding that the highest amount of research was conducted on somatoform disorders may suggest that mental disorder symptoms may be represented differently under the influence of socialism in North Korea., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Recently, there have been intense debates within the mental health field regarding the validity of the current diagnostic system, how to best work with individuals in distress, and what constitutes "mental illness." Proponents of a more biologically focused psychiatry are calling for a shift from a system of many discrete mental disorders based on somewhat arbitrary lists of symptoms to one that focuses on differences in brain activity, brain structure, and/or soon-to-be-discovered biomarkers as the basis for diagnostic categorization. Several national and federally funded organizations throughout the world, including the National Institute of Mental Health in the United States, have publicly avowed to support technologies and research focused on discovering brain-based pathology at the explicit expense of studies examining psychosocial factors and preventative measures for human suffering. Although the motivation for this shift is understandable, it continues to rely on a disease model based on an implausible reductionist view of human nature and contradicts robust research findings. It is likely that this new research focus will not only fail to achieve the breakthroughs it aims for, it will also serve to entrench current flawed assumptions about emotional distress to the detriment of many. By focusing on a narrow, brain-based etiology of emotional suffering, crucial factors, such as poverty, violence, family disharmony, and discrimination are marginalized or ignored. The need for a more comprehensive approach is discussed. [ABSTRACT FROM AUTHOR]

Objective: This paper aims to discuss the answers to Review Paper Exam for the Malaysian Master of Medicine (Psychiatry) May 2012 theory examination. The paper studied the psychotropic prescription practice in cancer patients using a health care registration database. Methods: One of the papers presented during the journal club presentation was picked-up for evaluation of student's critical appraisal. Results: Model answers were provided at the end of the Critical Review Paper. Conclusion: This review paper evaluates students' understanding and critical thinking on the topic of Psychotropic Drugs in cancer patients. This paper may serve as a guideline to teach students how to critically appraise topic related to psychiatry. [ABSTRACT FROM AUTHOR]

Purpose: Latino farmworkers are a vulnerable population who confront multiple threats to their mental health. Informed by the stress-process model of psychiatric disorder, the goal of this paper is to determine primary and context-specific stressors of poor mental health among Latino farmworkers. Methods: Structured interview data were obtained from farmworkers (N = 69) in 6 counties in eastern and western North Carolina. Findings: Results indicated that a substantial number of farmworkers have poor mental health, as indicated by elevated depressive symptoms (52.2%) and anxiety (16.4%). Results also indicated that each mental health outcome had different predictors. Conclusion: Addressing the mental health issues of farmworkers requires a comprehensive, multifaceted approach.

Many countries have enacted, or are in the process of enacting, emergency mental health legislation in response to the global pandemic of Covid-19 (coronavirus). In Ireland, the Emergency Measures in the Public Interest (Covid-19) Act, 2020 amends the Mental Health Act 2001 to permit the Mental Health Commission to request an independent psychiatric report about an involuntary patient from any consultant psychiatrist who is not treating the patient (and not just those on its designated panel). This independent examination may occur 'in person', 'by other appropriate means', or even, 'due to the exigencies of the public health emergency', not occur at all, once this is explained in the resultant report. The 2020 Act acknowledges that 'the exigencies of the public health emergency' might hamper the independent psychiatrist's work and requires a written report from the patient's treating psychiatrist 'no earlier than the day before' the tribunal, in lieu of the psychiatrist physically attending a tribunal hearing, although, if possible, they will attend (i.e. phone in to) a tribunal held by conference call. The 2020 Act permits the Mental Health Commission to, if necessary, appoint tribunals 'consisting of one member who shall be a practising barrister or solicitor'. Such a tribunal shall, if possible, consult with a consultant psychiatrist if the reports from the independent psychiatrist and treating psychiatrist conflict or if it is otherwise 'necessary in the interest of the patient'. A tribunal can extend an involuntary order by a second period of 14 days 'of its own motion if the tribunal, having due regard to the interest of the patient, is satisfied that it is necessary'. Tribunals for current involuntary patients will be prioritised over retrospective tribunals for discharged patients; a tribunal can direct a witness to provide 'a written statement' rather than attending; and the patient can make written representation to the tribunal instead of physically attending a tribunal hearing, although they may attend (i.e. phone in to) a tribunal held by conference call. Psycho-surgery for involuntary patients is banned. While it is clear that revisions are urgent and necessary in light of Covid-19, the proportionality of these changes will depend on how, and the extent to which, they are used in practice. With good communication, efficient team-working and close adherence to professional codes of practice and ethics, it is hoped that these amendments will result in a review system that is as reasonable, robust and reassuring as the current, highly unusual circumstances permit., Competing Interests: Declaration of Competing Interest The author was a member of the Expert Group on the Review of the Mental Health Act, 2001 (2015); was consulted by various parties at different stages in the development of the Emergency Measures in the Public Interest (Covid-19) Act, 2020; and is Editor-in-Chief of the International Journal of Law and Psychiatry and a co-editor of this special issue, but he played no role in the management of this paper during the editorial process. There is no other interest to declare., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Multiculturalism is a familiar concept in many developed countries. While cultural competency training is part of most medical curricula, training in cultural psychiatry at the undergraduate level is typically minimal. It is important that medical graduates are both culturally competent and able to respond to the mental health needs of patients from diverse cultures. This paper provides an overview of the teaching of cultural competency and cultural psychiatry to medical students, and discusses aspects of cultural psychiatry that could be included in medical courses. It was concluded that there needs to be more attention given to teaching of cultural psychiatry in the undergraduate curriculum. The challenge for medical curricula is in the provision of cultural psychiatry content to ensure that students are able effectively to communicate, assess and treat patients from different cultural backgrounds by the time they graduate and begin their professional careers.

The paper aims to analyze the hospital inpatient care use and medical fee of people with ID co-occurring with schizophrenia in Taiwan. A nationwide data were collected concerning hospital admission and medical expenditure of people with ID (n = 2565) among national health insurance beneficiaries in Taiwan. Multiple regression analyses were undertaken to determine the role of the explanatory variables to hospital psychiatric inpatient care and medical expenditure. We found that there were 2565 individuals with ID used hospital psychiatric inpatient care among people with ID in 2005, and 686 cases (26.7%) co-occurring with schizophrenia according to hospital discharge claims. Those ID patients co-occurring with schizophrenia consumed more annual inpatient fee than those without schizophrenia (251,346 vs. 126,666 NTD) (p less than 0.001). We found factors of female cases, longer hospital stay in chronic ward and general ward users among ID patients co-occurring with schizophrenia used more hospital inpatient care (R[superscript 2] = 0.417). Annual hospital inpatient days were significantly affected by factors of severe illness card holder, annual inpatient care fee, longer hospital stay in acute or chronic ward (R[superscript 2] = 0.746). Those factors of female cases, high inpatient care users, longer hospital stay in acute ward and general ward were consuming more medical care fee than their counterparts (R[superscript 2] = 0.620). The study highlights the future study should examine the efficacy of hospital inpatient care for people with ID and schizophrenia.

Research is a "core activity" of "central importance in improving mental health and social care" (NIME, CAMHS National Conference, 2005). This paper examines the philosophical issues confronted when considering psychoanalytic clinical research. It is argued that a well-suited partnership can be formed between psychoanalytic clinical research and Grounded Theory. The methodological issues encountered when using Grounded Theory to analyse qualitative clinical data are explored. The well-suited partnership formed between Grounded Theory and psychoanalytic clinical research has the capacity to provide explanatory mechanisms, findings that are translatable to routine clinical practice, and to discover new ways of grouping young people so that they are alike in the most significant aspects of their mental health presentations. This makes further clinical trials more reliable. Psychoanalytic clinical findings are used together with a range of material from different sources to develop concepts and theory that are readily accessible to the wider professional community. Illustrations will be provided from the author's doctoral research into Risk-Taking, Dangerous Behaviour. (Contains 3 figures.)

Of all of the medical specialties, child and adolescent psychiatry has the most severe shortage of practitioners. This shortage is even more pronounced in economically disadvantaged and rural areas. The American Indian population is younger, more economically disadvantaged, and more rural than the general U.S. population (United States Census Bureau, 2000). Researchers and many American Indians believe that their traumatic history and current marginalization has made them more likely to experience mental health problems such as alcoholism and posttraumatic stress disorder. Telepsychiatry, the use of real-time, interactive videoconferencing to deliver psychiatric services, is an exciting opportunity to ensure that American Indians are not left out of the improvement of mental health services. The use of telepsychiatry can assist in providing child and adolescent psychiatric services to patients in remote and underserved areas while sparing patients and providers long, expensive, and life-disrupting journeys. Furthermore, this paper presents an example of telepsychiatry being used to treat American Indian children.

Discusses how, following an intensive 2-day clinical experience for nursing students in a rural, culturally diverse region, student evaluations and papers showed evidence of cultural learning and increased knowledge of rural health care systems. Includes reflections by a teaching associate and two students. (Contains 33 references.) (SK)

This paper examines the early origins of the shift away from institutional psychiatry in the USA. It focuses on the period between 1900 and 1950. Attention is paid to the role of neurologists and disaffected asylum doctors in the early emergence of extra-institutional practice; to the impact of the National Committee for Mental Hygiene and Thomas Salmon; to the limited role of psychoanalysis during most of this period; and to the influence of the Rockefeller Foundation's decision to focus most of its effort in the medical sciences on psychiatry.