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This scoping review offers insight into researcher well-being when working with sensitive and traumatic topics in a qualitative research context. The study identified existing empirical research concerning researcher well-being and mental health. The databases included SSCI, ASSIA < IBISS, Scopus, Social Policy and Practice, PsycInfo, Social Science Database/Social Science Premium Collection (Proquest), and Open Grey. An international search was conducted, with no time constraints on publication dates to gather as wide a selection as possible. 55 papers met the criteria. We found that the terminology used within the papers was not consistent which necessitated grouping the (self-) reflection/reflexive practices researchers used and categorizing them under the umbrella term SRR practices. The research questions were: 1. Which disciplines or fields are conducting SRR practices on sensitive topics? 2. What SRR practices do researchers employ in the context of sensitive research? 3. What were the self-reported outcomes from using SRR practices as a tool of researchers working on sensitive research? A key finding of the scoping review is that many researchers who work on sensitive topics feel unprepared and receive little or no training or support for SRR practices. This poses particular challenges for early career researchers. We also identified that qualitative researchers have developed a range of SRR practices to manage the emotional impact of their sensitive research work. Many authors of the scoped papers stress the importance of peer-support as well as formal and informal debriefing meetings. Another key SRR practice discussed by many researchers is reflexive journaling. Our scoping review suggests that if it is combined with other activities, self-reflexive journaling can be an excellent way to acknowledge and assess the emotional impact of sensitive research. [ABSTRACT FROM AUTHOR]

The devastation of the Covid-19 pandemic on society raised the question of how best to gauge society's psychological adaptation to continually evolving global disruptor events, such as Covid-19. This paper aims to illustrate the use of different approaches to monitor society's psychological response to Covid-19, in order to argue for a more comprehensive, multi-model, approach. The results from different approaches are presented in two studies employing measures of mental disorders and mental distress, respectively, using South African samples for demonstration. The first study presents findings from repeat administration of measures of common mental disorders (major depressive and generalized anxiety disorders) across three consecutive years, while the second study presents findings from mood response profiles (measured with the Brunel Mood Scale) collected across five time points during the Covid-19 pandemic. Both studies showed that the Covid-19 pandemic was temporally associated with adverse mental health outcomes across the mental health continuum, and that mental health profiles were associated with both time since onset of Covid-19 and subsequent wave occurrence. Elevated prevalence of common mental disorders, as well as fluctuating patterns of mood response profiles, are discussed against the context of Covid-19. The paper concludes that a multi-modal approach, for instance measuring specific mental disorders as well as more general mental distress, is crucial to comprehensively understand society's psychological adaptation to major disruptor events, and guide health sector responses. The paper serves as a reminder to continue to observe mental health more inclusively to appropriately respond to the psychological needs of communities. Plain Language Summary: Measuring mental health across Covid-19 waves The impact of Covid-19 on mental health raised the question of how can we best measure how society adapts, psychologically, to major events that disrupt life. This article looked at two specific ways to measure and monitor society's psychological response to Covid-19. The first study looked at the prevalence of mental disorders, and the second looked at levels of mental distress. Both studies used South African samples to demonstrate this. The first study presented data from a repeat administration of scales that identify depressive and anxiety disorders, completed across three consecutive years. The second study presented findings from mood response profiles (measured with the Brunel Mood Scale) collected across five time points during the Covid-19 pandemic. The results showed that the pandemic was associated with adverse mental health outcomes—across the mental health continuum—and that mental health profiles were associated with both time since the start of Covid-19 and fluctuated with the subsequent waves across the pandemic time-line. This article demonstrated the importance of using a multi-modal approach to fully understand society's psychological response to major life disruptions. It also acted as reminder to monitor mental health continuously to be able to respond to the psychological needs of communities. [ABSTRACT FROM AUTHOR]

Marijuana, also known as cannabis, is a psychoactive drug that comes from the Cannabis plant. Marijuana can be smoked, vaporized, or consumed through edibles in a variety of ways. Perception changes, changes in mood, and problems with coordination are all possible side effects. Marijuana is used for both recreational and medical purposes to treat a variety of health conditions. The literature review on the effects of marijuana on the human body has increased in recent years as more states legalize its use. It is important to investigate the benefits and harmful effects of marijuana on individuals due to the widespread use of cannabis-derived substances like marijuana for medical, recreational, and combined purposes. The paper will review different aspects of marijuana in 4 main domains. A thorough discussion of marijuana's definition, history, mechanism of action, pharmacokinetics, and effects on human cells will be given in the first domain. The second domain will concentrate on marijuana's negative effects, while the third domain will look at marijuana's possible positive impacts, such as its usage in controlling multiple sclerosis, treating obesity, lowering social anxiety, and managing pain. The fourth domain will concentrate on marijuana's effects on anxiety, educational attainment, and social consequences. Additionally, this paper also will provide a highlight of the history of marijuana use and governmental legislation, both of which play a significant role in determining how the public views marijuana. In conclusion, this paper provides a comprehensive review of marijuana's effects, which may be of interest to a large readership. This review adds to the continuing discussion about the use of marijuana by analyzing the data that is currently available about the possible advantages and disadvantages of marijuana usage. [ABSTRACT FROM AUTHOR]

Background: Doctors with a history of mental health or substance use challenges face barriers accessing treatment and are difficult to recruit for research. This makes understanding their experiences challenging, yet essential. Overcoming barriers to research participation among unwell doctors is critical to advancing their overall health and wellbeing. Methods: A qualitative interview study of 21 allegedly impaired doctors in Australia and Aotearoa New Zealand who were subject to regulatory processes relating to their health. Based in an interpretative phenomenological paradigm, this paper examines participants' motivations for participation in this study and their reactions to participating. It highlights wider implications for sensitive research involving doctors and marginalised groups. Results: Participants were strongly motivated to participate in our research for their own benefit (desire to be heard, catharsis, and empowerment) and to benefit others (to change the system, and to avoid other doctors experiencing what they experienced). Careful planning and communication of unique legal risks fostered a trusting researcher-participant relationship. To assist other researchers undertaking sensitive qualitative research with vulnerable participants, we describe our research protocol, challenges, and successes in detail. Conclusions: Despite ethical concerns about research risk, researchers can and should pursue qualitative research into the experiences of under-represented groups, including allegedly impaired doctors. Without involving them in research that examines issues directly impacting on them, we may be inadvertently perpetuating the barriers and stigma that also hinder them from accessing treatment and support. This also deprives us of knowledge that can be used to improve doctors' health. This paper has broader relevance for anyone doing research with doctors, people in vulnerable positions, people disempowered by institutional or social systems, people who are stigmatised or shamed, and people who have experienced trauma. [ABSTRACT FROM AUTHOR]

Internationally, lead agencies and consumer movements emphasise the need for high-level research participation in mental health. However, evidence suggests that people with lived experience tend to be recruited as subjects rather than as active agents in research, or are consulted in tokenistic ways. Although participatory research has the potential to rectify epistemic disparities, few studies have grappled with how to move from exclusion and tokenism to high-level research participation. This paper describes a qualitative co-evaluation of a co-produced model of research partnership, Raising the Bar, which involved deliberate establishment and facilitation of six participatory research teams, comprising 28 lived experience and 'conventional' mental health researchers. Findings indicate that the theoretical elements of the model set the bar high from the outset, supporting research teams to address inconsistencies in knowledge about participation. It also provided researchers with the competencies and resources to undertake participatory research in egalitarian team structures, and to negotiate new forms of non-traditional research outputs - thereby challenging whom research might be for and how it might be made accessible. Finally, the model shifted collective meanings about research, lending credibility to participatory practices, which came to be seen as essential for meeting the needs of affected communities. Nonetheless, systemic barriers to participatory research remain, and need to be recognised and acted upon to promote a culture that supports high-level research participation. [ABSTRACT FROM AUTHOR]

MHCA mandates monthly reporting to the MHRBs of restraints imposed on the PwMI in the MHEs (Section 97). CB-MH services must be strengthened by effectively implementing DMHP and CB-MH services for ensuring the rights of PwMI to receive treatment in the least restrictive environment. Sir, The Mental Health Care Act, 2017,[1] was implemented in the country for ensuring the rights of persons with mental illness (PwMI).[2] Since its launch, it has been critiqued by the scientific community, highlighting its shortcomings and issues with implementation.[3]-[5] However, such critiques did not explicitly highlight the issues with the implementation of the MHCA in routine clinical discourse. [Extracted from the article]

Intro: This paper reports the demographics of a large sample of board gamers and their in-game motivations and preferences. Methods: We report the specific preferences of 1603 board gamers (i.e. preferred platform, mechanics, style, theme, player count and game length) and player demographics, i.e. age, gender, education level as well as neurodivergence in this population. Participants were sampled via board game groups and game distributor mailing lists. Results: Findings confirmed previous assumptions that board gamers are primarily middle-aged, university/college-educated, white males. We show that most gamers identify as mid-core/core with a preference for shorter, competitive Euro games. They tend to prefer in-person play with 3-4 players. However, a sizeable portion of the sample did not fit this description, showing a more complex picture. Discussion: Results describe the population's demographics and detailed description of gamers preferred, mechanics, themes, components, preferences and motivations. An anonymised version of this data set is provided alongside this work for game designers and academics to explore further and cross-reference relationships between demographics and preferences/motivations. Considering that a quarter of the sample were neurodivergent (i.e. reported at least one mental health or neurodevelopmental condition) the dataset could also help clinicians who use board games as interventional tools. We hope this dataset (https://osf.io/tu8yq) will be helpful to board game designers, clinicians, educators, teachers, therapists and researchers interested in utilising board games to make informed choices about which games they use. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic had a significant impact on medical education and gastroenterology fellowship training. As a result of the pandemic, a trainee's physical safety, mental health and wellness, clinical and procedural training, and educational opportunities were all potentially altered. Changes necessitated at the start of the pandemic were different than those needed further along in the pandemic course. Fellowship programs were required to modify policies and adapt to changes rapidly to advocate for their trainees and ensure quality education. Much of COVID-19's initial impact on education – decreased endoscopic procedures and the loss of educational conferences – has largely returned to pre-pandemic form. However, other changes made during the pandemic have persisted and likely will continue in the future. This includes a virtual interview format for fellowship matches, a virtual option for many national conferences, and an expansion of simulation training. This article reviews the impact that COVID-19 had on medical education with a specific focus on gastroenterology fellowship. The paper highlights the initial impact of COVID-19, the lingering effects, and discusses the areas needed for further research to best understand the total impact COVID-19 had on our trainees' education. [ABSTRACT FROM AUTHOR]

Background: Mental health issues are common among college students, and structured services have been proven to enhance outcomes. Despite increased enrolment for higher education in India, college mental health services remain sparse. JEEVANI is the first structured state-wide college mental health service in India. This paper describes its framework and provides an overview of its functioning during the initial five months. Methods: In 2019–2020, the Directorate of Collegiate Education, Government of Kerala, implemented the program in 66 colleges catering to approximately 60,000 students. Qualified counsellors were trained to identify issues and provide interventions and early referrals, using a stepped-care approach. They conducted awareness programs to promote mental health and reduce stigma. Results: The services were accessed by 2,315 students during the assessment period (October 2019 to February 2020). The beneficiaries were predominantly females (54.1%). Over a third (38.8%) belonged to the lower socio-economic strata, and 2.5% had significant vulnerabilities. Although no syndromal diagnoses were made, anxiety and depression were the most common presentations. The counsellors provided 3,758 individual sessions and facilitated support for students who reported academic difficulties or interpersonal issues. Severe mental illness was detected in 54 students, and referrals for specialist mental health input were initiated in 68. Conclusion: Describing the framework, sharing the technical material, and providing an overview of its functioning from a resource-constrained setting in India may encourage higher education institutions in low- and middle-income countries to consider similar projects. [ABSTRACT FROM AUTHOR]

Background: Doctors with a history of mental health or substance use challenges face barriers accessing treatment and are difficult to recruit for research. This makes understanding their experiences challenging, yet essential. Overcoming barriers to research participation among unwell doctors is critical to advancing their overall health and wellbeing. Methods: A qualitative interview study of 21 allegedly impaired doctors in Australia and Aotearoa New Zealand who were subject to regulatory processes relating to their health. Based in an interpretative phenomenological paradigm, this paper examines participants' motivations for participation in this study and their reactions to participating. It highlights wider implications for sensitive research involving doctors and marginalised groups. Results: Participants were strongly motivated to participate in our research for their own benefit (desire to be heard, catharsis, and empowerment) and to benefit others (to change the system, and to avoid other doctors experiencing what they experienced). Careful planning and communication of unique legal risks fostered a trusting researcher-participant relationship. To assist other researchers undertaking sensitive qualitative research with vulnerable participants, we describe our research protocol, challenges, and successes in detail. Conclusions: Despite ethical concerns about research risk, researchers can and should pursue qualitative research into the experiences of underrepresented groups, including allegedly impaired doctors. Without involving them in research that examines issues directly impacting on them, we may be inadvertently perpetuating the barriers and stigma that also hinder them from accessing treatment and support. This also deprives us of knowledge that can be used to improve doctors' health. This paper has broader relevance for anyone doing research with doctors, people in vulnerable positions, people disempowered by institutional or social systems, people who are stigmatised or shamed, and people who have experienced trauma. [ABSTRACT FROM AUTHOR]

Child sexual abuse is a detrimental experience that could cause deleterious mental-health outcomes in the survivor. Decades of research have revealed the complex nature of child sexual abuse in terms of its characteristics, dynamics, causes, and consequences. Efficacious psychological interventions for managing child sexual abuse-related outcomes in children exist. However, it is now well recognized that interventions alone are not enough for recovery from sexual or any other type of trauma; it requires an entire human service system that is well-informed about trauma and its effects. Given the lack of awareness about the consequences of child sexual abuse and the stigmatization that exists in the Indian context, which significantly contributes toward the evolution and severity of trauma outcomes in victimized children, this paper is an attempt to discuss the relevance of adopting a trauma-informed approach while responding to child sexual abuse. [ABSTRACT FROM AUTHOR]

Objective: Previous research has evaluated the sources of post-secondary student stress, but has failed to explore whether stressors fluctuate over time. The purpose of this research was to use the Post-Secondary Student Stressors Index to examine whether stressors changed significantly and meaningfully over the course of an academic year. Due to the timing of data collection, results also provide context around students' experiences of stress during the COVID-19 pandemic. Method: Cross-sectional data was collected at 3 time points via online surveys over the course of the 2020–2021 academic year from >10,000 students. Participants attended 15 post-secondary institutions across Canada, representing 9 provinces and 1 territory. Validated instruments were used to assess levels of stress, distress and the severity of student-specific stressors. Kruskal–Wallis ranked tests and multiple pairwise comparison analyses were conducted to assess whether the mean severity of stressors changed over time. Standard effect sizes were calculated using Cohen's d. Results: Mean levels of stress and psychological distress were high at the start of the study and remained high across time points. A similarly high level of stress was observed on average for student-specific stressors. While significant differences in mean severity were observed over time for some stressors, standardized effect sizes were negligible, suggesting little meaningful change and consistent levels of chronic stress over the course of the academic year. Conclusions: This is the first paper to examine trends in student-specific stress using a nationwide sample of Canadian post-secondary students during the first year of the COVID-19 pandemic. Patterns observed in student-specific stressors reflected changes likely to be indicative of the pandemic, including the most severe stress associated with academics, finances and concerns for the future. Implications for future research are discussed, in particular, the importance of examining stressors related to COVID-19 and their impact on student mental health. [ABSTRACT FROM AUTHOR]

Mitigating the impacts of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) and substance use requires comprehensive and systematic thinking in designing interventions and developing policies. This study describes the growth of research publications from 1991 to 2021 in the Web of Science database and points out current research landscapes in the fields of HIV/AIDS and substance use. Latent Dirichlet Allocation was used for classifying 21 359 papers into corresponding topics. The most common topics were HIV transmission, HIV infection, quality of life and mental health of substance users, and the biomedical effect of substance use. Emerging research landscapes include vulnerabilities of people who inject drugs to HIV transmission and related health problems. This study found a lack of research on health services, interdisciplinary and inter-sectoral in combination with clinical evaluation and treatment services. Future investment and implementation of HIV/AIDS and substance use programs should focus on research of health services and clinical evaluation, especially context-specific interventions. [ABSTRACT FROM AUTHOR]

Background: In India, mental health rehabilitation centers run income generation programs (IGP) for therapeutic engagement, skills training, and income generation of clients. The centers have evolved IGP models relevant to their settings. There is a paucity of published literature on practices employed by the centers. Methods: This paper compiles data gathered from visits to 13 centers between November 2018 and April 2019. Information was collected through observation and interviews with staff involved in IGP, using a semi-structured pro forma designed for study. Results: Most centers were based in south India (n = 11) and urban areas (n = 12). Each center ran two to seven IGP. Each center involved 20–50 clients in IGP. Clients involved in IGP were aged 20–60 years. The centers ran a range of IGP, including the manufacturing of household consumables, paper products, textile products, handicraft products, food products, and jute products; animal husbandry and horticulture initiatives; and running cafeterias and petty shops. IGP were mostly selected based on market demand and sales value of products (n = 11); ease of doing (n = 5); interests, abilities, exposure, and experience of clients (n = 5); and availability of resources (n = 3). Products were priced primarily to cover input and labor costs (n = 8), and many centers sold products below the market rates (n = 5). Running stalls during public events was a common strategy for the sale of products (n = 9). Personal contacts and "word of mouth" publicity were used for advertisement (n = 6). Four centers involved family members in IGP. Conclusion: The nature of IGP varied in terms of setting, available resources, and profile of clients availing the services. Marketing and sales were a challenge. A supportive framework of policies and schemes is essential to promote IGP at mental health rehabilitation centers. This report may be helpful for professionals and centers planning to set up an IGP. [ABSTRACT FROM AUTHOR]

Background: As a signatory of the United Nations Commission on Child Rights, India has enacted laws and policies to protect the child's interests. The Juvenile Justice Act of 2015 addresses the needs and well-being of the most vulnerable children, including those who do not have anyone to care for or have experienced a traumatic upbringing and those who are allegedly in conflict with the law. No research from India addresses these vulnerable children's mental health and well-being. The current paper describes a pilot project to create mental health awareness and improve children's care access in India's Juvenile Justice System (JJS). Methods: Permission was obtained from appropriate governmental agencies in Odisha and Tamil Nadu and Child Care Institutions (CCIs) that consented to participate. A co-creation model was utilized to create youth-friendly spaces and methods to deliver mental health literacy for all stakeholders and access to care. Results: Seven CCIs and 278 children across two states participated in the implementation of the project. 37.8% of the children had resided for less than six months and 34.5% for more than two years in the current CCI. Of the various adverse childhood experiences, neglect was the highest at 76.3% followed by parental issues at 32%. Conclusions: Children in the JJS have many risk factors predisposing them to develop mental health issues. This unique pilot project describes implementing a codesigned and co-created model of delivery of mental health literacy and access to care to this vulnerable group of children. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic had a significant impact on medical education and gastroenterology fellowship training. As a result of the pandemic, a trainee’s physical safety, mental health and wellness, clinical and procedural training, and educational opportunities were all potentially altered. Changes necessitated at the start of the pandemic were different than those needed further along in the pandemic course. Fellowship programs were required to modify policies and adapt to changes rapidly to advocate for their trainees and ensure quality education. Much of COVID-19’s initial impact on education – decreased endoscopic procedures and the loss of educational conferences – has largely returned to pre-pandemic form. However, other changes made during the pandemic have persisted and likely will continue in the future. This includes a virtual interview format for fellowship matches, a virtual option for many national conferences, and an expansion of simulation training. This article reviews the impact that COVID-19 had on medical education with a specific focus on gastroenterology fellowship. The paper highlights the initial impact of COVID-19, the lingering effects, and discusses the areas needed for further research to best understand the total impact COVID-19 had on our trainees’ education. [ABSTRACT FROM AUTHOR]

Internationally, lead agencies and consumer movements emphasise the need for high-level research participation in mental health. However, evidence suggests that people with lived experience tend to be recruited as subjects rather than as active agents in research, or are consulted in tokenistic ways. Although participatory research has the potential to rectify epistemic disparities, few studies have grappled with how to move from exclusion and tokenism to high-level research participation. This paper describes a qualitative co-evaluation of a co-produced model of research partnership, Raising the Bar, which involved deliberate establishment and facilitation of six participatory research teams, comprising 28 lived experience and 'conventional' mental health researchers. Findings indicate that the theoretical elements of the model set the bar high from the outset, supporting research teams to address inconsistencies in knowledge about participation. It also provided researchers with the competencies and resources to undertake participatory research in egalitarian team structures, and to negotiate new forms of non-traditional research outputs - thereby challenging whom research might be for and how it might be made accessible. Finally, the model shifted collective meanings about research, lending credibility to participatory practices, which came to be seen as essential for meeting the needs of affected communities. Nonetheless, systemic barriers to participatory research remain, and need to be recognised and acted upon to promote a culture that supports high-level research participation. [ABSTRACT FROM AUTHOR]

BACKGROUND: The purpose of this paper is to provide a preliminary evaluation of treatment outcomes, retention and client satisfaction following a 12-week combined cognitive behavioural therapy (CBT) and motivational enhancement therapy (MET) group treatment for cannabis use disorder (CUD) delivered in an outpatient setting. Implementation of the program is also described. METHODS: A retrospective observational cohort study was conducted using data collected from medical records and self-report assessments. Participants were treatment-seeking cannabis users at the Centre for Addiction and Mental Health, Toronto. Cannabis use, cannabis-related problems, craving, withdrawal symptoms, self-efficacy for remaining abstinent, depression and anxiety were assessed pre- and post-treatment. Treatment retention was calculated by inspecting clinic attendance records, and client satisfaction was evaluated using an anonymous feedback survey. Potential predictors of treatment outcomes and retention were investigated in exploratory analyses. RESULTS: Cannabis use was lower and days of abstinence higher post-treatment (vs pre-treatment). Post-treatment improvements in can-nabis-related problems, craving, withdrawal symptoms, self-efficacy and mood were also observed. Completion of group treatment (≥75% of sessions attended) was 57% and moderate levels of treatment satisfaction were reported. CONCLUSIONS: This study provides preliminary evidence that a 12-week combined CBT and MET treatment for cannabis use disorder delivered in a novel group setting improves cannabis use outcomes. Potential predictors of reduced cannabis use and retention were identified. Future controlled studies are warranted, and strategies for increasing retention should be explored. [ABSTRACT FROM AUTHOR]

Mitigating the impacts of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) and substance use requires comprehensive and systematic thinking in designing interventions and developing policies. This study describes the growth of research publications from 1991 to 2021 in the Web of Science database and points out current research landscapes in the fields of HIV/AIDS and substance use. Latent Dirichlet Allocation was used for classifying 21 359 papers into corresponding topics. The most common topics were HIV transmission, HIV infection, quality of life and mental health of substance users, and the biomedical effect of substance use. Emerging research landscapes include vulnerabilities of people who inject drugs to HIV transmission and related health problems. This study found a lack of research on health services, interdisciplinary and inter-sectoral in combination with clinical evaluation and treatment services. Future investment and implementation of HIV/AIDS and substance use programs should focus on research of health services and clinical evaluation, especially context-specific interventions. [ABSTRACT FROM AUTHOR]

Objective: Throughout the COVID-19 pandemic, there have been concerns about the mental health of health care workers (HCW). Although numerous studies have investigated the level of distress among HCW, few studies have explored programs to improve their mental well-being. In this paper, we describe the implementation and evaluation of a program to support the mental health of HCW at University Health Network (UHN), Canada's largest healthcare network. Methods: Using a quality improvement approach, we conducted a needs assessment and then created and evaluated a modified stepped-care model to address HCW mental health during the pandemic. This included: online resources focused on psychoeducation and self-management, access to online support and psychotherapeutic groups, and self-referral for individual care from a psychologist or psychiatrist. We used ongoing mixed-methods evaluation, combining quantitative and qualitative analysis, to improve program quality. Results: The program is ongoing, running continuously throughout the pandemic. We present data up to November 30, 2021. There were over 12,000 hits to the UHN's COVID mental health intranet web page, which included self-management resources and information on group support. One hundred and sixty-six people self-referred for individual psychological or psychiatric care. The mean wait time from referral to initial appointment was 5.4 days, with an average of seven appointments for each service user. The majority had moderate to severe symptoms of depression and anxiety at referral, with over 20% expressing thoughts of self-harm or suicide. Post-care user feedback, collected through self-report surveys and semistructured interviews, indicated that the program is effective and valued. Conclusions: Development of a high-quality internal mental health support for HCW program is feasible, effective, and highly valued. By using early and frequent feedback from multiple perspectives and stakeholders to address demand and implement changes responsively, the program was adjusted to meet HCW mental health needs as the pandemic evolved. [ABSTRACT FROM AUTHOR]

Objectives: Youth face numerous challenges in receiving coordinated and continuous mental health services, particularly as they reach the age of transition from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS). The Longitudinal Youth in Transition Study (LYiTS) follows youth prospectively as they cross this transition boundary to better understand their transition pathways and resulting symptoms and health service use outcomes. The current paper presents the baseline profile description for the LYiTS cohort and additionally examines differences in symptoms and functioning and health service utilization between youth receiving services at hospital- versus community-based CAMHS. Methods: A cross-sectional design was used. A sample of 237 16–18-year-old youth recruited from outpatient CAMHS at two hospitals and two community sites completed self-report measures at their first of four annual assessments. A latent profile analysis was conducted to identify symptomology profiles, and youth were compared on symptoms and health service use between hospital- and community-based sites. Results: Four distinct symptomology profiles were identified (subclinical, moderate internalizing, moderate externalizing, and high symptomology). Symptom profiles and functioning levels reported by youth were no different across both types of organization, although there were differences detected in health service utilization, such as type of provider seen and use of medications. Conclusions: These findings suggest that there is little difference in symptomology between youth accessing hospital versus community-based CAMHS. With growing interest in understanding the effectiveness and cost-effectiveness of different models of mental health care, these findings provide a new understanding of the clinical and service use profiles of transition-aged youth that will be explored further as this cohort is followed across the CAMHS to AMHS transition boundary. [ABSTRACT FROM AUTHOR]

Background: Problematic use of the internet (PUI) is a growing concern, particularly in the young population. Family factors influence internet use among children in negative ways. This study examined the existing literature on familial or parental factors related to PUI in children. Methods: A scoping review was conducted in EBSCOhost, PubMed, ScienceDirect, JSTOR, Biomed Central, VHL Regional Portal, Cochrane Library, Emerald Insight, and Oxford Academic Journal databases. Studies reporting data on family factors associated with PUI in children, published in English in the 10 years to July 2020 were included. The following data were extracted from each paper by two independent reviewers: methodology and demographic, familial, psychiatric, and behavioral correlates of PUI in children. Results: Sixty-nine studies fulfilled the eligibility criteria. Three themes emerged: parenting, parental mental health, and intrafamilial demographic correlates of PUI in children. Parenting styles, parental mediation, and parent–child attachment were the major parenting correlates. Conclusion: Literature on significant familial and parental factors associated with PUI in children is scarce. More research is required to identify the interactions of familial and parental factors with PUI in children, to develop informed management strategies to address this issue. [ABSTRACT FROM AUTHOR]

The objective of this paper was to examine the school-related experiences of youth during the COVID-19 pandemic. Participants represented both clinical and community youth aged 14 to 28 who were sampled as part of a larger study. Feedback from youth attending school during the pandemic was qualitatively examined and youth who planned to attend school prior to the pandemic and did (n = 246) and youth who planned to attend but did not (n = 28) were compared quantitatively. Youth appreciated the flexibility of online learning and some also reported experiencing a lack of support from their school and the need for instructor training on how to deliver virtual classes effectively. Future studies should examine what factors influence student engagement with virtual learning, what strategies could improve supports for student in their long-term career development, and the longitudinal experiences of youth who may have chosen not to go back to school due to the pandemic. This survey was conducted in Ontario, Canada. A more diverse sample collected outside of Ontario would improve generalizability. Qualitative data were based on survey responses and not interviews. Thus we were unable to discern the reasons youth decided to attend school, or not, during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

This article presents a description of a specific Indigenous research methodology, Kaupapa Māori Research (KMR), followed by a discussion of the potential contribution that KMR and other Indigenous frameworks make toward understanding and addressing widespread mental health inequities affecting the world's Indigenous peoples. The contribution of existing qualitative KMR to the fields of health and mental health in New Zealand is discussed, and innovative approaches employed within these studies will be outlined. This paper describes the utility of KMR methodology which informed the development of qualitative interviews and the adaptation of an analytic framework used to explore the impact of systems on the experiences of Māori (the Indigenous peoples of New Zealand) with bipolar disorder (BD). This paper adds to others published in this journal that describe the value, inherent innovation, and transformative potential of KMR methodologies to inform future qualitative research with Indigenous peoples and to enact systemic change. Transformation is achieved by privileging the voices of Māori describing their experiences of mental health systems; presenting their expert critique to those responsible for the design and delivery of mental health services; and ensuring equal weight is given to exploring the clinical, structural and organizational changes required to achieve health equity. It is proposed that this approach to research praxis is required to ensure that studies do not perpetuate institutional racism, which requires close adherence to Indigenous research priorities and partnership with Indigenous peoples in all steps of the research process. [ABSTRACT FROM AUTHOR]

Substance use and mental ill health constitute a major public health burden, and a key global policy priority is to reduce illicit and other harmful substance use. Amphetamine-type stimulants (ATS) are the second most used class of illicit drugs and a range of mental health issues have been documented amongst users. This paper explores the relationship between mental health and ATS use, through a thematic analysis of qualitative interviews with n = 18 current and former ATS users in England. The findings are presented by trajectory point of; (1) Initiation of ATS use; (2) continued and increased ATS use and (3) decreased and remitted ATS use. This work helps to develop understanding around the complex and bi-directional relationship between ATS use and mental health. Many ATS users lead chaotic lives and engage in multiple risk behaviours, however there is a need to better understand and conceptualise the dynamic interaction between different individual, social, environment and cultural factors that determine individuals' mental health and substance use. There is no 'one size fits all' approach to prevention and treatment, and these findings highlight the need for more joined-up, tailored and holistic approaches to intervention development. [ABSTRACT FROM AUTHOR]

Background: The objective of this review was to identify and synthesize the findings of the existing literature that highlighted the psychosocial and mental health issues of the migrants during the COVID-19 pandemic in India. Materials and Methods: An exploration of the PubMed, Google Scholar, Web of Science, ScienceDirect, Google search, and some other manual searches was undertaken so that no relevant study was missed. A search on Indian scientific literature and cross-references retrieved was also conducted to get further information. The period of the search has been one year from March 1, 2020, to March 31, 2021. The database was searched with the terms "migrants," "migrant workers," "COVID-19 pandemic," "lockdown," "migrant population," "mental health issues," "psychosocial issues" to retrieve the published literature. Results: Initially, 48 research articles were retrieved and 10 of them were excluded as they had no sufficient information about mental and psychosocial challenges faced by the migrants. In the remaining 38 articles, 9 articles were original research work (n = 9) published from India related to the impact of COVID-19 on migrants. The second category consisted of editorials or commentary or letters to the editor or policy paper on psychosocial and mental health aspects of migrants during the COVID-19 pandemic (n = 17). The third category was 11 articles on perspectives or opinions or viewpoints (n = 11) related to various psychosocial and mental health issues among migrants in India during the COVID-19 pandemic. Predominantly psychosocial issues found among migrants were living conditions, basic needs, family concerns, and joblessness. The mental health issues found among migrants during the COVID-19 pandemic included psychological distress, depressive disorders, anxiety disorders, substance use disorders. Conclusion: Existing literature from India has shown that the COVID-19 pandemic severely impacted the psychosocial and mental health status of the migrants in India. This review suggests the need for more research work from the affected states of India and the development of psychosocial and mental health intervention strategies to minimize the impact of the COVID-19 pandemic on migrants. [ABSTRACT FROM AUTHOR]

This review examines the impact of COVID-19 on the substance-abuse landscape and climate with particular attention on Singapore's. Substance-abuse has received the least attention during the COVID-19 outbreak and this pandemic has further sheared the problem's visibility and the provision of care for this population of sufferers. The authors examine the current literature to look at the access and utility of street drugs due to border closure, the influence of the pandemic on prevailing drug behaviours as well as the effect of social distancing on drug-users. Two case studies are described. The paper serves to illuminate the ever-present problem of substance-abuse even during a viral pandemic and to remind the local government and healthcare system to continue efforts in caring for this group of patients. [ABSTRACT FROM AUTHOR]

This position paper has been substantially revised by the Canadian Psychiatric Association (CPA)'s Section on Transcultural Psychiatry and the Standing Committee on Education and approved for republication by the CPA's Board of Directors on February 8, 2019. The original position paper1 was first approved by the CPA Board on September 28, 2011. [ABSTRACT FROM AUTHOR]

Substance use and mental ill health constitute a major public health burden, and a key global policy priority is to reduce illicit and other harmful substance use. Amphetamine-type stimulants (ATS) are the second most used class of illicit drugs and a range of mental health issues have been documented amongst users. This paper explores the relationship between mental health and ATS use, through a thematic analysis of qualitative interviews with n = 18 current and former ATS users in England. The findings are presented by trajectory point of; (1) Initiation of ATS use; (2) continued and increased ATS use and (3) decreased and remitted ATS use. This work helps to develop understanding around the complex and bi-directional relationship between ATS use and mental health. Many ATS users lead chaotic lives and engage in multiple risk behaviours, however there is a need to better understand and conceptualise the dynamic interaction between different individual, social, environment and cultural factors that determine individuals' mental health and substance use. There is no 'one size fits all' approach to prevention and treatment, and these findings highlight the need for more joined-up, tailored and holistic approaches to intervention development. [ABSTRACT FROM AUTHOR]

This review examines the impact of COVID-19 on the substance-abuse landscape and climate with particular attention on Singapore's. Substance-abuse has received the least attention during the COVID-19 outbreak and this pandemic has further sheared the problem's visibility and the provision of care for this population of sufferers. The authors examine the current literature to look at the access and utility of street drugs due to border closure, the influence of the pandemic on prevailing drug behaviours as well as the effect of social distancing on drug-users. Two case studies are described. The paper serves to illuminate the ever-present problem of substance-abuse even during a viral pandemic and to remind the local government and healthcare system to continue efforts in caring for this group of patients. [ABSTRACT FROM AUTHOR]

Background: India has the second-largest population of elderly in the world. Serious mental illness (SMI) is a subset of the mental disorders that result in significant functional impairment and is usually long term. Persons with SMI face several challenges in their old age that are different from the issues faced by younger people with SMI. Understanding the problems faced by elderly individuals suffering from SMI is fundamental for planning programs to address them. The SENIOR (Support Systems Evaluation of Neuropsychiatric Illness in Old age) project is a study aimed at evaluating the problems faced in obtaining mental health care by elderly persons having SMI in the Kerala state of India. Aim: To describe the scientific methodology of the SENIOR project. Methods: This study employs mixed-methods cross-sectional design among a minimum sample of 768 SMI patients identified through cluster sampling from three districts, and Focus Group Discussion among mental health program officials. Discussion: This paper presents a methodological model to assist researchers in future field epidemiological studies on mental illness. Assessing service needs and barriers to access for the most vulnerable among the mentally ill will help the policymakers make evidence-based decisions to improve their quality of life. [ABSTRACT FROM AUTHOR]

In this brief paper, we will look at whether doctors who experience mental health difficulties require specialist treatment services. This said, we acknowledge that not all would subscribe to the view that doctors are "different", and debating this issue is crucial in answering the question we pose in this paper - "Are specialist treatment services needed for doctors with mental health problems?" 19 Brooks SK, Gerada C, Chalder T. The specific needs of doctors with mental health problems: Qualitative analysis of doctor-patients' experiences with the Practitioner Health Programme. [Extracted from the article]

Psychiatric research has increased remarkably over recent decades to help in understanding the current trends and better therapeutic options for illness. On the other hand, there is also a trend toward higher rates of retraction of published papers in the recent years. Ethics is required to maintain and increase the overall quality and morality of research. Psychiatric research faces several unique ethical challenges. Ethical guidelines are very important tool of research which safeguards participants; however, there is a dearth of such guidelines in India. The present paper aims to review available ethical issues and guidelines pertaining to psychiatric research. A search was conducted on Pubmed using search terms (e.g., "ethics," "psychiatry," "research"). Relevant studies were selected for the review after manual screening of title/abstract. Additional sources were referred to using cross references and Google Scholar. Psychiatric research has several important ethical issues which are different from other medical disciplines. These issues are related to informed consent, confidentiality, conflict of interest, therapeutic misconception, placebo related, vulnerability, exploitation, operational challenges, among others. The current paper has made several recommendations to deal with ethical challenges commonly faced in psychiatric research. The ethical guidelines are utmost needed for Indian psychiatric research. Specific guidelines are lacking pertaining to psychiatric research. The issues and recommendations merit a further discussion and consideration. [ABSTRACT FROM AUTHOR]

Background: COVID-19 has a profound impact on people with existing mental disorders, augmenting the prevailing inequalities in mental health. Methods: In order to understand the status of telepsychiatry in India and the role of artificial intelligence (AI) in mental health and its potential applications, a scoping review was done between March 2020 and May 2020. The literature review revealed 253 papers, which were used to derive the primary framework for analysis. The information was then reviewed for ideas and concepts, which were integrated with evidence from gray literature and categorized under broader themes based on the insights derived. Finally, a thematic framework was developed for discussion to tailor scientific information for decision-makers' needs. Results: Review findings are summarized under the following headings: changing patterns of health-seeking behavior, origin and evolution of telepsychiatry, possible applications of telepsychiatry and AI, technological features, and AI models in mental health. Conclusions: Though there are several potential opportunities, the time is not yet ripe for telepsychiatry and AI to be adopted fully in the field of mental health care. But it is time that we develop indigenous proprietary technology and test and validate it. With many solutions offered by telepsychiatry and AI, psychiatrists must choose an appropriate tool based on their requirements, availability of resources, and feasibility of deployment. Harmony between conventional care and technology-based care must be reached gradually. [ABSTRACT FROM AUTHOR]

Objective: This paper reports on substance use, mental health problems, and mental health service utilisation in an early adolescent school-based sample.Method: Participants were 1,360 grade 7 and 8 students from 4 regions of Ontario, Canada. Students completed an in-class survey on mental health and substance use. The sampling strategy and survey items on demographics, substance use, service utilisation, and distress were adapted from the Ontario Student Drug Use and Health Survey. Internalising and externalising mental health problems were assessed using the Global Assessment of Individual Needs - Short Screener. Distress was defined as fair or poor self-rated mental health.Results: Rates of internalising and/or externalising problems above the threshold exceeded 30%; yet, fewer than half had received mental health services in the past 12 mo. Substance use was associated with increased odds of internalising and externalising problems above the threshold and distress. Youth using cannabis had 10-times the odds of exceeding the threshold for internalising or externalising problems. The use of substances other than alcohol or cannabis was associated with increased odds of fair or poor self-rated mental health among grade 8 students. Of the youth who confirmed at least a substance use problem, most also reported mental health problems; this association was stronger among girls than boys.Conclusions: Early adolescent substance use was associated with concurrent self-reported mental health problems in a non-clinical sample. The low levels of service utilisation reported highlight the need for improved access to early identification and intervention to prevent the development of concurrent disorders. [ABSTRACT FROM AUTHOR]

The article presents a paper, a part of a planned series of Elements of Care papers, focusing on identifying common elements which are important for providing appropriate psychiatric care in different models of care in Canada. It focuses on direct patient care or service for payment in traditional care model and also discusses indirect services involved in such models, like diagnostic assessment or patient management. It also focuses on involvement of family or caregivers in indirect services.

1. This article aims to provide a long-term update 2 years on from our initial paper and summarises service evaluation data collected from 21 pain management programmes, using a solution-focused approach in a community pain service. 2. An examination of the larger baseline and subsequent follow-up data suggests an improvement in participants' function, pain self-efficacy and mental well-being following CPS PMP, and corroborates the findings of the earlier dataset. 3. Additional findings suggest that CPS PMP may help pain interfere less in participants' lives (post-PMP and at 10-week follow-up) and that improvements in mental well-being and self-efficacy are maintained on a long-term basis (at 6- and 12-month follow-up). Limitations of the data are discussed. 4. The article also discusses the nature of community healthcare services for chronic pain, including how we view PMP treatment intensity, deliver cost effectiveness, measure outcomes and support patients post-PMP. 5. It is suggested that effective, meaningful PMPs can be facilitated successfully by multi-professional teams in the community, at arguably lower cost than secondary/tertiary settings, while enabling convenient and long-lasting integration of self-management into people's lives. [ABSTRACT FROM AUTHOR]

Night terrors are phenomena that emerge in the phase of deep sleep in children and that are extremely disturbing for the parents. While research suggests that they tend to resolve by middle childhood, in children where these persist and cause dysfunction, behavioral interventions have proved to be useful. The paper presents the case report of an 8-year-old boy, who presented with night terrors and a decline in academic performance. In therapy along with using behavioral techniques and parent management strategies, creative modalities including art-work and play were employed. The child though vocal could not describe vocally the nighttime events or his understanding of possible stresses. With the use of projective techniques in assessment and semi-structured techniques in therapy, several difficult and possibly traumatic life events were understood and resolved with the child. [ABSTRACT FROM AUTHOR]

Objective: The mass media may increase stigma against people with mental health problems by reinforcing common stereotypes. Media professionals thus represent a target group for antistigma interventions. This paper aims to review available literature on antistigma interventions for mass media professionals, seeking to clarify what kind of interventions have been found to be effective in reducing mental health stigma among mass media professionals.Method: Six electronic databases (MEDLINE, PsycINFO, Embase, Cochrane Reviews Library and Cochrane Central Register of Controlled Trials, Web of Science, and Applied Social Sciences Index & Abstracts) were systematically searched through March 2017 for studies addressing antistigma interventions on mass media professionals.  Results: A total of 27 studies on antistigma interventions targeted to media professionals were found. Reviewed articles were classified into 3 categories: media-monitoring projects/reporting guidelines ( n = 23), interventions for educating journalists ( n = 2), and interventions for educating journalism students ( n = 2). Overall, antistigma interventions for media professionals seem to have some effect in improving reporting style, thus providing a more balanced portrayal of people with mental health problems: the most promising interventions are contact-based educational approaches and the provision of guidelines by authoritative institutions.Conclusion: It should be useful to promote and disseminate contact-based educational interventions targeted to journalists and to include specific modules on mental health topics in the training curricula of journalism students. However, as research in the field suffers from several limitations, high-quality studies exploring the long-term effect of antistigma interventions for media professionals are needed. [ABSTRACT FROM AUTHOR]

The past one decade has witnessed a boom in the availability of Internet-based self-help apps in the field of mental health. Several apps have emerged that aim to provide information and strategies to empower individuals with self-help approaches to deal with issues and concerns related to mental health. A large number of these apps in developing countries are likely to be those which depend entirely on the users to go over the self-help program on their own (unguided internet-based self-help). Only a few apps add a component of periodic professional contact/technical support through phone/email or other means to supplement the self-help strategies suggested in the app that the user is expected to utilize. This scenario poses several challenges in use of unguided self-help apps for mental health. This paper enumerates some of these challenges for potential users of the apps from the perspective of clinicians. These range from difficulties in choosing the right app, limited scope for contextualization, and motivation management to awareness about when to step up to a higher intensity intervention. Despite these challenges, unguided self-help apps can serve important purposes, and hence we propose a few recommendations to address such challenges. [ABSTRACT FROM AUTHOR]

This paper is an initial attempt to collate the literature on psychiatric inpatient recovery- based care and, more broadly, to situate the inpatient care sector within a mental health reform dialogue that, to date, has focused almost exclusively on outpatient and community practices. We make the argument that until an evidence base is developed for recovery- oriented practices on hospital wards, the effort to advance recovery-oriented systems will stagnate. Our scoping review was conducted in line with the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (commonly referred to as PRISMA) guidelines. Among the 27 papers selected for review, most were descriptive or uncontrolled outcome studies. Studies addressing strategies for improving care quality provide some modest evidence for reflective dialogue with former inpatient clients, role play and mentorship, and pairing general training in recovery oriented care with training in specific interventions, such as Illness Management and Recovery. Relative to some other fields of medicine, evidence surrounding the question of recovery-oriented care on psychiatric wards and how it may be implemented is underdeveloped. Attention to mental health reform in hospitals is critical to the emergence of recovery-oriented systems of care and the realization of the mandate set forward in the Mental Health Strategy for Canada. [ABSTRACT FROM AUTHOR]

The notion of recovery has been embraced by key stakeholders across Canada and elsewhere. This has led to a proliferation of definitions, models, and research on recovery, making it vitally important to examine the data to disentangle the evidence from the rhetoric. In this paper, first we ask, what do people living with severe mental illness (SMI) say about recovery in autobiographical accounts? Second, what do they say about recovery in qualitative studies? Third, from what we have uncovered about recovery, can we learn anything from quantitative studies about proportions of people leading lives of recovery? Finally, can we identify interventions and approaches that may be consistent or inconsistent with the grounded notions of recovery unearthed in this paper? We found that people with mental illness frequently state that recovery is a journey, characterized by a growing sense of agency and autonomy, as well as greater participation in normative activities, such as employment, education, and community life. However, the evidence suggests that most people with SMI still live in a manner inconsistent with recovery; for example, their unemployment rate is over 80%, and they are disproportionately vulnerable to homelessness, stigma, and victimization. Research stemming from rehabilitation science suggests that recovery can be enhanced by various evidence-based services, such as supported employment, as well as by clinical approaches, such as shared decision making and peer support. But these are not routinely available. As such, significant systemic changes are necessary to truly create a recovery-oriented mental health system. [ABSTRACT FROM AUTHOR]

Objective: Death by suicide is widely held as an undesirable outcome. Most Western countries place emphasis on patient autonomy, a concept of controversy in relation to suicide. This paper explores the tensions between patients' rights and many societies' overarching desire to prevent suicide, while clarifying the relations between mental disorders, mental capacity, and rational suicide. Method: A literature search was conducted using search terms of suicide and ethics in the PubMed and LexisNexis Academic databases. Article titles and abstracts were reviewed and deemed relevant if the paper addressed topics of rational suicide, patient autonomy or rights, or responsibility for life. Further articles were found from reference lists and by suggestion from preliminary reviewers of this paper. Results: Suicidal behaviour in a person cannot be reliably predicted, yet various associations and organizations have developed standards of care for managing patients exhibiting suicidal behaviour. The responsibility for preventing suicide tends to be placed on the treating clinician. In cases where a person is capable of making treatment decisions-uninfluenced by any mental disorder-there is growing interest in the concept of rational suicide. Conclusions: There is much debate about whether suicide can ever be rational. Designating suicide as an undesirable event that should never occur raises the debate of who is responsible for one's life and runs the risk of erroneously attributing blame for suicide. While upholding patient rights of autonomy in psychiatric care is laudable, cases of suicidality warrant a delicate consideration of clinical judgment, duty of care, and legal obligations. [ABSTRACT FROM AUTHOR]

Objective Attention to knowledge translation (KT) has increased in the health care field in an effort to improve uptake and implementation of potentially beneficial knowledge. We provide an overview of the current state of KT literature and discuss the relevance of KT for health care professionals working in mental health. Method: A systematic search was conducted using MEDLINE, PsycINFO, and CINAHL databases to identify review articles published in journals from 2007 to 2012. We selected articles on the basis of eligibility criteria and then added further articles deemed pertinent to the focus of our paper. Results: After removing duplicates, we scanned 214 review articles for relevance and, subsequently, we added 46 articles identified through hand searches of reference lists or from other sources. A total of 61 papers were retained for full review. Qualitative synthesis identified 5 main themes: defining KT and development of KT science; effective KT strategies; factors influencing the effectiveness of KT; KT frameworks and guides; and relevance of KT to health care providers. Conclusions: Despite limitations in existing evidence, the concept and practice of KT holds potential value for mental health care providers. Understanding of, and familiarity with, effective approaches to KT holds the potential to enhance providers' treatment approaches and to promote the use of new knowledge in practice to enhance outcomes. [ABSTRACT FROM AUTHOR]

Background: There is growing global interest into the attitudes and clinical management of persons who deliberately self-harm. People who self-harm experience many problems and typically have many needs related to management of their psychological wellbeing. A positive attitude amongst general hospital staff should prevail with people who self-harm. The principal purpose was to determine student staff attitudes towards patients who self-harmed from a professional and cultural perspective, which might influence patient treatment following hospital admission. The focus concentrated upon staff knowledge, attitudes and beliefs regarding self-harm. Methods: A cross sectional survey of the hospital staff using a validated questionnaire was carried out. This paper reports on interdisciplinary staff from two large general hospitals in Mysuru, South India (n=773). Results: Findings suggest that within a general hospital setting there is wide variation in staff attitudes and knowledge levels related to self-harm. Whilst there is attitudinal evidence for staff attitudes, this study investigates interprofessional differences in an attempt to progress treatment approaches to a vulnerable societal group. Very few staff had any training in assessment of self harm survivors. Conclusion: There is an urgent need for training general hospital staff in self harm assessment and prevention in south India. The results allow a series of recommendations for educational and skills initiatives before progressing to patient assessment and treatment projects and opens potential for cross cultural comparison studies. In addition, interventions must focus on current resources and contexts to move the evidence base and approaches to patient care forward. [ABSTRACT FROM AUTHOR]

This commentary speaks to several issues that arise from the papers in this special issue. Two articles--Kessler (2002) and Mirowsky and Ross (2002)--focus on a major measurement issue: dimensional versus diagnostic-type assessments. One topic requires greater attention: the correspondence of these measures with the underlying states they supposedly measure--constructs in the psychometric tradition and empirically defined illnesses in the medical or psychiatric tradition. Conclusions about the nature of these unobserved states remain tentative at this time. Three articles--Keyes (2002), Schwartz (2002), and Umberson, Williams, and Anderson (2002)--address the expansion of mental health outcomes. The existing reliance on emotional distress is problematic for sociological research because a single disorder is not a good proxy for estimates of the overall mental health consequences of social arrangements. Although these papers present diverse and sometimes conflicting perspectives, collectively they demonstrate that no one approach to outcomes is best for all research questions. [ABSTRACT FROM AUTHOR]

This paper introduces the concept of 'working utopias' (WUs) and explores their relation to social movements. WUs are used in a variety of ways by social movements, it is argued, and they play a central role in the reproduction and advancement of movements. They reproduce the movement habitus and illusio, extend and reproduce networks, generate new forms of knowledge and practice, and serve, to some extent at least, as 'proof' of the validity of movement claims. Two utopias from within radical mental health movements are focused upon in the paper: the Kingsley Hall therapeutic community and the 'Trieste experiment'. The significance of these working utopias is explored by way of interviews with movement activists who have been involved with them in various ways. [ABSTRACT FROM AUTHOR]

When I began my psychiatric residency training in Boston in the late 1950s, sociologists and other social scientists were active members of many major academic departments of psychiatry. Collaboration between psychiatrists and sociologists and anthropologists was widespread and had considerable influence on theory and clinical practice. NIMH had established its Laboratory of Socio-Environmental Studies under the leadership of John Clausen. Sociologists and anthropologists were active in policy-making and research activities at NIMH and at many foundations. The influential works of Stanton and Schwartz (1954), Hollingshead and Redlich (1958), and Greenblatt, Levinson, and Williams (1957) reflect this period of collaboration. Over the subsequent three decades, the relationship between sociology and psychiatry changed considerably. Now relatively few academic departments of psychiatry have social scientists on their full-time faculty. Interaction between psychiatrists and social scientists, in many instances, has become adversarial. This adversarial quality, I believe, is reflected in the paper by Mirowsky and Ross. Their paper illustrates a genre of social science criticism of psychiatry which challenges the scientific validity of the concept of mental illness and raises important issues in measurement. Mirowsky and Ross, however, go beyond the scientific issues; they offer a social criticism of recent changes in psychiatry which they perceive to be the "legacy of nineteenth-century epidemiology and microbiology." Mirowsky and Ross are correct in their perception that significant shifts have occurred within psychiatry over the past decade. Yet their historical reconstruction of those changes and their understanding of the scientific basis for current research and clinical practice are seriously limited; they reflect their ideological commitment more than an appreciation of the increased sophistication of recent theoretical discourse and empirical research in psychiatry. In my commentary I will attempt to correct this imbalance by reconstructing the recent history and by explicating the rationale behind the current approach to psychiatric diagnostic categories. [ABSTRACT FROM AUTHOR]

This paper reports a study of the premedical student culture at a major university, based on fieldwork and interviews with 30 premedical students. The paper examines the role of stereotypes in the premedical culture; specifically, the common belief in "cut-throats" among premedical students. Cut-throats are described as excessively competitive, selfish, gradehungry students who cheat, steal books and lab reports, and sabotage lab experiments. Despite the widespread belief, our findings suggest cut-throats are a myth. We found more evidence for cooperative than cut-throat behavior. The myth emerges from the competitive and pressured situation of premedical students and the uncertainty of the medical school admission process, and is in part a manifestation of students' collective anxiety. More significantly, it provides cultural explanations for failure and success for premedical students. We discuss its connection to the general premedical stereotype and its relation to pre-medical education. [ABSTRACT FROM AUTHOR]

The National Trajectory Project examined longitudinal data from a large sample of people found not criminally responsible on account of mental disorder (NCRMD) to assess the presence of provincial differences in the application of the law, to examine the characteristics of people with serious mental illness who come into conflict with the law and receive this verdict, and to investigate the trajectories of NCRMD-accused people as they traverse the mental health and criminal justice systems. Our paper describes the rationale for the National Trajectory Project and the methods used to collect data in Quebec, Ontario, and British Columbia, the 3 most populous provinces in Canada and the 3 provinces with the most people found NCRMD. [ABSTRACT FROM AUTHOR]