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Covid-19, the disease caused by severe acute respiratory syndrome coronavirus 2 is recognised as one of the most challenging global events of the twenty-first Century. The detrimental impact of the pandemic resulted in high rates of infection, morbidity, and mortality, with health-care workers firmly positioned on the frontline of this unparalleled international crisis. An emerging literature detailing the impact of COVID-19 on health-care practitioners identifies high levels of depression, anxiety, and distress. Accordingly, there are calls for the implementation of effective interventions to tackle the impending spectre of psychological morbidities and staff burnout. While it is important to explore new approaches, it is also valuable to examine how existing strategies, such as reflective practice, can be repurposed to specifically address practitioner well-being. This requires a reimagining of reflective practice and a reimagining of the reflective practice contexts in which reflective activity occurs. This paper presents The Reflective Practice Integrative Framework, which illustrates how reflective practice can be used to address the complex aims of supporting effective patient care, while also facilitating practitioner well-being. The Reflective Organisational Learning Framework is also presented which can be used to develop effective reflective practice environments through single, double, and/or triple loop learning. [ABSTRACT FROM AUTHOR]

The paper presents the introductory remarks to the special series "Science-Informed Treatment Adaptations with Youth: Bridging Pathways for Specialized Settings and Unique Populations" for Evidence-Based Practice in Children & Adolescent Mental Health. We discuss barriers to EST in specialized settings and with unique populations and consider possible bridging pathways to over-come these obstacles at both the individual and organizational levels. The paper concludes with a brief summary of the papers grouped into the following conceptual areas: 1) Bridging models within the related domains of case conceptualization, treatment planning, and continuous assessment; 2) science-informed adaptable treatment models in specialized settings; and 3) education and treatment pathways for clinicians practicing with unique youth populations. [ABSTRACT FROM AUTHOR]

The article presents the discussion on improving emotional well-being in older adults. Topics include seeking to understand mental health needs of veterans across mental health conditions; and examining innovative interventions using novel approaches such as mindfulness, meditation, nature, performance art, and visual art.

Hearing voices is a highly stigmatised experience, despite being common across clinical and non-clinical populations. The stigma held by healthcare professions of the clinical populations they work with can have a detrimental impact on the recovery trajectory of people with mental illness, with early career professionals and students thought to have among the most negative attitudes. The current study examined the efficacy of an education intervention to reduce implicit and explicit stigma surrounding voice hearing in psychology students (N = 49). With the world turning to digital delivery methods in the face of COVID-19, the study also examined the impact of intervention delivery mode: comparing online with face-to-face delivery. Results indicated that the education intervention was associated with improvements to explicit – but not implicit – stigma towards voice hearing. Comparisons between education delivery type suggested online and face-to-face delivery methods found no difference in associated reductions to explicit stigma. These findings provide further support for the use of education interventions to reduce stigma surrounding voice hearing and support the online administration of such interventions to allow for more widespread education delivery to a broader audience. What is already known about this topic: Hearing voices is a common yet highly stigmatised experience. Stigma towards mental illness is common among by healthcare professionals, with early career professionals and students holding particularly negative attitudes. Education interventions can be effective in reducing stigma held towards mental illness in healthcare professionals. What this paper adds: This paper supports the use of an education intervention to reduce psychology students' explicit stigma towards voice hearing. It also provides support for education interventions to be delivered in both online and face-to-face formats. This may allow education interventions to be delivered to broader audiences in the future. [ABSTRACT FROM AUTHOR]

The article announces the deadline for submission of the manuscripts about the research examining any aspect of the use of clinical assessment devices in relation to medical illnesses. The topics of interest which include the assessment of psychopathology in primary care settings, use of personality assessment in medical settings, assessment of psychological factors involved in biological variables or chronic disease and problems in the assessment of psychotropic drug effects are also presented.

This systematic review examines research on Sufi spirituality and mental well-being. Earlier investigations have focused on general spiritual practice in mental health care and found a connection between spirituality and mental health. In this systematic review, we aimed to explore existing research specifically considering the relationship between Sufi spirituality and mental well-being and examine the quality of this research. We identified 49 papers published between the years 2007–2022. Our findings revealed a positive connection between Sufi spirituality and reducing anxiety and depression in patients. However, most studies were of low quality. This review highlights the need to provide more comprehensive and higher quality research to redress the methodological limitations of the current evidence base. [ABSTRACT FROM AUTHOR]

Background: Despite significant need for mental health services targeting the requirements of inmates transitioning into the community there is little research about successful recovery-oriented or person-centred transition programs. Aims: This systematic narrative review brings together existing evidence to inform policymakers and practitioners about current practice in transition support, and barriers and facilitators of effective practice. Method: We carried out a systematic narrative review of recovery-oriented or person-centred mental health support programs supporting transition from incarceration to the community. Results were obtained from a systematic search of Medline, PubMed and Scopus databases. Results: We found 23 papers which met the paper inclusion criteria along with four other papers which were identified incidentally. Conclusions: Identified barriers to the implementation of effective transition support programs are: administrative problems leading to ineffective in-reach into correctional facilities or untimely support, lack of support for immediate needs meaning that inmates deprioritise their mental health needs, a lack of ongoing program resources and poor communication between correctional facilities and mental health services. Enablers for transition reflect the inverse of these barriers, alongside other successful strategies including medical home models, regionalised programs, programs which target connections with primary care, nurse-led patient-centred health programs and peer support initiatives. [ABSTRACT FROM AUTHOR]

This concluding paper draws together the dominant themes across the papers published in this issue. The majority of the papers clearly point to disparities between the aims of policy-makers and mental health workers. Using a variety of perspectives and methods, the authors of these insightful papers argue that modernist, rational approaches to structuring and evaluating services are at odds with the professional needs of mental health workers. At one level this critique is self-evident given the messiness and uncertainties inherent in working with service users whose individual problems require flexible approaches tailored from a broad and evolving practice-base. For some authors, the focus is epistemological and methodological; they offer much needed examples of analysing policy construction, interpreting statistics and the concurrent application of the widely used concepts of medicalisation and structural inequality. Together, the papers indicate that the progress of mental health reform in many western countries remains inconsistent and, in some cases, obstructive to effective professional practice. [ABSTRACT FROM AUTHOR]

An introduction to articles in the issue is presented on topics including the transformational power of the therapeutic nurse-patient relationship, societal conditions that were prevalent in the history of mental health nursing, and barriers influencing the use of sensory approaches in acute psychiatric units.

Trans people experience high levels of depression, anxiety, and suicidal ideation and attempts, as well as poor experiences seeking mental health support. There is limited research into the experience and effectiveness of using Art Therapy with trans clients. This paper describes an Art Therapy group with trans clients. The group took place online due to the COVID-19 pandemic. Participants consented to have their images and experiences used in this practice paper. Building on the work of Beaumont (2012. Art therapy for gender variant individuals: A compassion oriented approach. Canadian Art Therapy Association Journal, 25(2), 1–6. https://doi.org/10.1080/08322473.2012.11415565), and using a neurobiological understanding of Art Therapy, this paper theorises that Art Therapy strategies known to be effective with trauma survivors may also support clients experiencing gender dysphoria. Considering Beaumont's model, a six-week online Art Therapy intervention using weekly focused themes was developed. A strong focus was given to creating group cohesion through co-creating a working alliance. Clients reflected together on artwork created through arts journaling between sessions. Participant engagement was high. The intervention received consistently positive solicited and unsolicited feedback from clients. Limitations of this feedback are noted. Trans clients reported that the use of an online arts journaling group approach facilitated a powerful sense of belonging created in the group and reflected through the artwork. Research is needed to consider Art Therapy's effectiveness in improving wellbeing for trans clients through creating a sense of belonging. Research could also consider whether clients experiencing gender dysphoria could be supported by Art Therapy approaches known to work well with traumatised clients. Trans clients are likely to need support with their mental health due to experiencing high rates of depression, anxiety, and suicidal feelings. They are also likely to describe poor experiences of seeking out mental health support. This highlights the importance of developing appropriate, supportive Art Therapy interventions with this client group. This paper describes a six-week online Art Therapy group with trans clients. The group took place in the context of a charity programme to support improved mental health and wellbeing in the trans community. Due to the COVID-19 pandemic, the group took place online. The group used an arts journaling approach. Clients made artwork between sessions, and shared and reflected on what they had created as a group over Zoom. I describe the theoretical approach which led to the creation of the group, noting the lack of research into working with this client base. I also outline the perspectives considered when recreating the intervention online due to the COVID-19 pandemic. I describe the group's online sessions. I show how the group worked together to create a strong working agreement and shared values. I explore participants' reflections on their artworks. I consider the emergence of a strong sense of belonging within the group. I also reflect on participants' feedback, giving space for clients' own words about their experience. Client feedback shows that participants value sharing their experiences with people they feel understand them and experiencing a sense of belonging in a supportive community. Further research is needed to explore the effectiveness of Art Therapy in improving mental health and wellbeing with this client group. Clients hoped that sharing their experiences could help enable an Art Therapy approach to be considered with trans clients in other contexts. [ABSTRACT FROM AUTHOR]

AbstractNurses are at the forefront of care in mental health services but their role is conflicted; they carry the most responsibility for care and also for restrictive practices. The harmful effects of restrictive practices for mental health patients are well documented, have attracted negative media attention, public concern, and criticism directed specifically at nursing staff. The need to reduce restrictive practices has been highlighted by patients, carer groups, legislators, policy makers, academics, and mental health service providers. Policies and best practice guidelines have resulted, but restrictive practices remain a global problem. This theory paper proposes that inertia is partly due to the absence of a coherent model that explains the initiation and maintenance of restrictive practice in inpatient mental health settings. The conceptual development and synthesis of the model and its practical implications are discussed. [ABSTRACT FROM AUTHOR]

For decades the mental health system has been 'in crisis,' with too little funding, too much demand and fragmented services. In England and Wales, decisions made concerning the care and treatment of those suffering from a mental disorder is governed by the Mental Health Act 1983 (as amended) (MHA 1983). Detention under the legislation is fraught with conflict; patient and clinical views are often at odds. Mental health tribunals enable patients to seek a review of their case and the legality of their detention. This paper argues that with the increased use of formal detention under the MHA 1983, the caseloads of mental health tribunals have similarly risen. Whether it is possible to advance therapeutic benefit to psychiatric patients attending tribunals is open to question. While mental health tribunals have a role to play in generating a positive psychological impact on an applicant, there is a risk that time and resource pressures may inhibit the adoption of a therapeutic approach. This paper considers the key drivers that are currently pushing detention rates up, the impact this is having on mental health tribunal caseloads and whether it is possible to bring therapeutic jurisprudence to the patient. [ABSTRACT FROM AUTHOR]

COVID-19 has been defined as one of the biggest collective traumas faced by the human population worldwide. Thus, there is a need for trauma-focused psychotherapy during the pandemic. Due to the highly transmissive virus, the safest and most realistic option for conducting trauma-focused psychotherapy was through online platforms, since then online psychotherapy has been one of the most preferred ways of conducting psychotherapy. The current article reviewed available literature, to illustrate different potential challenges and obstacles mental-health practitioners face when providing trauma-focused online psychotherapy in Malaysia. These challenges are categorized into (a) ethical issues, (b) therapeutic relationships and environment, (c) techniques, and (d) psychotherapists' self-care. Practical research-driven suggestions were provided to tackle these challenges. [ABSTRACT FROM AUTHOR]

As an emerging form of health care with accelerated growth in recent years, online medical consultation (OMC) has received extensive attention worldwide. Although the number of studies on OMC has increased substantially, few provide a comprehensive and up-to-date review of OMC's research constituents, themes, and trends. This study, therefore, extracted 1,801 OMC-related articles published in English from the Web of Science (WoS) Core Collection database during the past 30 years and employed a bibliometric analysis of WoS and CiteSpace to examine major constituents' distribution, collaboration relationships, themes, and trends. The results indicate that the United States, England, and China contributed the most to the proliferation of OMC studies. The United States had the greatest academic influence and the most collaborative connections, while China demonstrated the sharpest increase and most active development in recent years. However, there is a lack of substantial and close collaboration between researchers worldwide. The main themes of OMC research were Internet hospitals, COVID-19, mixed methods, online health community, and information technology. Researchers have recently shifted their attention to social media, management, efficacy, word of mouth, mental health, and anxiety. This review paper provides researchers and practitioners with a holistic and clear understanding of the features and trends of OMC research. It also identifies potential areas for future OMC research and sheds light on OMC practices. [ABSTRACT FROM AUTHOR]

Globally, transgender people have been described as a highly marginalised population due to cisgenderism that delegitimises their gender identities and expressions. Despite robust evidence from many countries noting the association of discrimination and stigma for being transgender with heightened mental health risks, qualitative research that examines the nuances of mental health indicators using health equity frameworks has been scant both in Aotearoa/New Zealand and overseas. Using an inductive thematic approach, this paper analysed 222 open-text responses in the mental health section of the 2018 Counting Ourselves: Aotearoa New Zealand, Trans and Non-binary Health Survey. Our findings showed four overarching themes: gender-affirming healthcare, mental healthcare services and accessibility, gender minority stress, and self-affirmation and social support. Participants' narratives described pervasive gender minority stress experiences in gender-affirming and mental healthcare services, including unmet healthcare needs, lack of competency in healthcare delivery, and pathologisation of their genders. In social settings, our participants commonly reported discrimination and violence, although they also reported that self-affirmation strategies and social support offset the impacts of gender minority stress on their mental health. The current findings indicate the importance of exploring mental health outcomes for transgender people in relation to cisgenderism and resultant gender minority stress. [ABSTRACT FROM AUTHOR]

In light of some concerning trends regarding social service delivery, this paper syntheses the emerging literature on religious congregations. After government, congregations are the most prominent providers of social services in the United States. Because the long-term viability of government human services is threatened by growing deficits and escalating social needs, congregations are likely to be an increasingly important vehicle for alleviating human suffering. Congregations also offer serval unique strengths. For example, they frequently assist underserved populations that more traditional secular providers may not reach, a practice that may help ameliorate health disparities. They also provide a forum in which entrepreneurial social enterprises can be incubated. This paper concludes by offering several suggestions to assist social workers and other helping professionals work with congregations to enhance client wellness. [ABSTRACT FROM AUTHOR]

This paper aims to explore the impact of the COVID-19 pandemic on the health and mental health of necessary entrepreneurs in Brasilian favelas, the social problems they experienced and implications for public health social work. The study used structured in-person interviews within selected Favela's, with a sample size of 721 entrepreneurs, aged between 16–70 years. All participants both worked and were resident in 15 out of the 27 Brasilian federal states. The bespoke questions explored socio-demographic questions, sought information on their entrepreneurship, health and administered the Warwick-Edinburgh Mental Wellbeing Scale for Health. The results highlighted that many entrepreneurs have engaged in this form of enterprise due to economic necessity, with 64% of women and 43.6% of men identifying increased levels of anxiety through the pandemic, with the presence of children in the family being statistically significant (p ≤ 0.05 chi-square test) for anxiety. Of the 9.8% sample respondents have accessed the health care service and for women with children, the impact of the pandemic accentuated existing problems of childcare and patriarchy. We conclude by highlighting the importance of universal and accessible health and mental health support and care, their ongoing accessibility, along with the importance of social work during crisis. [ABSTRACT FROM AUTHOR]

The aim of this study was to provide evidence of the acceptability of the primary care psychology services that have been enhanced by the employment of assistant psychologists in Ireland to the parents of children with psychological difficulties. Data were collected from a sample of 74 parents who responded to quantitative and qualitative questions on the experience of service questionnaire. Reflexive thematic analysis was used to analyse the questionnaire responses. On average 88% of participants selected 'certainly true' in response to the statements in the experience of service questionnaire statement they were 'Totally satisfied'. Three major themes were developed; 'communication is more than talking', 'structure can facilitate or impede', and 'emotional reactions'. 'Communication is more than talking' is organised around communication The 'structure can facilitate or impede' acknowledges that systems influence psychological supports. 'Emotional reactions' captured parents' experiences, such as joy, frustration, and solidarity. The results demonstrate that the newly enhanced mental health service is acceptable to parents. Their voices provide ideas about what helps and hinders their experience of care. [ABSTRACT FROM AUTHOR]

This study aimed to explore the perspectives of working-aged adults with post-stroke aphasia (PWA) towards what has or would help them in living well with aphasia (LWA). This paper reports the findings in relation to stroke care and its relevance for LWA. This qualitative study was designed with input from a Public and Patient Involvement advisory group. We conducted in-depth, semi-structured interviews with 14 PWA. Data were analysed following principles of reflexive thematic analysis. Support services and LWA spanned five themes: Inpatient care; Support in the community; Speech therapy; Mental health; and Aphasia education and training. Per the findings, all aspects of stroke care were affected and challenged by aphasia. Access to services and information was variable. PWA of working-age, their families and children need access to person-centred stroke care and information responsive to their changing needs at all stages of recovery. Healthcare workers must be equipped with aphasia competency. The results highlight a need for equitable, transparent, responsive access to services, information and stroke liaison support. The findings extend knowledge of the importance of stroke care for supporting working-aged adults and their families to live well in the context of aphasia. There is a need for equitable, transparent access to a responsive integrated pathway of stroke care to support living well with aphasia. People with aphasia post-stroke and their families need access to person-centred stroke care and information responsive to their changing needs at all stages of recovery. This includes flexible access to mental healthcare and speech and language therapy. In order to access relevant care, people with post-stroke aphasia need access to information and stroke liaison support. Training to improve aphasia competency is imperative for healthcare workers. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has resulted in rapid and unprecedented public policy and legislative interventions to reduce the global spread of the virus. The scope of these challenges has been particularly broad and pressing within health care settings. Individuals with severe mental illness hospitalized in psychiatric facilities are at greater risk of infection than the general population due to both the characteristics of the population (e.g., mentally ill individuals may find the physical distancing measures difficult to understand) and the nature of the settings (e.g., communal living, frequent admissions and discharges). Therefore, it is essential that preventative measures are taken to minimize the chance of nosocomial outbreak in long-term psychiatric facilities; yet minimal information specific to forensic contexts is available. This paper reviews the system-wide strategies that have been put in place across a large Canadian forensic facility and offers recommendations on how to respond to a pandemic or other outbreak in a secure psychiatric setting. Taking the response to COVID-19 in the context of a forensic psychiatric setting, we discuss a wide range of essential aspects of pandemic planning and provide examples of innovative practices that should be considered for retention, future research and broader implementation. [ABSTRACT FROM AUTHOR]

From artificial intelligence, predictive analytics and biometric sensors, to advanced robotics, virtual reality and mobile applications, rapid advances in technology are transforming the design, delivery and experience of mental healthcare. This paper explores the promise and pitfalls of three technologies (apps, avatars and robots) posed to transform mental health education, practice and research. By highlighting potential practical and ethical implications, this paper argues mental health professionals must actively engage in the co-design and development of new technologies, and reflexively reflect on whether the future will be a techno-utopia or dystopia. [ABSTRACT FROM AUTHOR]

There is limited literature describing innovative models for forensic care. This paper describes the patient group, the model of care, and outcomes for residents in a 24-h supported hostel for mentally disordered offenders leaving secure setting over 13 years. In this period, of 160 referrals received, the service accepted 81 individuals. Over half moved to less supported placements following their tenure. This type of provision moves individuals to less supported settings and may contribute to a reduction in costly hospital stays for forensic patients with complex needs and histories of harming others. [ABSTRACT FROM AUTHOR]

This paper describes the experience of mitigation experts in first degree murder cases in the penalty phase of the trial. The first author, who is a sociologist, has worked in capital murder cases since 1988, as a mitigation expert in over 200 such cases. The second author assists in the mitigation process by analyzing mental health and educational records. The focus of the paper is a discussion of a specific case in which the defendant committed suicide before the case went to trial. [ABSTRACT FROM AUTHOR]

Changes to professional work now ensure that social care and health care workers should be accountable to service users, and not only to their professional colleagues. This paper seeks to explore how this may eventually be realised in new working relationships that will profoundly affect mental health social work. These changes are driven by factors that are external to the social work profession-in policy initiatives that introduce measures of performance that incorporate the service user in both evaluating and planning services, in efforts to build new relationships, and in a breakdown of barriers between social work practitioners and service managers. While these changes are sometimes likely to be resisted by practitioners and service users alike, the demands of policy makers for a new professional accountability to service users can be used to pave the way for effective dialogue. The paper outlines the steps necessary to build confidence among both service users and service providers. This requires sensitive management and leadership. It also requires that action demonstrably follows from such dialogue. The paper uses evidence from Community Mental Health Teams in Swansea, over a three-year period, to demonstrate how the policy and management imperatives faced by service providers can be reconciled with the expressed desires of mental health service users. [ABSTRACT FROM AUTHOR]

The behavioral service system is searching for solutions to the opioid overdose epidemic, which has led to increased fatalities and substantial costs. This paper is a brief report on Certified Community Behavioral Health Clinics (CCBHC), a federal demonstration program designed to enhance behavioral health organizations' capacity to engage and care for people with substance use disorders through evidence-based practices and integrated health solutions. Designated CCBHC clinics provide a comprehensive range of mental health and substance use disorder services to vulnerable individuals and receive increased prospective funding from Medicaid. Preliminary evaluations have shown increases in accessibility, workforce, and capacity to provide substance use and mental health services. With social workers comprising the majority of mental health providers, this delivery system innovation expands opportunities for the profession to address the opioid epidemic. [ABSTRACT FROM AUTHOR]

With the increasing prevalence of mental illness, there is an ever-growing need for supportive and rehabilitative social and health services and facilities. In many countries, the healthcare infrastructure, transitional services and communities are isolated from one another, creating physical and mental barriers to rehabilitation. Therapeutic landscape research suggests that outdoor spaces can facilitate rehabilitative healing, foster community support and self-empowerment. Design focused on facilitating preventative and rehabilitative health may bridge the gap between treatment at the institutional level and day-to-day living environment, by supporting the well-being of vulnerable people. In this paper, the literature as well as individual case studies are explored to better understand how therapeutic environments may enable the built infrastructure and transitional landscapes to fruitfully coexist. Findings suggest that suitable urban integration of services through therapeutic landscapes can provide a catalyst for the well-being of the wider community, mediating healthcare stigmas. [ABSTRACT FROM AUTHOR]

The aim of this paper is to provide the international community with a broad and updated picture of key policies and services for people with severe mental health disorders in Vietnam. In particular, the paper (1) reviews the most important national policies governing care for people with mental health disorders, (2) reviews the status of free-of-charge care provided to people with severe mental health disorders in a network of government-funded facilities across the nation and (3) discusses the future policy directions of Vietnam regarding people with mental health disorders. [ABSTRACT FROM AUTHOR]

Eating disorders are mental illnesses that can have a significant and persistent physical impact, especially for those who are not treated early in their disease trajectory. Although many persons with eating disorders may make a full recovery, some may not; this is especially the case when it comes to persons with severe and enduring anorexia nervosa (SEAN), namely, those who have had anorexia for between 6 and 12 years or more. Given that persons with SEAN are less likely to make a full recovery, a different treatment philosophy might be ethically warranted. One potential yet scarcely considered way to treat persons with SEAN is that of a harm reduction approach. A harm reduction philosophy is deemed widely defensible in certain contexts (e.g. in the substance use and addictions domain), and in this paper we argue that it may be similarly ethically defensible for treating persons with SEAN in some circumstances. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has been stressful for many, increasing levels of anxiety, depression and other mental health concerns worldwide. With the spread of the virus, many youth found themselves physically isolated from their peers and confined to their homes, and medical and mental health services previously provided in person had to adapt by providing virtual sessions. The transition to virtual care created many new challenges for clinicians and patients, including some specific to transgender youth and their families. Pre-pandemic, transgender youth comprised a marginalized and vulnerable population, with elevated risk for adverse mental health outcomes. However, community support, strong group identification and family affirmation can serve as important mitigating factors. In this paper, we will discuss unique challenges encountered in working with the parents and caregivers of transgender youth during virtual visits that have the potential to interfere with development of a therapeutic alliance and the movement toward increased family acceptance. We will provide clinical case examples and propose methods through which to address difficulties and improve care. [ABSTRACT FROM AUTHOR]

Pediatric psychologists have much to contribute to growing efforts to mitigate the impact of parent mental and behavioral health problems on children's health and development. However, providing parent-focused psychological services within the pediatric setting brings many new ethical considerations and challenges. Guided by the American Psychological Association's Ethics Code, this paper presents an ethical case for providing these types of services, followed by a comprehensive analysis of the unique ethical challenges likely to be encountered when doing so. Recommendations are offered to support the ethical delivery of parent-focused psychological services in pediatric settings. [ABSTRACT FROM AUTHOR]

This paper describes implementation of narrative-informed occupation-based service delivery in outpatient community mental health that addresses (1) the need for outcome data on occupational therapy in this setting, (2) an ongoing mental health provider shortage, and (3) a need for innovative approaches to supporting mental health. We found a significant improvement from baseline to post-intervention in occupational participation. Dose of occupational therapy was significantly related to improvements in roles, habits, values, long-term goals, social environment, and readiness for change. This study supports future, larger effectiveness studies of narrative-informed occupation-based intervention delivered by occupational therapists in outpatient community mental health. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has stricken mental health worldwide. Marginalized populations in low- and middle-income countries have been the most affected, as they were already experiencing barriers to accessing mental health care prior to the pandemic and are unequally exposed to the stressors associated with the health emergency, such as economic ravages or increased risk of complicated disease outcomes. The aim of this paper is to describe a comprehensive initiative resulting from a public-civil partnership to address the increased burden of mental health illness associated with the COVID-19 pandemic in rural Chiapas, Mexico. To address the emerging health needs of the general population and health professionals resulting from the pandemic, Compañeros En Salud (CES), a non-profit civil society organization based in Chiapas, implemented a comprehensive strategy to compensate for the shortage of mental health services in the region in collaboration with the Chiapas Ministry of Health. The strategy included three components: capacity building in mental health care delivery, psychosocial support to the general population, and provision of mental health care to CES collaborating staff. In this capacity building article, implementers from CES and the government share descriptive information on the specific interventions carried out and their beneficiaries, as well as a critical discussion of the strategy followed. Through this strategy, we have been successful in filling the gaps in the public health system to ensure that CES-served populations and CES-collaborating health professionals have access to mental health care. However, further studies to quantify the impact of this intervention in alleviating the burden of mental health illnesses associated with the pandemic are needed. The current situation represents an opportunity to reimagine global mental health. Only through the promotion of community-based initiatives and the development of integrated approaches will we ensure the well-being of marginalized populations. [ABSTRACT FROM AUTHOR]

As the availability of new communication technologies increases, mental health professionals have incorporated these innovations into their practice and research. Up to now several studies have presented promising results in using the power and convenience of the Internet for clinical care. While multiple contributions focus on the potential and the advantages of therapies delivered through the Internet, mental health practitioners may take into account new technological opportunities to improve their practice. Mobile phone diffusion is expanding worldwide at breath-taking speed. In fewer than 20 years, mobile phones have gone from being rare and expensive pieces of equipment used primarily by the business elite, to a pervasive low-cost personal item. In many countries, mobile phones now outnumber land-line telephones, with most adults and many children now owning mobile phones. With high levels of mobile telephone penetration, a mobile culture has evolved, where the phone becomes a key social and cultural tool. The purpose of this paper is to explore the potentialities that mobile phones may offer in clinical care. The paper will investigate in which areas of clinical interventions mobile phones have already been successfully applied. Moreover, the paper will discuss these opportunities by presenting the results of two different studies based on the use of the mobile phone for anxiety management. [ABSTRACT FROM AUTHOR]

Background:The Mental Health Act Commission (MHAC) is a body which monitors the care and treatment of patients compulsorily detained in hospital in England and Wales. It does this through listening to their views and by observing the conditions in which they are held; this direct exposure to the experience of service users contrasts with other models of quality assurance which rely mainly on secondary data. Aims: This paper reviews the work of the Commission, focusing on its visiting role and methodology. Methods: The paper is based on published and unpublished literature, drawing also on personal experience as a member of the MHAC. Results: It argues that textual data tend to be privileged over talk because of the need for evidence-based recommendations and that patients' views are for this reason relatively neglected in Commission reports. The paper highlights ambiguities in the role of the Commission and identifies two divergent goals, firstly protection of legal rights, secondly audit and inspection. Conclusions: The paper finds that it has been difficult for the MHAC to reconcile these goals. While it has successfully raised standards of compliance with the Mental Health Act, it has been less successful in tackling wider issues of quality of care. There is a risk that its user-centred approach may be lost as a result of changes in regulatory structures. [ABSTRACT FROM AUTHOR]

Agency in marginalised youth has been studied from various perspectives, yet the challenges that mental health problems pose for their agency remain poorly understood. Drawing on data from a study on youth transitions fractured by mental health problems, this study sheds light on this important issue. The data consists of 49 life story interviews with young adults. Using Ruth Lister's four-dimensional taxonomy of agency, the analysis shows how everyday struggles with mental distress are entangled with the practices of the social security system, medical care, education, labour markets, and work life. It also reveals how emerging attempts at strategic agency can fail or flourish depending on the response of the social and structural context. If strategic agency is restricted by institutional practices, it will soon return to day-to-day struggling or become everyday resistance and cynicism towards the system. However, if the strategic agency is supported by institutional practices, a genuine path out of distress emerges. The paper suggests that taking seriously the experiences of mental distress and situating them in a specific socio-political context is essential for understanding youth agency today. [ABSTRACT FROM AUTHOR]

Symptoms of depression are common in adolescents and have negative impacts on academic engagement and achievement, as well as on future mental health and functioning. A number of psychological therapies are effective for the treatment of adolescent depression but there are barriers to young people accessing treatment promptly. Providing treatment in school may help improve access to mental health care; school-based mental health care is routinely provided in some parts of the world and is currently a policy priority in the UK. However, introducing mental health services into schools will require services to adapt. This paper illustrates how a short-term psychological therapy can be delivered successfully in schools. It describes the treatment and outcomes for two young people with symptoms of depression. Both received Brief Behavioural Activation (Brief BA) which has been adapted specifically for adolescents. Brief BA focuses on helping young people engage with valued activities in different areas of their life, thus increasing rewards and reducing symptoms of depression. The two cases highlight a range of educational and clinical benefits of Brief BA for young people with depression symptoms and illustrate how the treatment and service delivery were adapted for schools. [ABSTRACT FROM AUTHOR]

Despite increased empirical support for, and consensus recognition of, the values of responsive treatment personalization in the delivery of evidence-based mental health care for youth, the literature has actually offered very little structured guidance with which to inform the actual practice of treatment flexibility. The present paper offers aworking heuristic framework for navigating the necessary deliberations that must be at the center of individual therapist efforts to thoughtfully tailor evidence-based practices. Our guiding Strategic Flexibility Model is organized around five critical questions/deliberations, which we collectively refer to as "the Who, What, When, Where, and Why of Strategic Flexibility." Specifically, our model has the therapist thoughtfully consider: (1) who warrants treatment flexibility?; (2) what treatment components merit flexibility, and what modifications can be applied?; (3) when in treatment is flexibility warranted?; (4) where (i.e., in what settings) is flexibility needed, and where (in what settings) can flexibility by applied?; and (5) why (i.e., to what end) should flexibility be applied under specific circumstances? Strategic Flexibility is conceptualized as an active and dynamic process of careful consideration, hypothesis generation, hypothesis testing, and course correction, as needed. Within our model, it is haphazard clinical "off-roading"– not protocol non-adherence, per say– that is of primary concern. Specific examples are offered throughout, and recommendations for future efforts on this front are discussed. [ABSTRACT FROM AUTHOR]

Intensive psychosocial treatment is presented as a specialized model of care to bridge the research-to-practice gap for evidence-based treatments (EBTs). In the present paper, we describe the UCLA Pediatric Obsessive-Compulsive Disorder Intensive Outpatient Program as an exemplary intervention setting for clinicians to adapt empirically supported treatment principles (e.g., cognitive-behavioral, acceptance-based and dialectical behavioral interventions) and clinical practices (e.g., symptom monitoring, training and supervision, and disposition planning) to address common treatment barriers in the real world, such as clinical complexity, low family engagement, and limited access to specialized treatment. We argue that flexibility in treatment approach, format, and dosage facilitates the dissemination of treatments that are evidence-based but currently under-utilized in usual care settings (e.g., exposure and response prevention for OCD). [ABSTRACT FROM AUTHOR]

Background: This paper is concerned with the issue of service user involvement in education and training within psychological therapy training within the UK. Aims: In particular this paper reflects on the literature on user involvement to gain a deep understanding of its status in the education and training of psychological therapists. Method: A systematic search of the literature indicates minimal involvement from service users in the education and training of psychological therapists. Results: The possible reasons for this are discussed, along with what service users might want from such involvement, what it might add to psychological therapies training, the models of involvement that might be adopted, how service users may be recruited and how they may be involved in the various stages of the educational process, from commissioning, through delivery, to evaluation of programmes. Conclusion: If service user involvement in psychological therapy training is carefully planned, supported and evaluated, it could improve the trainees' practice, so that it reflected the priorities and wishes of those receiving the service. Nevertheless, it is currently an underdeveloped area within contemporary psychological educational practice. Declaration of interests: None. [ABSTRACT FROM AUTHOR]

From a socio-cultural standpoint, the concept of otherness is central to explaining the way risk is associated with certain social groups rather than others. In the mental health field, writers have frequently employed the concept of otherness to describe the ways in which mental health service users have been perceived, especially since the implementation of community care policies in the UK in the 1990s. Despite its popularity, few empirical studies have explored the concept of otherness and its use in explaining the risks associated with being mentally ill in any depth, and fewer still have done so in relation to professional practice. The present paper draws upon data from semi-structured interviews with 39 mental health social workers in order to explore the relevance of this concept in risk assessment. The paper employs the concept of liminal otherness as an analytic tool to explain how social workers assessed the risk of clients who were 'difficult to place' because of uncertainty about whether their behaviour was the result of their personality or their mental illness. It is concluded that liminality is relevant to understanding the following: the way in which some service users are found 'in-between' places in terms of service provision; the allocation of responsibility for the management of the risks they represent to social work as a liminal profession; and the symbolic importance of 'the street' as a liminal space within which forms of 'racial otherness' have become central to contemporary constructions of community care. [ABSTRACT FROM AUTHOR]

This paper describes a two-tiered community intervention model in response to a call from the Center for Mental Health Services for the development of best-practice strategies for homeless mothers with mental health and/or substance use disorders and their children. This model incorporates best practice principles gained from previous research projects pitched at the system and client levels. The model has been conceptualized, presented, and funded by CMHS and is currently being implemented in a local community. This model is unique in that it develops an intervention that addresses both levels of service delivery (i.e., system and client) in a single project. Blending systems integration/wraparound service philosophy and consumer-driven/ strength-based development approaches provides a model that encompasses interventions at the individual client level via supported case management, and improved coordination and collaboration at the service system level. While this model was developed for a specific community population, the approach is general in its applicability to other areas of practice. [ABSTRACT FROM AUTHOR]

Objective: We hypothesised that providing evidence-based care to people presenting in crisis to three Emergency Departments and the 24/7 phone Psychiatric Triage Service in Victoria, Australia, would improve their clinical outcomes over time and experience of the adult mental health system. We tested this through a service prototype, the agile Psychological Medicine clinic. Method: Descriptive statistics were used to understand the characteristics of people who presented in crisis. Patient journey maps were used to understand the impact of the system on the patient and assess whether they received the best clinical care over time. Insights from these analyses, and the evidence base, led to the development of the prototype. Using an open trial design, 194 patients received specialist treatment and effectiveness was measured through patient-reported outcome measures administered at initial and final appointments. Service utilisation was measured 12-months pre and post treatment. Results: The agile Psychological Medicine clinic delivered value; outcomes significantly improved across psychological symptomology and behaviours. Reductions in emergency department presentations, phone triage calls and service costs resulted. Conclusions: This innovative clinic demonstrated that access to front-end mental health treatment improves clinical outcomes, mitigates later complications and increases the prospects of keeping patients well over the longer term. KEY POINTS: What is already known about this topic: (1) Hospital emergency departments (EDs) can often be the initial point of care for people seeking immediate help for mental health crises. (2) Demand has increased, patient satisfaction has decreased and patients increasingly re-present in crisis. (3) Therapeutic alliance has been shown to be a robust predictor of treatment outcome. What this paper adds: (1) Mental health care could be improved for those presenting in situational crises by bringing evidence-based treatment with a consistent clinician with whom they could form a therapeutic alliance (2) The agile Psychological Medicine clinic demonstrated that bringing specialist treatment to the front end of the system of care, improves clinical outcomes, mitigates later complications and increases the prospects of keeping patients well over the longer term. (3) Patients who engaged in treatment had a 37% reduction in ED presentations 12 months after therapeutic intervention resulting in significant cost savings. Abbreviations: aPM: agile Psychological Medicine; CATT: Crisis Assessment and Treatment Team; CBT: Cognitive behaviour therapy; CCT: Continuing Care Team; ECATT: Emergency Crisis Assessment and Treatment Team; ED: Emergency Department; PTS: Psychiatric Triage Service; SECASA: South Eastern Centre Against Sexual Assault [ABSTRACT FROM AUTHOR]

Missing persons incidents incur considerable societal costs but research has overwhelmingly concentrated on missing children. Understanding the phenomenon among adults is underdeveloped as a result. We conducted an evolutionary concept analysis of the 'missing person' in relation to adults. Evolutionary concept analysis provides a structured narrative review methodology which aims to clarify how poorly defined phenomena have been discussed in the professional/academic literature in order to promote conceptual clarity and provide building blocks for future theoretical development. A systematic literature search identified k = 73 relevant papers from which surrogate terms for, and antecedents, consequences, and attributes of the occurrence of adult missing persons were extracted and analysed. The core attributes of the adult missing person are (i) actual or perceived unexpected or unwanted absence accompanied by an absence of information and (ii) a potential adverse risk outcome as perceived by those left behind. The centrality of mental ill-health in actual adult missing persons cases is not reflected in theoretical development which largely comprises descriptive typologies of variable quality and questionable utility. There is a clear need to shift research emphasis towards clinical and psychological domains of inquiry in order to further advance the field of adult missing persons research. [ABSTRACT FROM AUTHOR]

Background: Technology could answer the substantial need in human resources available for supporting those who suffer from mental illness, by providing scalable methods to train and engage non-professionals to those who need their support. 7 Cups of Tea (7COT) platform was chosen for this study, because it provides a good case study for examining this kind of solution. Aim: The aim of this paper was to provide empirical findings regarding users' satisfaction with online emotional support provided by trained volunteers and how it is perceived in comparison to psychotherapy. Methods: An online survey was conducted among a convenience sample of 7COT users. Results: The findings showed high user satisfaction with the support provided by 7COT listeners and, on average, users who indicated to receive psychotherapy in their past marked the listeners' support to be as helpful as psychotherapy. Relating to psychotherapy and online emotional support advantages, different advantages were found. The findings suggest that receiving support from volunteers makes users feel that the support is more genuine. Conclusion: The paper provides preliminary evidence that people in emotional distress may find non-professionals support delivered through the use of technology to be helpful. Limitations and implications are discussed. [ABSTRACT FROM AUTHOR]

Purpose: Recovery approaches to healthcare now feature in the mental health policies and plans of many western countries. However, the operationalisation of these approaches has met with numerous challenges. This paper considers the reasons why, from the point of view of spousal or family carers of people with chronic and severe mental illness. Method: A single-case embedded study was used to analyse the process and outcomes of the implementation of Recovery-oriented services into a public health service organisation located in a major urban centre in south-eastern Australia. The unit of analysis considered in this paper is the experience of carers with the Recovery-oriented services. Findings: Seven of the ten carers who were interviewed had not heard of Recovery or the implementation of Recovery-oriented services. Nine out of the ten carers had noticed no recent improvements in the way services were delivered. Instead, most carers observed a trend to shift the responsibility for overseeing the consumer's treatment and care from health professionals to carers. The carers went on to describe the limited support and training they receive to undertake their role; and the effects of health professionals with-holding the information required by the carer to provide effective care. Carers also identified solutions to the many service issues they identified, including the development of a designated clinical role, in which a health professional would be available to work with carers who are supporting consumers on their Recovery-journey. Conclusion: Inherent to Recovery approaches is collaboration and partnerships between all key stakeholders, including carers. It is important that mental health services focus on strengthening this aspect of service delivery to address ongoing issues with the operationalisation of Recovery-oriented services. [ABSTRACT FROM AUTHOR]

This paper explores an innovative approach to recovery training in which the medium of delivery – as much as the actual content of what was delivered – challenged the conventional construction of professional relationships. The training group comprised service users together with the practitioners who normally worked with them and would continue to do so. The paper examines the staff experiences of the training and the impact on their practice through qualitative interviews conducted 6 months post-training with a sample of four staff participants. The thematic analysis of the interviews demonstrated that this approach could be a powerful experience that brought about lasting changes in working relationships and professional identities. Particular themes that emerged included challenging power relationships and the value of the trainers disclosing their own lived experience and recovery narratives in creating a "safe space" for collaborative learning. This approach demonstrated the potential to be transformative for staff and their relationships with service users, although care may need to be exercised when offering it to staff with little prior exposure to recovery-oriented practice. [ABSTRACT FROM AUTHOR]

This paper presents a brief history of Palestinian mental health care, a discussion of the current status of mental health and health services in the occupied Palestinian territory, and a critique of the biomedical Western-led discourse as it relates to the mental health needs of Palestinians. Medicalising distress and providing psychological therapies for Palestinians offer little in the way of alleviating the underlying causes of ongoing collective trauma. This paper emphasises the importance of separating clinical responses to mental illness from the public health response to mass political violation and distress. Palestinian academic research reframes the mental health paradigm utilising an approach based on the broader framework of social justice, quality of life, human rights and human security. Recognising social suffering as a public mental health issue requires a shift in the emphasis from narrow medical indicators, injury and illness to the lack of human security and human rights violations experienced by ordinary Palestinians. Such a change in perspective requires a parallel change in mental health policies from short-term emergency humanitarian aid to the development of a sustainable system of public mental health services, in combination with advocacy for human rights and the restoration of political, historical and moral justice. [ABSTRACT FROM AUTHOR]