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This study examines the role of external actors in the crises affecting the Arab world. These interventions often exploit the fragility of Arab countries to achieve goals of hegemony and control. This research aims to clarify the relationship between internal crises and regional and international interventions and how these factors impact Arab national security. The significance of this study arises from the long history of political conflicts and the economic and social challenges faced in the region, which are not merely passing phenomena. The interventions by both central and regional powers have added complexity to these crises, making it essential to investigate their causes and potential solutions to better understand the mechanisms of such interventions. The study explores the connections between the Arab crises and three main factors: the historical issues stemming from the legacy of colonialism, the fragility of Arab states, and the lack of civil peace due to tensions and conflicts among the various components of Arab society. In conclusion, addressing, resolving, or managing the crises in the Arab world requires genuine cooperation among Arab nations without the influence of international interventions. Furthermore, most international interventions have exacerbated these crises, as seen in Iraq, Yemen, Libya, and others. [ABSTRACT FROM AUTHOR]

The high prevalence of trauma among people with HIV (PWH) and its negative impact on HIV outcomes underscore the need for Ryan White-funded HIV clinics (RWCs) to implement trauma-informed care (TIC) inclusive of crisis prevention and response. As part of a mixed-methods study of TIC practices employed by RWCs, we conducted qualitative interviews with 36 administrators, providers, and staff from Southeastern RWCs exploring crisis prevention and response strategies. Interviews were guided by the Substance Abuse and Mental Health Services Administration TIC framework and analyzed using a framework-driven, qualitative thematic approach. Crisis prevention strategies included: using electronic medical records to identify patients at risk for experiencing crisis, peer navigators to help patients bypass clinic public spaces, protocols to ensure perpetrator-victim pairs were not concurrently scheduled, and social workers to help patients identify crisis triggers and develop safety plans, plus dedicating safe spaces for patients with extensive trauma histories. Crisis response included patient referral to onsite and community crisis intake, trauma support, and mental health services and having onsite security personnel and alarm systems. Several participants requested additional training in response protocols. Study findings highlight the need for RW network-wide TIC training and sharing of best practices in crisis prevention and response. [ABSTRACT FROM AUTHOR]

Phenomenon: Effective communication between team members is essential during the resuscitation of critically-ill patients. Failure of junior doctors to speak up and challenge erroneous clinical decisions made by their senior doctors is a serious communication failure which can result in catastrophic outcomes and jeopardize patient safety. Crisis resource management (CRM) and conflict resolution tools have been increasingly employed in the healthcare setting to reduce communication failure among healthcare providers and improve patient safety during crisis situations. The aims of our study were to: 1) evaluate the factors affecting junior doctors' ability to speak up on medical errors, 2) examine the effectiveness of CRM and conflict resolution tools, and 3) formulate a communication framework directed at training junior doctors in appropriate intellectual questioning of authority. Approach: From January to April 2019, we recruited twenty-five second-year postgraduate junior doctors working in an Emergency Department in Singapore. We provided training in CRM and conflict resolution communication for participants in the intervention arm. Participants underwent a high-fidelity simulated resuscitation scenario which was standardized to include faculty misdirection in the form of erroneous instructions given by a role-played senior doctor. We observed if participants appropriately challenged the erroneous instructions. We subsequently interviewed participants on their response during the simulation to elicit their barriers and motivations toward challenging authority. Video recordings were analyzed by an independent panel of investigators. Findings: Participants employed various non-verbal and verbal approaches when challenging erroneous decisions. We uncovered multiple personal, interpersonal, and situation-based factors influencing the junior doctor's willingness to challenge erroneous decisions made by seniors. From their responses, we conceptualized a theoretical model designed as a "weighing scale" to demonstrate how junior doctor's eventual response is the outcome of a delicate interplay of multiple barriers and motivations. Our intervention did not significantly increase the participants' likelihood of challenging authority (69% in control arm vs 75% in intervention arm, p = 1.00). Insights: Our study provides insights into the mindset of junior doctors when faced with the dilemma of challenging authority on medical errors. Established CRM training may not be effective in addressing the challenges junior doctors face when communicating against the hierarchal gradient. We propose strategies to further develop and optimize CRM training to enhance its value for junior doctors. Drawing from our findings, we formulated a "SAFE" communication tool (State the safety concern, suggest Alternative course of action, Support with Facts, Engage via Enquiry) directed at helping junior doctors in appropriate intellectual questioning of authority. [ABSTRACT FROM AUTHOR]

Systematic crises may disrupt well‐designed nutrition interventions. Continuing services requires understanding the intervention paths that have been disrupted and adapting as crises permit. Alive & Thrive developed an intervention to integrate nutrition services into urban antenatal care services in Dhaka, which started at the onset of COVID‐19 and encountered extraordinary disruption of services. We investigated the disruptions and adaptations that occurred to continue the delivery of services for women and children and elucidated how the intervention team made those adaptations. We examined the intervention components planned and those implemented annotating the disruptions and adaptations. Subsequently, we detailed the intervention paths (capacity building, supportive supervision, demand generation, counselling services, and reporting, data management and performance review). We sorted out processes at the system, organizational, service delivery and individual levels on how the intervention team made the adaptations. Disruptions included decreased client load and demand for services, attrition of providers and intervention staff, key intervention activities becoming unfeasible and clients and providers facing challenges affecting utilization and provision of services. Adaptations included incorporating new guidance for the continuity of services, managing workforce turnover and incorporating remote modalities for all intervention components. The intervention adapted to continue by incorporating hybrid modalities including both original activities that were feasible and adapted activities. Amidst health system crises, the adapted intervention was successfully delivered. This knowledge of how to identify disruptions and adapt interventions during major crises is critical as Bangladesh and other countries face new threats (conflict, climate, economic downturns, inequities and epidemics). Key messages: Well‐designed nutrition interventions may be disrupted by crises that affect the interventions themselves and the platforms on which they run.Combining contextualized expertise in operational settings with a data‐driven decision‐making process can facilitate the timely identification of intervention disruptions and enable swift adaptations.Continuity of nutrition services amidst crises is feasible by adopting hybrid modalities including both original and adapted implementation paths.Visualizing adaptations to the intervention paths sheds light on how to deliver nutrition services during major systematic disruptions.Knowledge of how to adapt nutrition interventions during crises is critical going forward to respond successfully in future disruptive events. [ABSTRACT FROM AUTHOR]

Police attendance in mental health contexts is often traumatic for the person in crisis, their family and first responders. Existing literature on police involvement in mental health responses tends to focus on police perspectives. Scholarship exploring lived experience perspectives is limited, yet is crucial for informing programmes, policies and reforms. We present findings from one of the first projects co-produced with people with lived experiences of being apprehended by police under mental health legislation. Interviews were conducted with twenty participants who had experience(s) of police apprehension across Australia. Findings highlight the social disadvantage experienced by participants prior to being apprehended and that use of force (such as tasering, pepper spraying and restraining in locked police vans) was common and over-used. Our study identified that police apprehension has lasting and wide-ranging impacts, leading to loss of employment, trauma, property damage, negative self-perceptions, discrimination, and fear of future police responses. Some participants were also apprehended by police while experiencing family violence and were misidentified as perpetrators. We argue police use of force mirrors the use of force within mental health services, with participants not experiencing a clear separation between police and mental health responses. The article shares participants' ideas for change, including response models based on human rights, police non-attendance and peer-led initiatives. Our findings suggest the need for investment in alternatives to police responses and further research involving lived experience perspectives to inform out understanding of mental health crisis responses. [ABSTRACT FROM AUTHOR]

The frequent occurrence of global disasters poses unprecedented challenges to nursing practice. The frontline nurses in disaster relief are exposed to these events and bear significant levels of stress and psychological distress. Resilience and posttraumatic growth (PTG) are essential protective factors that contribute to sustaining their mental health. The purpose of this study was to determine the directional relationship between resilience and PTG using a cross-lagged design. Furthermore, employing longitudinal mediation to test whether the T1 resilience of frontline nurses would promote the development of T3 resilience through the mediating role of T2 PTG. A total of 258 frontline nurses were selected as subjects. They completed self-reported measurements in three periods. The present study was conducted using a cross-lagged panel model and a longitudinal mediation model. The results of cross-lagged path analysis from T2 to T3 showed that PTG could positively predict the development of resilience (β = 0.235, p < 0.001). Resilience did not positively predict the development of PTG (p > 0.05). The analysis of mediating effect results showed that the development of PTG at T2 mediated the relationship between resilience from T1 to T3. Findings may be limited by self-report, recall bias of resilience before the epidemic and short tracking frequency. These results can identify individuals with an increased risk of low resilience under disaster and the mediating role of posttraumatic growth in promoting the development of nurses' resilience, which provides a theoretical basis for psychological crisis intervention and the resilience promotion plan for posttraumatic growth under disaster events. • Cross-lagged and longitudinal mediation are used to infer causality. • The posttraumatic growth of frontline nurses can positively predict their resilience. • The posttraumatic growth of frontline nurses serves as a mediator in the development of resilience. • Developing posttraumatic growth in frontline nurses is essential to bolster resilience and prepare for future medical crises. [ABSTRACT FROM AUTHOR]

Objective: The authors aimed to examine how certified community behavioral health clinics (CCBHCs) fulfill crisis service requirements and whether clinics added crisis services after becoming a CCBHC. Methods: National survey data on CCBHC crisis services were paired with data on clinic features and the demographic and socioeconomic characteristics of the counties within a CCBHC service area. The dependent variables were whether CCBHCs provided the three categories of CCBHC crisis services (i.e., crisis call lines, mobile crisis response, and crisis stabilization) directly or through another organization and whether these services were added after becoming a CCBHC. Descriptive statistics and multivariable logistic regression analyses were performed with data about clinics and the counties they served. In total, 449 CCBHCs were surveyed in the summer of 2022, with a response rate of 56%. The final sample comprised 247 clinics. Results: The number of CCBHC employees per 1,000 people within a CCBHC service area was significantly and positively associated with clinics providing some crisis services directly (mobile crisis response: adjusted OR [AOR]=1.46, 95% CI=1.08–1.98; crisis stabilization services: AOR=1.60, 95% CI=1.17–2.19). Compared with clinics that did not receive a CCBHC Medicaid bundled payment, clinics that received this payment had higher odds of adding mobile crisis response (AOR=2.52, 95% CI=1.28–4.97) and crisis stabilization services (AOR=3.19, 95% CI=1.51–6.72) after becoming a CCBHC. Conclusions: CCBHC initiatives, particularly CCBHC Medicaid bundled payments, may provide opportunities to increase the availability of behavioral health crisis services, but the sufficiency of this increase for meeting crisis care needs remains unknown. [ABSTRACT FROM AUTHOR]

Amidst escalating global crises, universities and colleges are becoming increasingly digitalized to respond to evolving educational demands. However, technology and digitalization are also introducing new forms of inequality and extending existing disparities. The purpose of this study was to investigate these disparities, their impact on education, and how academic institutions’ responses during the COVID 19 crisis further impacted these disparities and inequalities. We used a grounded theory approach with an interpretive epistemology which is appropriate and well suited for this study. We interviewed 24 informants holding university leadership and decision-making positions, including deans, IT managers, university presidents, provosts, and chief information officers. Public and private universities, historically black colleges and universities (HBCU), and minority institutions were represented. Our findings showed that digitalization of learning and institution processes expanded gaps in digital access, equity, and socio-economic status. The findings also supported that some universities proactively implemented best practices that extended beyond investing in digital infrastructure to include initiatives to support equity, inclusivity, and accessibility. The outcome of the study can inform evidence-based decision making, develop targeted crisis interventions, and advocate for systemic changes that promote an equitable and inclusive digital learning environment. [ABSTRACT FROM AUTHOR]

This paper outlines the development of standardized scenarios used to assess the efficacy of Crisis Intervention Team (CIT) training in a randomized, controlled trial. The objective was to create scenarios that accurately simulate mental health crisis situations for law enforcement officers, ensuring that each scenario tests specific CIT skills relevant to real-world encounters. Our process involved building an interdisciplinary team and drawing from the knowledge and experience of professionals in law enforcement, mental health, and performance arts to design a set of scenarios that are both realistic and challenging. The scenarios were developed to represent mental health crises that officers frequently encounter, such as mania, psychosis with agitation, and depression with suicidality. Each scenario requires officers to demonstrate CIT-specific skills such as verbal de-escalation, empathy, and critical decision-making. Our structured approach to developing these scenarios provides a replicable model for future studies that aim to assess the real-world effectiveness of mental health training for law enforcement as well as other professional groups. [ABSTRACT FROM AUTHOR]

The article delves into the experiences of children under 14 in confinement for violent and nonviolent crimes, examining facility size, self-classification, and locked or unlocked status. It compares the placement of juvenile offenders based on data from the Office of Juvenile Justice and Delinquency Prevention, with a focus on racial disparities, particularly among minority youth. The research aims to understand how confinement conditions impact the mental health and rehabilitation of young offenders, emphasizing the need for equitable treatment across race and crime type in the juvenile justice system. The collection of academic articles further explores various aspects of juvenile justice, including racial disparities in detention decisions and trauma-informed interventions for justice-involved youth, highlighting the importance of addressing biases and providing support for all youth in the system. [Extracted from the article]

The existing models for understanding suicidal ideation and behavior do not provide satisfactory orientation for clinical-therapeutic work with suicidal clients. Based on the observation that ambivalence accompanies the entire suicidal process and building on the empirical knowledge about suicidal ambivalence, this article presents the ambivalence model of suicidality (ABS model), a new clinical working model that aims to provide a framework for risk assessment, case conceptualization and treatment planning in the treatment of suicidal individuals. The model divides the suicidal process into three phases (uncertainty phase, transition phase and action phase), describes the psychological state within the different phases, and identifies phase-specific therapeutic interventions. The ABS model is a descriptive model that can be used to structure and organize crisis intervention and psychotherapy with suicidal patients. [ABSTRACT FROM AUTHOR]

A gap in research on family interventions is the understanding of long‐term effects on hypothesized mechanisms of effect regarding children's processes of responding to family stressors. This study assessed the long‐term effects of an intervention designed to improve interparental and family conflict resolution on adolescents' emotional insecurity about interparental conflict. Emotional insecurity about interparental conflict has long been linked with adolescents' risk for adjustment problems. These findings have motivated the development of several family‐based preventive interventions, one of which is the focus of this study. A community sample of 225 adolescents and their parents participated in an RCT‐based study of an intervention designed to reduce adolescent's emotional insecurity about interparental conflict. The intervention's effect on patterns of change in adolescents', mothers', and fathers' reports of the three components of adolescents' emotional insecurity (emotional reactivity, behavioral dysregulation, and cognitive representations) from posttest through the 3‐year follow‐up were examined using multilevel modeling. Results suggested that the intervention predicted immediate (pre to posttest) and long‐term linear decreases in emotional reactivity, as well as long‐term quadratic change in behavioral dysregulation. These findings support the beneficial effects of a brief intervention on multiple components of emotional security. The results also underscore the importance of considering the potential of long‐term (including nonlinear) patterns of change that may occur as a function of family‐based interventions, as well as that the impact of family‐based interventions may vary as a function of reporter and component of emotional insecurity. [ABSTRACT FROM AUTHOR]

Background: The 4 decades of conflict have particularly exacerbated the mental health of Afghan war widows, a population that has not been extensively studied in this context. Aim: This study aims to fill the gap in the literature by providing robust data on the prevalence of depression and anxiety symptoms and identifying associated factors among Afghan war widows. Methods: A cross-sectional study was carried out in 2023, interviewing war widows from four community health centers in Kandahar, Afghanistan. We employed a validated Patient Health Questionnaire and Generalized Anxiety Disorder Scale. A multivariable binary logistic regression model was used to determine factors associated with depression and anxiety symptoms. Results: The prevalence of depression and anxiety symptoms was 57.9% (95% CI: 52.7%–62.8%) and 61.5% (95% CI: 56.4%–66.4%), respectively. There were significant differences in the prevalence of mental health symptoms across our population with different sociodemographic and health-related profiles (in particular, time since widowhood, household income, history of comorbidity, and level of social support). Conclusion: The stark prevalence of mental health issues among Afghan war widows underscores an overlooked humanitarian crisis. The findings call for immediate mental health interventions, tailored to the sociopolitical realities of Afghanistan. [ABSTRACT FROM AUTHOR]

This discussion examines how and why the peacebuilding environment in Solomon Islands presents profound constraints for women despite the promises of global, regional, and national policy stipulating the importance of this activity. The analysis draws on theories of scale to explain how gendered geometries of power are configured in the Solomon Islands peacebuilding environment. These power geometries are shaped by interplaying local and global factors and have limited the space that is open to women peacebuilders. A "crisis response" orientation to Australian-led conflict stabilization missions has been coupled with a national bureaucratic tendency to equate "customary governance" with peacebuilding. Both trends have augmented masculine power and constrained the space for women to engage in conflict mediation. As I show, these developments contradict United Nations Women Peace and Security principles, set out in United Nations Security Council Resolution 1325 and localized in National Action Plans developed in Australia and in Solomon Islands. These expressly stipulate the importance of supporting women's contributions to peacebuilding when conflict flares. The article's analysis makes clear how women continue to push against these constraints, but against overwhelming pressures. It concludes with the claim that conflict mediation processes can only be made more durable in Solomon Islands if the discriminatory gendered geometries of power identified are confronted and greater emphasis is placed on women's customary authority and capacities as peacebuilders. [ABSTRACT FROM AUTHOR]

Scholars have noted several connections between the COVID‐19 pandemic and the climate crisis, ranging from the material influence of the pandemic on climate change processes (e.g., how lockdowns temporarily lowered climate emissions) to the similar ways the crises have been managed. Both crises are also global in scope, have exerted a significant toll on human lives and require major changes in our lifestyles. However, while collective responses to COVID‐19 were rapid and concerted, efforts to address climate change continue to be met with resistance. In this article, we investigate the social vulnerabilities common to both crises and the lessons that policymakers in the climate field can take away from the pandemic. After outlining the theoretical and empirical similarities between the two crises, we present a general framework and recommendations for the use of social science‐based interventions. We focus on two broad topics of contemporary interest that lay bare social vulnerabilities of the coronavirus pandemic—conspiracy theories and racial and ethnic inequities—to highlight the ways that understanding social and psychological processes associated with the pandemic can help inform more efficient climate policies. Public Significance Statement: This paper shows how the COVID‐19 pandemic's social and psychological lessons can guide climate change policies. By leveraging social science insights, we propose strategies and illustrations to combat misinformation and address social inequities, ultimately fostering more effective and inclusive climate actions and benefiting policymakers and society at large. [ABSTRACT FROM AUTHOR]

Background: A substantial number of police–citizen interactions involve a civilian presenting in a mental health crisis, often with law enforcement as the first point of contact. Traditional training methods offer minimal opportunity for police to practice navigating such civilian interactions or to develop and strengthen relevant skills. Virtual reality (VR) offers a promising avenue for addressing this gap by immersing police officers in realistic, controlled environments that could help them to acclimatise to these encounters and understand their own reactions to them. Aims: To examine the extent to which law enforcement officers become immersed in a virtual training environment (VTE), to assess their empathy and sympathy towards a non‐player character (NPC) presenting with schizophrenic psychosis and how empathy and sympathy relate to virtual immersion. Methods: Forty police officers—about a fifth of the department approached—participated in a VR mental health training scenario. Officers' immersion in the VTE was assessed using a 28‐item Presence Questionnaire and their empathy and sympathy were measured using adapted standard scales. The study employed Fisher's Exact Test and Spearman's correlation to analyse the relationships between immersion, empathy and sympathy. Results: Most officers experienced good levels of immersion, although nearly half felt confused or disoriented at the beginning of the session. Officers reported moderate levels of sympathy and higher empathy towards a non‐player character. Significant correlations were found between specific aspects of immersion (e.g. sensory engagement) and empathy. Fisher's Exact Test revealed strong associations between physical interactions in the VTE and empathy/sympathy. Conclusions: Our findings show that police are willing and able to engage in a VR exercise to learn about their response to people in a mental health crisis and that, in such circumstances, they can be both sympathetic and empathic. Next steps will be exploration of the value of such a tool to enhance real‐life responding. [ABSTRACT FROM AUTHOR]

Purpose: Brief Admission by self-referral (BA) is a standardized crisis-management intervention for individuals with self-harm and risk for suicide. This study explored relatives' experiences of BA. Relatives' perspectives may contribute to an increased understanding of the effects of BA given the relatives' role as support and informal caregivers as well as being co-sufferers. Methods: Fourteen relatives to adults with access to BA within one Swedish region participated in focus groups analysed with reflexive thematic analysis. Results: We generated themes evolving around three meaning-based concepts: access (A low threshold to a safe back-up is crucial and obstacles may easily break faith), independence (Trust in their ability with care and respect), and recovery (The rest and relational recovery we all get are needed and invaluable). Conclusions: BA brings considerable value to users and relatives, by supporting them to take care of themselves and each other. Communication and involvement of relatives may enhance users' ability to overcome obstacles to accessing BA. Implementation and adherence may be strengthened by supervision of BA staff and education of emergency care staff. Resources are needed to improve access. Mapping hurdles to BA, support through peers and targeted psychoeducation may improve recovery for BA users and their relatives. [ABSTRACT FROM AUTHOR]

Purpose: Sisu refers to extraordinary internal strength in the face of adversities. Although originally a Finnish concept, it can be a universally useful concept for studying managerial well-being and performance during difficult or even emergency periods. Previous research on sisu categorizes it into beneficial and harmful sisu and suggests that these two dimensions of sisu are useful when studying determination and resoluteness in crisis situations. This study applies the concept of sisu to examine managers' well-being in times of crisis. Methodology: Interviews were conducted with 15 managers in the hotel, manufacturing and retail industries in Finland. Results: The beneficial effects of sisu seem to dissolve when it is used too often. The study also highlighted the paradoxical tension involved in the decision to stop or continue actions in a difficult situation and contributes to sisu research by discussing collective sisu. Conclusion: The results of this study suggest that beneficial sisu helps to overcome adversity, while harmful sisu causes distortions in thinking that are detrimental to managers. Understanding one's own tendency towards beneficial or harmful sisu in difficult situations can help in managerial work. Collective sisu is an excellent resource for overcoming difficult situations in workplaces. [ABSTRACT FROM AUTHOR]

Palestine continues to face emergencies and a series of humanitarian crises. This study aims to comprehend emergency planning and response including the recent COVID-19 pandemic. Comprehending and recording these experiences will facilitate on-going improvement of Palestine's Public Health Emergency Preparedness (PHEP). A qualitative exploratory study. Fifteen semi-structured interviews were conducted with key informant decision-makers representing various sectors of the Palestinian health system. The data collection period took place from April 2022–December 2022. A convenient purposive sample was chosen based on identifying important stakeholders in the West Bank's health sector. Every interview was transcribed. Major themes and subthemes were identified using content thematic analysis. The study demonstrates Palestine's inadequate preparation for emergencies, instead there is a focus on response once a crisis has occurred. No national entity or mechanism is leading the collective preparedness efforts, which might ultimately result in a stronger emergency response. Instead, the efforts are dispersed across several entities, and decisions are not made cooperatively. As for resources, the study indicates that an emergency budget has not been allocated. The study showed a good degree of multi-sectoral collaboration with some reservations regarding the creation of various committees and their efficacy in handling crises. The findings made it abundantly evident that significant efforts are needed to improve Palestine's level of preparedness and planning. One of the study's primary conclusions is that the health sector must shift from a reactionary to a preparedness-oriented mindset. Additionally, it is necessary to keep an eye on any changes in the nation's health and analysis must take place to strengthen the health system's response plans. Moreover, the activation of the emergency operation center in Palestine is one of the key advancements of the preparedness system. [ABSTRACT FROM AUTHOR]

The global rise in adolescent self-harm and suicidal behaviours has intensified the demand for mental health services in the UK. This has further strained already underfunded and understaffed resources, resulting in longer waiting times and increased emergency department visits among teenagers. To address the overwhelming need for effective community-based emergency support, a brief psychodynamic crisis therapeutic intervention was developed within a CAMHS adolescent crisis team, inspired by child psychotherapist Ruth Schmidt Neven's work on time-limited psychotherapy with adolescents and their families. This 12-session intervention offers both individual therapy for the adolescent and sessions for their parents, along with regular family reviews. Two psychotherapists work closely together on each case – one with the young person, the other with the parents. The brief model views crises as opportunities for deeper understanding, moving beyond diagnostic and symptom-centred approaches, as well as standard risk management and safety-planning strategies, and underlines the centrality of parent involvement in adolescent crisis work. This paper outlines the intervention's theoretical foundation, guiding principles, and practical design, and presents preliminary findings from a pilot study of 22 cases, run over two and a half years. Early results suggest broad potential for this psychodynamic crisis approach in various adolescent crises, and merit further investigation. [ABSTRACT FROM AUTHOR]

The term 'mental health crisis' is a widely used concept in clinical practice and research, appearing prominently in mental health literature across healthcare and social science disciplines. Within these contexts, the term is frequently either left undefined or defined rather narrowly, confined to clinical observations or guidelines targeted at healthcare providers and negating the multifaceted nature of crisis as described by those with lived experience. Therefore, the aim of this paper is to explore the characteristics of and provide a conceptual definition for the concept of 'mental health crisis'. Rodgers' method of evolutionary concept analysis was employed and 34 articles, ranging from 1994 to 2021 and a variety of disciplines, were analysed. The results highlighted the contrast between clinically oriented surrogate terms and related concepts and those used by individuals with lived crisis experience. Antecedents of crisis included underlying vulnerabilities, relational dysfunction, collapse of life structure and struggles with activities of daily living. The concept's attributes encompassed the temporality of crisis, signs and symptoms of crisis, functional decline and crisis in family and caregivers. Finally, the consequences comprised looking inward for help, looking outward for help, and opportunities and dangers. This concept analysis serves as a foundational step in understanding 'mental health crisis' and its various dimensions, facilitating more nuanced discussions and interventions in the realm of mental healthcare. [ABSTRACT FROM AUTHOR]

Previous studies have reported that patients with borderline personality disorder (BPD) often have negative experiences in psychiatric inpatient care. To address this issue, a novel intervention known as patient‐initiated brief admission (PIBA) has been developed. PIBA offers a constructive approach to crisis management in situations of heightened anxiety, as well as during instances of self‐harm and suicidal ideation. The intervention allows patients to directly contact the psychiatric ward to initiate a brief admission lasting 1–3 days. This easily accessible care option during a crisis has the potential to prevent harm to the patient and reduce the need for prolonged hospital stays. The aim of the present study is to investigate the effects of PIBA on psychiatric care consumption among patients diagnosed with BPD. This retrospective register‐based study includes data from both inpatient and outpatient care registries for patients diagnosed with BPD. Data were extracted from the National Board of Health and Welfare in Sweden. The study period encompasses 2013–2020, with the PIBA intervention occurring between 2016 and 2019. The sample included 107 patients in the PIBA group and 5659 matched controls. Data were analysed using a difference‐in‐differences (DiD) approach through ordinary least squares (OLS) regression and ordinal logistic regression. Throughout the 3‐year follow‐up, both groups exhibited a reduction in the number of days of utilisation of psychiatric inpatient care services. The DiD analysis indicated an additional decrease of 1.5 days at the 6‐month mark for the PIBA group (β = −1.436, SE = 1.531), expanding to 3 days fewer at the 12‐month follow‐up (β = −3.590, SE = 3.546), although not statistically significant. For outpatient care, the PIBA group displayed an increase in the number of visits, averaging to half a visit more every 6 months (β = 0.503, SE = 0.263) compared with the controls. Statistically significant differences were observed for two out of six measurements at the 12‐month (β = 0.960, SE = 0.456) and 18‐month follow‐up period (β = 0.436, SE = 0.219). The PIBA group had a statistically significant lower odds of experiencing extended lengths of inpatient care days after the index date than the controls (OR 0.56, 95% CI: 0.44–0.72). In conclusion, PIBA was associated with a significant reduction in the length of individual hospital stays, but not in the overall number of inpatient care days. PIBA may be linked to a shift from longer inpatient care utilisation to outpatient care utilisation. These findings suggest that PIBA may reduce the risk of prolonged hospitalisations for patients who have access to the intervention. Future research should explore the impact of PIBA on healthcare costs and cost‐effectiveness, both in relation to health care for the individual and cost‐effectiveness in relation to recovery and health. [ABSTRACT FROM AUTHOR]

Hate crime victimization targeting the victim's religious identity poses a serious problem for individuals, communities, and societies. This systematic review describes countermeasures to such victimization, aiming for broad descriptive inclusion by canvassing personal adaptations, collective programs, and institutional-governmental policies. Targeting peer-reviewed articles published between 2002 and 2022, we found 44 articles describing measures related to religion-based victimization prevention. We classified the studied measures into 12 main types. The most salient personal adaptations included camouflage-type blending in to avoid victimization, using religion as a source of resilience, and changing routines to deflect risk. At the collective level, mobilizing community resilience, stereotype reduction, and place-based solutions were often researched. The relatively few institutional-level studies addressed measures to enhance the connection between victims and authorities by various means. The experimental studies heavily concentrated on experiments supporting the efficacy of changing people's perceptions as a means of prevention. The review concludes with a discussion about research and policy implications. [ABSTRACT FROM AUTHOR]

Background: Acute crises in patients with personality disorders (PD) are often accompanied by suicidal and self-harming behavior. Their management is challenging, as both coercive measures and prolonged inpatient-treatment are known to be counterproductive. Only in crises that cannot be controlled by outpatient means, inpatient treatment is to be taken into account. This treatment should be time-limited and not involve coercion. Aims: The aim of this study was to assess if the introduction of a specialized crisis intervention track is associated with a reduction of coercive measures as well as a shorter in-hospital stay in PD patients. Methods: In this 8-year, hospital-wide, longitudinal, observational study, we investigated the frequency of coercive measures and the median length of in-hospital stay in 1,752 inpatient-cases with PD admitted to the Adult Psychiatry, UPK, Basel, Switzerland, between 01.01.2012 and 31.12.2019. By means of an interrupted-time-series analysis, we compared the period before and after the implementation of a specialized crisis intervention track for PD patients. Results: Our data show a significant decrease in the median length of in-hospital stay and no significant reduction in the incidence rate of coercion among PD patients after the intervention. The latter is likely due to a floor effect, since there was a significant decrease in coercive measures over the entire observation period, already reaching very low rates before the intervention. Conclusions: Our study underlines the clinical importance of specialized short-term crisis management in PD, which comes along with shorter lengths of in-hospital stays and a stable low rate of coercive measure. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Involuntary detention is a legislative power that allows people to be taken against their will for a mandatory mental health assessment and is known to be a restrictive and traumatizing process for patients.While there is some literature examining police/ambulance and mental health worker co‐response models, the conclusions are mixed as to whether they reduce rates of involuntary detentions in mentally ill people.The Police, Ambulance, Clinician Early Response (PACER) model is an example of a tri‐response mental health crisis response team whose role is to respond and assess people thought to be experiencing a mental health crisis.There is little literature to determine whether PACER tri‐response model reduces incidents of involuntary detention when compared with standard police and/or ambulance responses. What this paper adds to existing knowledge?: This paper describes the outcomes of patients assessed by a PACER team, compared with patients who were assessed by police or ambulance.It demonstrates that PACER may reduce unnecessary involuntary detentions through expert mental health assessment for patients coming to emergency services for assistance. It is one of only two published studies examining a tri‐response model. What are the implications for practice?: The results of this study may support health and policing policymakers to implement PACER models as a means of reducing involuntary detentions, reducing demand for emergency departments, reducing time spent by emergency services responding to people experiencing mental health crisis and improving outcomes for people with mental illness. Background: Involuntary detention is a common method of enforcing mental health assessment and treatment; however, it is associated with poor patient outcomes and high emergency service and hospital demand. Aim: To examine the association between (1) Police, Ambulance, Clinician, Early Response (PACER) model, (2) police or (3) ambulance response and rates of involuntary detention of mentally ill people. Methods: A retrospective observational study using routine administrative data in an Australian City, over a 12‐month period (2019–2020). Results: Over a 12‐month period, 8577 people received crisis mental health intervention in the study setting. We observed an 18% increase in the relative risk of being involuntarily detained by police, and a 640% increase in the relative risk of being detained by ambulance. The PACER team detained 10% of their total presentations, as compared with 12% by police and 74% by ambulance. Involuntary detentions enacted by PACER were more likely to convert to a post‐detention hospitalization (72%), when compared with police (27%) and ambulance (17%). Discussion: PACER was associated with lower rates of involuntary detention and higher rates of post‐detention hospitalization when compared to police and ambulance response. Implications for Practice: PACER cohort experience more positive outcomes than with police or ambulance cohorts. [ABSTRACT FROM AUTHOR]

Objective: Shared Individual Formulation Therapy (SIFT) is a brief, hybrid psychotherapy intervention that uses shared formulation and psychodynamic psychotherapy techniques to help participants expand their understanding of their difficulties. It was used in a pilot study for 29 adults with functional neurological disorder (FND). This analysis explores the experiences of participants using qualitative methods. Method: Participants underwent semistructured interviews about their experiences of SIFT, which were analysed using reflexive thematic analysis from a critical realist standpoint. Findings were triangulated with the previously published quantitative results. Results: Participants experienced SIFT as providing a safe space to help them explore and make sense of their FND. The resulting self‐knowledge was experienced as promoting recovery and growth, but some participants experienced the process as challenging and were ambivalent about it. Conclusion: The findings support SIFT's potential value for treating adults with FND. The psychodynamic aspects are an important component of SIFT for many, but not all, participants. [ABSTRACT FROM AUTHOR]

Interagency cooperation may increase efficiency and cost-effectiveness in an era of resource austerity and increased workload for both the police and their partners. Yet the effect of a strategic police-security collaboration on routine operations across multiple sites is unknown. In a controlled experiment, we introduced an interagency collaboration between state and non-state guardianships to train stations across England. A mixed-methods approach, with multiple crime indicators and a survey administered with police officers and security partners, was applied through a series of before-and-after comparisons with staggered start dates to control for confounding variables. Crime recording, police proactivity and crisis intervention increased compared to controls. Security staff and officers valued collaboration and saw it as beneficial and efficient. The findings support police-private-security collaboration on crime and disorder, but more research with larger and more diverse samples and stricter control over rival explanations is needed. [ABSTRACT FROM AUTHOR]

As the number of children and young people (CYP) attending the emergency department (ED) with a mental health crisis is increasing, it has become evident that neither the environment nor the training for general paediatricians is adequate to meet CYPs' mental health needs. This short article provides an essential toolkit for paediatricians and other healthcare professionals working with CYP. It provides a resource encompassing skills and knowledge to promote understanding of mental health crises and strategies to address these when CYP are in ED or admitted to the ward. It will allow general paediatricians to address the agitation and distress experienced by many CYP in EDs or on paediatric wards and use verbal de-scalation techniques rather than medications. The toolkit highlights how to take an appropriate mental health history, perform a mental state examination and if necessary medical investigations required, as well as providing an overview of the legal framework under which mental health conditions are managed in different age groups. A short section highlights the most common mental health issues and their management. Lastly, the CAMHS structure is explained to support the multi-professional collaboration needed to ensure CYP are managed appropriately between teams and have the best support and care possible in the ED and on paediatric wards. [ABSTRACT FROM AUTHOR]

Objective: The authors examined whether use of a co-responder program reduced the likelihood of an involuntary commitment examination as the disposition of a police encounter with youths experiencing a mental health crisis and 1 year after the initial incident. Methods: Using a quasi-experimental design, the authors compared 206 incidents that involved the co-response program with 327 incidents that did not involve the program. Propensity score matching was used to balance groups on demographic and incident characteristics. The dependent variables included the disposition of the incident (deescalation or involuntary commitment examination), whether the youths experienced a later involuntary commitment examination within 1 year of the initial intervention, and time to the subsequent examination. Propensity score–weighted binary logistic regression and time-to-event analysis were used. Results: The co-responder program was associated with a significantly lower likelihood of police officer–initiated involuntary commitment examinations and a lower likelihood of an involuntary commitment examination within 1 year. Eighty percent of the incidents that resulted in a co-response involving a police officer and a mental health professional were deescalated, allowing the youth to remain in the community with a safety plan, whereas 17% of incidents with a police-only response ended with crisis deescalation. Conclusions: These findings provide further support for the implementation of co-responder options that are available to police officers during encounters with children and adolescents experiencing a mental health crisis. [ABSTRACT FROM AUTHOR]

Objective: Online communities promote social connection and can be used for formal peer support and crisis intervention. Although some communities have programs to support their members' mental health, few programs have been formally evaluated. The authors present findings from a mixed-methods evaluation of the Stack Up Overwatch Program (StOP), a digital peer support intervention delivered in an online gaming community. Methods: Data were collected from members of the Stack Up Discord server between June and October 2020 and included chat messages, survey responses, encounter forms (documenting information from private interactions between users and peer supporters), and interviews with peer support team members. The authors analyzed data on demographic characteristics, mental health and crises, use of and experiences with StOP, and chat posts. Thematic analysis and descriptive statistics were combined in a joint display table, with mixed-methods findings explained in narrative form. Results: The findings show that StOP provides users in crisis with a source of mental health support when other options have been exhausted and that military and veteran users valued the connections and friendships they formed while using it. Participants reported that StOP met needs for support and connection when formal services were inaccessible or did not meet their needs, and volunteer peer supporters detailed how StOP's design facilitates use of the intervention. Volunteering offered members of the peer support team a "family feeling" facilitated by the unique chat room structure. Conclusions: Community-based crisis prevention programs administered through chat rooms may provide valuable support to both users and peer support providers. [ABSTRACT FROM AUTHOR]

Historically, the prevention of youth homelessness has not been a priority in Canada or the United States. In recent years, this has begun to change. While there is growing recognition that a shift by preventing homelessness is required to bring a substantive end to homelessness, a common and shared understanding of what prevention is and what it involves has remained largely absent or obscured in both policy and practice. In this paper, we focus specifically on the prevention of youth homelessness and set out to provide conceptual clarity through presenting a clear definition of what prevention is and what it is not. Accompanying the definition is a five-point typology that includes (1) structural prevention; (2) systems prevention; (3) early intervention; (4) crisis intervention, and (5) housing stabilization. Each of the five elements of the typology is defined, identifying who is responsible for implementation. In addition, the typology is populated with examples of different approaches to the prevention of youth homelessness. We conclude with some key considerations to guide the implementation of preventive interventions and present core principles designed to support the development of effective and quality prevention interventions. [ABSTRACT FROM AUTHOR]

Since the financial crisis, financial networks, such as interbank lending networks, have been highly concerned by regulators in terms of their vulnerability. To study the risk contagion power of financial networks deeply, this paper integrates short-term and long-term lending data among commercial banks and stress tests the Chinese interbank lending network by using the extended distress and default contagion model. The results show that the reconstructed short-term lending network utilizing information on bank assets exhibits a core–periphery structure with systemically important banks at its core. Stress test results suggest that an interbank lending network that does not consider long-term lending data underestimates the network's systemic risk when market conditions are poor. In addition, we find that the Chinese interbank lending network has gradually become more risk-resistant over time, and the vulnerability of the network after the outbreak of COVID-19 is lower than that before. Finally, we suggest that regulators can make full use of ancillary data, such as long-term interbank lending data, to stress test financial networks, thereby accurately capturing the network's structure and preparing for ex-ante interventions before a crisis strikes to mitigate network systemic risk. [ABSTRACT FROM AUTHOR]

The Fayetteville, AR, Police Department (FPD) initiated a co-response program in 2021, partnering with social workers to respond to individuals in crisis. Originally started with a University of Arkansas School of Social Work (UA) internship, the Crisis Intervention Response Team (CIRT) has grown over time. The program now includes two full-time co-response teams, two social work interns, and plans for further expansion. UA provides support for the program through continued internships, clinical supervision, and program evaluation. This article reports on one aspect of the UA program evaluation focusing on FPD employees' perspectives on integrating social workers into their department and how those perspectives have changed over time as the program has expanded. Through semi-structured interviews and survey data collected in 2021 and 2023, this research highlights key factors contributing to the program's successes and continued challenges. The results provide valuable insights, suggestions, and other factors to consider for similar police departments when making decisions whether to establish or expand co-response initiatives. [ABSTRACT FROM AUTHOR]

The article "The Sound of Silence" from the Journal of the American Psychoanalytic Association delves into the author's mother's experiences growing up in a household filled with art and abuse. The memoir recounts the emergence of repressed memories of sexual assault by her father, the impact of these memories on her life, and the process of healing through therapy and support. The narrative also explores themes of silence, resilience, and forgiveness within the context of a complex family history. [Extracted from the article]

This clinical trial examined the individual and combined effects of three different approaches to reducing alcohol misuse among a sample of sexual minority men (SMM) with HIV. Specifically, we used a 2 × 2 × 2 randomized factorial design to compare: (a) behavioral intervention based in motivational interviewing (MI) vs. brief intervention (BI), (b) interactive text messaging (ITM) for alcohol use vs. no ITM, and (c) extended intervention (EI) length of nine months vs. a one-month intervention duration. Participants (N = 188) were SMM with HIV and alcohol misuse recruited in Miami, FL, and Boston, MA. Participants were randomized to one of eight intervention combinations and assessed at 6- and 12-month follow-ups. Large reductions of over 50% in drinks per week and heavy drinking days were observed in all conditions at follow-up. Those who received ITM, compared to those who did not, reported significantly lower drinks consumed per week at 6 and 12 months (incidence rate ratios = 0.73 [95% CI = 0.57, 0.90] and 0.72 [95% CI = 0.56, 0.87], respectively), and increased odds of cessation of alcohol misuse at 12 months, odds ratio = 1.46, 95% CI = 1.03, 2.08. Results provided no evidence of better alcohol use outcomes for either MI or EI relative to their comparison conditions, and no specific combination of intervention components demonstrated a notable benefit. This study suggests a two-session BI can effectuate substantial reductions in alcohol use in SMM with HIV and that adding one month of ITM can yield further improvements. Clinical Trials Number: NCT02709759 [ABSTRACT FROM AUTHOR]

This article introduces an artificial intelligence (AI)‐based system for forecasting food insecurity in data‐limited settings, employing unsupervised neural networks for topic modeling on news data. Unlike traditional methods, our system operates without relying on expert assumptions about food insecurity factors. Through a case study in Somalia, we show that the method can yield competitive performance, even in the absence of traditional food security indicators such as food prices. This system is valuable in supporting expert assessments of food insecurity, unlocking a wealth of untapped information from news outlets, and offering a path toward more frequent and automated food insecurity monitoring for timely crisis intervention. [ABSTRACT FROM AUTHOR]

Background: Chronic ischemic heart disease (IHD) is one of the leading causes of morbidity and mortality. Physical activity (PA) is an effective secondary preventive strategy in IHD management. The German treatment guideline recommends that general practitioners (GPs) deliver PA advice to patients. This recommendation seems inadequately implemented, often due to GP's insufficient specific training. International guidelines recommend training GPs in how to deliver such advice effectively and efficiently. Evidence is lacking on whether such training can enhance the frequency and quality of PA advice in routine care. The OptiCor project aims to develop and evaluate a GP training in the delivery of very brief PA advice to optimise the treatment of patients with IHD in general practice. Methods: OptiCor comprises three study phases according to the Medical Research Council recommendations for developing and evaluating complex interventions. Phase 1 (needs analysis): A nationwide representative household survey will be conducted to collect data on the receipt of GP-delivered PA advice in people with IHD. Qualitative interviews and group discussions with GPs and people with IHD will help to explore, e.g., attitudes, experiences with, and barriers and facilitators of PA advice implementation or reception, respectively. Findings will inform the training development. Phase 2 (pilot): A pragmatic cluster randomised controlled trial (cRCT) on the effectiveness of the developed training on proportions of GP-delivered PA advice during routine care of IHD patients will be piloted. Phase 3 (evaluation): A full pragmatic cRCT will be conducted with patient-reported proportions of GP-delivered PA advice as primary endpoint. Collection of health economic and process-related data will facilitate a potential future broad implementation and health economic evaluation of the training. Discussion: If the developed training successfully improves proportions and quality of GP delivered PA advice to patients with IHD, it could serve as a low-threshold and sustainable strategy for implementing PA recommendations in the secondary prevention of IHD in routine GP practice. Trial registration: Work package (WP) 1, WP5, and WP6 have been prospectively registered at German Clinical Trials Register (WP1: DRKS00031304, 19/06/2023; WP5: DRKS00034641, 10/07/2024; WP6: DRKS00034642; 10/07/2024). [ABSTRACT FROM AUTHOR]

Background: Safety incidents are common in adult acute inpatient mental health services, and detrimental to all. Incidents spread via social contagion within the ward, but social contagion is difficult to quantify. Better measures of social contagion could support a milieu in which safety incidents are less likely to be prolonged, spread, or repeated, with widespread benefits. The WardSonar project, based in the United Kingdom (UK), developed and evaluated a prototype digital safety monitoring tool to collect real-time information from patients on acute adult mental health wards, about their perceptions of ward safety. A prototype Wardsonar tool was developed from a collaborative, co-design approach, and implemented in real-world hospital settings. The current study aimed to understand whether the tool can help to predict incidents, by examining (i) the feasibility of capturing real-time feedback from patients about safety and (ii) how the resulting data related to quality and safety metrics. This study was registered as ISRCTN14470430 on 10/January/2022. Method: Patients can record real-time perceptions of ward safety using the tool, and staff can access these as anonymous, aggregated data. The tool was implemented in the UK in six National Health Service adult acute mental health wards. A novel approach to analysis involved construction of an hour-by-hour dataset over each ward. This revealed relationships between quantity and content of patient reports, staffing, time of day, and ward incidents, per ward. Results: There is strong evidence that an incident leads to increased probability of further incidents within the next four hours. This supports the idea of social/behavioural contagion and puts a measure on the extent to which the contagion persists. COVID-19 impacted the research processes. Conclusions: There is potential to use the WardSonar digital tool for proactive real-time safety monitoring, to identify developing incidents and help staff to facilitate timely preventative or de-escalating interventions. Further refinement and testing in a post COVID-19 context are needed. Trial registration: ISRCTN14470430 https://doi.org/10.1186/ISRCTN14470430. Registered 10/January/2022. [ABSTRACT FROM AUTHOR]

ABSTRACT A number of people experiencing a mental health crisis who present to a hospital emergency department (ED) do not wait (DNW) for assessment or care and leave. This phenomenon is poorly understood and offers an opportunity to enhance quality of care. We sought to understand the characteristics and reasons of those who DNW for assessment or care, and what happens after leaving the ED. We used a semi‐structured telephone interview method with open‐ended and single choice responses. Participants were recruited from Eastern Health hospitals who had been referred from the ED for specialist mental health care. Respondents (N = 42) tended to be female adults in their 30s, accompanied by another person, and seeking short‐term relief and long‐term care for a mental health crisis. It became increasingly obvious over time to participants that the cost of waiting was outweighed by the benefit of leaving. A range of factors were identified that took them to this tipping point. Over half reported their condition as having improved and did not seek further care after leaving the ED. Respondents thought a comfortable ‘safe place’ and communication that conveyed respect and reduced uncertainty while waiting would reduce early leaving. There were challenges in engaging a DNW population. Nonetheless this study offers valuable insights into this phenomenon in an ED setting. Many of the expressed views for reducing DNW appear to be reasonable and achievable. [ABSTRACT FROM AUTHOR]

Agri-biotech promotes genetically modified organisms (GMO) as solutions to achieve food security by increasing yields, reducing pesticide use through genetically introduced resistance to herbicides and as strategy for climate change mitigation and adaptation. After 30 years of biotechnological crops, these proposals have failed on their pledges, while the risk assessment, non-considered outcomes to the environment, biodiversity and health have been overlooked. New Plant-Breeding Technologies (NPBTs), with the capacity of inserting, deleting, or modifying DNA or RNA nucleotides in specific genetic regions have emerged in the last 15 years. The most prominent technique used to edit genomes is CRISPR-Cas. Its proponents argue that mutations introduced via genome editing pose no risk to the environment and/or human health; thus, these products should be exempted from any regulation, risk assessment, traceability and labeling, a push that would actually restrict the freedom to choose of farmers and consumers. Our work summarizes the outcomes reported in the scientific literature on the use of gene editing tools in food crops. We discuss perspectives for upgrading biosafety governance of these new GMO in order to promote the autonomy of farmers, away from positivist techno-scientific fixes that downplay the systemic crises in which industrial agriculture plays a major role [ABSTRACT FROM AUTHOR]

Aim(s): To understand how nurses experience their positioning amidst hospital crises. Background: Nursing leadership literature is predominantly focused on the skills and competencies of nurses and less on the relations in practice with nurses. Nurses are often valued for bedside care but are overlooked in strategic decision‐making during crises. Foundational research emphasizes the need for nurses' equal participation in interprofessional healthcare practices and governance. Methods: We conducted a qualitative interpretive interview and focus group study, amidst the COVID‐19 crisis. We interviewed 64 chairs of nurse councils and deepened our understanding of our initial findings in four focus groups with 34 participants. Results: Nurses differ widely on (a) what is important to them in crisis management, (b) how they can contribute to crisis management, and (c) how they value their involvement or lack of it. Furthermore, we uncovered three relational leadership struggles for nurses concerning (1) navigating, (2) positioning, and (3) collaborating, in crisis management structures. Conclusion: The ailing positioning and representation of nurses in crisis management result from their limited participation in strategic decision‐making, and the lack of intervention on this by board members, physicians, and managers. Implications for Nursing Management: This study highlights the need for agents such as board members, managers, physicians, and nurses themselves to create clear frameworks and policies that define nurses' roles in crisis situations, emphasizing the importance of addressing power dynamics and enhancing communication and collaboration in hospital settings. Effective crisis management requires involving nurses from the start, providing regular training, and promoting a more equal approach to teamwork. Understanding relational leadership and its impact during crises can empower nurses and improve overall hospital crisis response. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions This study investigated the trajectories of interpersonal stress and psychological pain and their effects on self‐harm behaviors in adolescents and explored the reciprocal associations between interpersonal stress and NSSI/SA.The participants included 1149 adolescents (50.3% women; Mage = 12.86, SD = 0.69) who participated in three waves of data collection. Latent class growth models and cross‐lagged panel models were used to identify subgroups of individuals and interactions between interpersonal stress and NSSI/SA.Controlling for sex and age, compared to the low interpersonal stress class, the moderate to high and increasing classes have higher risks of NSSI and SA. Compared to adolescents in the low increasing feelings with high increasing avoidance class, those in the low increasing feelings with low decreasing avoidance class reported lower probabilities of NSSI and SA. Pain avoidance and painful feelings mediated the pathway from interpersonal stress to NSSI/SA, whereas pain arousal mediated the pathway from NSSI/SA to interpersonal stress.Shared impact of interpersonal stress and distinct effects of psychological pain over time on maintaining and distinguishing self‐harm behaviors were found. Adolescent crisis interventions should simultaneously focus on building social networks within the school context and regulating maladaptive minds. [ABSTRACT FROM AUTHOR]

Introduction: Suicidality is a growing problem in the US, and the emergency department (ED) is often the front line for the management and effective treatment of acutely suicidal patients. There is a dearth of interventions that emergency physicians may use to manage and effectively treat acutely suicidal patients. To the extent that recently described interventions are available for ED personnel, no review has been conducted to identify them. This scoping review is intended to fill this gap by systematically reviewing the literature to identify recently described interventions that can be administered in the ED to reduce symptoms and stabilize patients. Methods: We conducted a search of PubMed, SCOPUS, and CINAHL in January 2024 to identify papers published between 2013–2023 for original research trialing recent interventions for the effective treatment of suicidality in the ED. We assessed 16 full-text articles for eligibility, and nine met inclusion criteria. Included studies were evaluated for features and characteristics, the fit of the intervention to the ED environment, and interventional efficacy. Results: Four studies assessed the efficacy of a single dose of the anesthetic/analgesic agent ketamine. Three studies assessed the efficacy of a brief psychosocial intervention delivered in the ED, two of which paired this intervention with the provision of follow-up care (postcard contact and referral assistance/ case management, respectively). The remaining two studies trialed a brief, motivational interviewingbased intervention. Included studies had strong experimental designs (randomized controlled trials) but small sample sizes (average 57). Among the interventions represented across these nine studies, a single dose of ketamine and the brief psychosocial intervention Crisis Response Planning (CRP) show promise as ED-appropriate interventions for suicidality. Ketamine and CRP demonstrated the strongest fit to the ED environment and most robust efficacy findings. Conclusion: This review identified one drug (ketamine) and four unique psychological/behavioral interventions that have been used to treat acute suicidality in the ED. There is currently insufficient evidence to suggest that these interventions will prove efficacious and well-suited to be delivered in the ED environment. Future studies should continue to test these interventions in the ED setting to determine their feasibility and efficacy. [ABSTRACT FROM AUTHOR]

Food insecurity and malnutrition are rising worldwide due to disruptions in food systems related to interconnected health-, climate- and conflict-related crises. Although governments globally are committed to addressing nutritional challenges, policy responses have increasingly focused on food security and, particularly, on food affordability. However, these short-term measures often overlook the necessity of integrating nutritious foods into the food system to ensure improved long-term nutrition. By drawing on the United Nations Committee on World Food Security's Voluntary guidelines on food systems and nutrition, this article outlines opportunities for policy-makers to integrate nutrition into key elements of the crisis response. Key policy areas where nutrition could be further integrated include social protection, agricultural investment, trade policy and urban planning. Strengthening the focus of nutrition in these measures will be essential to establish long-term incentives that support food systems transformation for improved nutrition. Drawing on theories of the policy process, I propose that stronger governance and cross-sectoral dialogue will be critical to achieve sustained nutritional outcomes. Health policy-makers can play a leadership role in supporting cross-sectoral policy change by carefully framing the policy issues, advocating for institutional structures that promote collaboration across sectors to prioritize nutrition, and strengthening the management of conflicts of interest in food system policy-making. [ABSTRACT FROM AUTHOR]

Traditional forms of psychiatric crisis treatment increasingly are being buttressed by services along the Psychiatric Crisis Continuum of Care, such as short-term crisis stabilization services and peer crisis services. The UT Health Living Room (LR) is an outpatient crisis counseling service that adds three promising elements to the Continuum: (1) it integrates outpatient treatment plans into crisis counseling, (2) provides care in a space and with staff who are familiar to patients, and (3) provides training in evidence-based crisis intervention. We examined two-year LR feasibility and outcome data. Mixed-method analyses used longitudinal clinic data and patient self-report measures. Results provide initial support for the feasibility, cost effectiveness and clinical effectiveness of the LR. Limitations include non-blinded ratings, limited experimental control, and simple cost-effectiveness methodology. The UT Living Room is feasible and offers novel elements to help patients in community clinics address emotional crises. [ABSTRACT FROM AUTHOR]

Background: This study examines the impact of the COVID-19 pandemic on abdominal trauma management by comparing pre-pandemic (17 February 2018–26 February 2020) and pandemic periods (27 February 2020–7 March 2022). Methods: Analyzing data from 118 patients at the Emergency County Clinical Hospital of Craiova, we identified significant shifts in clinical practices affecting patient outcomes. Results: During the pandemic, a moderate increase in surgical interventions for specific abdominal traumas indicated the effective adaptation of the medical system. Prioritizing critical cases and deferring non-urgent procedures optimized limited resources. Demographic and clinical factors—including age, sex, body mass index (BMI), and red cell distribution width (RDW)—significantly influenced the hospitalization duration and recovery outcomes. Gender disparities in mortality lessened during the pandemic, possibly due to standardized interventions and the physiological effects of SARS-CoV-2. The link between occupation and obesity highlighted how work environments impact trauma severity, especially as lifestyle changes affect BMI. While age remained a major predictor of mortality, its influence slightly decreased, potentially due to improved protocols for elderly patients. RDW emerged as an important prognostic marker for disease severity and mortality risk. Conclusions: Employing advanced co-occurrence analysis enhanced with machine learning, we uncovered complex relationships between clinical and demographic variables often overlooked by traditional methods. This innovative approach provided deeper insights into the collective impact of various factors on patient outcomes. Our findings demonstrate the healthcare system's rapid adaptations during the pandemic and offer critical insights for optimizing medical strategies and developing personalized interventions in global crises. [ABSTRACT FROM AUTHOR]

Background Veterans transitioning to civilian life often have chronic pain from service-related musculoskeletal disorders (MSD) with higher risk for substance misuse. Many seek VA (Department of Veterans Affairs) compensation for MSD. Use of Screening, Brief Intervention, and Referral to Treatment for Pain Management (SBIRT-PM) by VA Post-9/11 Military2VA (M2VA) case managers presents an opportunity to engage these veterans in VA pain care and address substance misuse. Implementation facilitation might help case managers use SBIRT-PM and engage veterans in services to improve outcomes. Design This study is a 2-cohort multisite cluster-randomized hybrid type 2 effectiveness-implementation trial. Within 2 separate cohorts of 14 VA sites each, sites will be allocated to receive an implementation strategy through the use of a constrained randomization procedure: virtual implementation facilitation or training-as-usual. Sites and M2VA case managers will receive the assigned implementation strategy to support use of SBIRT-PM. Recently discharged veterans (n  = 1848) claiming service-connected MSD will be recruited, with case managers blind to veterans' study enrollment. The proportion of participants who receive any SBIRT-PM will be the primary implementation outcome. Veteran participants will complete baseline, 12-week, and 36-week assessments, irrespective of whether case managers conduct SBIRT-PM with them (intent-to-treat). Pain intensity and interference will be the primary clinical outcomes. The study emphasizes pragmatic over explanatory methodological features. Summary This pragmatic trial will examine implementation facilitation versus training-as-usual in implementing SBIRT-PM to promote veteran engagement in nonpharmacological pain services. Using innovative methods to train and support VA case managers in SBIRT-PM, study outcomes could have broad implications for case management systems of care across the VA. [ABSTRACT FROM AUTHOR]

Mental health has become increasingly important for the applied sport psychologist, a factor which may include screening, promoting literacy, individual support, and educational programs. However, despite of this importance, few checks have been made on the perceived preparedness of sport psychologists to undertake this work and whether differences may exist between those recently qualified compared to experienced practitioners. Underpinned by the theoretical domains framework, 62 Health and Care Professions Council registered practitioner sport and exercise psychologists (30 females: age: M = 46.13 years and SD = 10.44 years and 32 males: age: M = 43.25 years and SD = 10.47 years) completed an online survey to assess whether they felt equipped to address the mental health dimension of their work. The survey comprised three sections: Demographic and background information, a series of statements (n = 31) adapted from the determinants of implementation behavior questionnaire, and three questions with space for free text comments, inviting participants to explain their level of preparedness to incorporate and deliver mental health interventions. A 6 × 12 analyses of variance yielded significant differences between domain ratings but not across levels of experience or interactions. Data from free text comments were analyzed thematically and categorized into the following three themes: (a) complementing the performance role, (b) awareness of professional boundaries, and (c) importance of further continued professional development. Combined, although practitioners emphasized importance, preparedness ratings ranged from neutral to somewhat agree, calling for further specific sport psychology‐based mental health training. Highlights: An online survey, underpinned by the theoretical domains framework, was used to assess whether registered sport and exercise psychology practitioners in the United Kingdom felt prepared to undertake the mental health dimension of their work.Analysis through ANOVA yielded no significant differences across experience or interactions, suggesting that preparedness and implementation do not differ regardless of whether recently qualified or experienced practitioners. Furthermore, average ratings across all domains revealed practitioners feel only "somewhat prepared" to address client needs in this area.Free text comments provided additional insight to levels of preparedness where practitioners noted the frequent necessity to offer mental health support, why it complements the performance focus, and how they are uniquely placed to understand the specific contextual demands, yet were cognizant of their competencies, knowledge base, and boundaries.Calls for further specific sport psychology‐based mental health training are warranted by the professional bodies in the United Kingdom to ensure practitioners feel equipped to address this increasingly important factor of their work. [ABSTRACT FROM AUTHOR]

Background: Psychotherapeutic interventions play a crucial role in alleviating psychological distress and promoting resilience during personal and global crises. Objective: What general principles are relevant for psychotherapeutic crisis interventions in acute psychiatry? What contributes to an in-depth understanding of individual reactions to the course of crises? When do global crises translate into personal crises? How can global crises be integrated into the psychotherapeutic process? Material and methods: Selected results from the scientific literature on psychiatric psychotherapeutic crisis interventions in acute psychiatry are reviewed and summarized. Results: Although the evidence for specific crisis intervention strategies in acute psychiatry is limited, general principles for psychotherapeutic crisis interventions can be derived. Conclusion: Understanding early relational experiences based on psychodynamic or learning theory processes influences the application of further crisis intervention techniques and their impact on affected individuals. [ABSTRACT FROM AUTHOR]

The article suggests partnership and cooperation between mental health clinicians and law enforcement to prevent mental illness. Topics include role of Crisis Intervention Team (CIT programs) in preparing officers to assist individuals experiencing a mental health crisis, way psychiatrists and mental health clinicians can improve crisis response within their communities, and the use of the Sequential Intercept Model to address the overrepresentation of individuals with serious mental illness.