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IntroductionMental health problems are common globally, and typically have their onset in adolescence and early adulthood—making youth (aged 11–25) an optimal target for prevention and early intervention efforts. While increasing numbers of youth mental health (YMH) initiatives are now underway, thus far few have been subject to economic evaluations. Here we describe an approach to determining the return on investment of YMH service transformation via the pan-Canadian ACCESS Open Minds (AOM) project, for which a key focus is on improving access to mental health care and reducing unmet need in community settings.ApproachAs a complex intervention package, it is hoped that the AOM transformation will: (i) enable early intervention through accessible, community-based services; (ii) shift care away toward these primary/community settings and away from acute hospital and emergency services; and (iii) offset at least some of the increased costs of primary care/community-based mental health services with reductions in the volume of more resource-intensive acute, emergency, hospital or specialist services utilized. Co-designed with three diverse sites that represent different Canadian contexts, a return on investment analysis will (separately at each site) compare the costs generated by the intervention, including volumes and expenditures associated with the AOM service transformation and any contemporaneous changes in acute, emergency, hospital or service utilization (vs. historical or parallel comparators). Available data from health system partners are being mobilized to assess these hypotheses.Anticipated resultsAcross urban, semi-urban and Indigenous sites, the additional costs of the AOM transformation and its implementation in community settings are expected to be at least partially offset by a reduction in the need for acute, emergency, hospital or specialist care.DiscussionComplex interventions such as AOM aim to shift care “upstream”: away from acute, emergency, hospital and specialist services and toward community-based programming which is more easily accessible, often more appropriate for early-stage presentations, and more resource-efficient. Carrying out economic evaluations of such interventions is challenging given the constraints of available data and health system organization. Nonetheless, such analyses can advance knowledge, strengthen stakeholder engagement, and further implementation of this public health priority.

Introduction: Early psychosis is a critical period for establishing long-term trajectories in mental health and other outcomes. Experiences of coercion, such as involuntary or forensic hospitalization early in the course of illness may initiate people in cycles of coercion, disengagement, and relapse. While there is substantial evidence on involuntary admission in early psychosis, it is unclear what is known regarding forensic mental health system contact in this population. Objective: The objective of this study is to scope the extent and type of evidence available around contact with forensic mental health services early in the course of psychotic illness. In particular, to identify whether there is evidence available on prevalence or incidence of contact with forensic mental health services, and associated risk factors and outcomes, within an early psychosis population. Inclusion criteria: Studies including early psychosis participants (within 5 years of psychosis onset) and forensic mental health service use in any context will be included. Methods: MEDLINE, EMBASE, CINAHL, and PsycINFO will be searched using keyword and subject heading searches (no language or date restrictions will be applied). Searches of dissertation and thesis databases (ProQuest Dissertations & Theses Global), and forward and backward citation searching of included studies will also be conducted. Two independent reviewers will screen each study for inclusion at each stage (title/abstract, full text). Data on participants, concept, and context, as well as key findings relevant to forensic mental health service use in early psychosis, will be charted by two independent reviewers using a piloted data extraction tool. Data will be presented in tabular form and narrative summaries will be drafted. Conclusions: Findings from this scoping review will identify knowledge gaps related to forensic mental health service use in early psychosis to inform future studies involving administrative health data. Introduction Early psychosis, referring to the two- to five-year period following a first psychotic episode, is considered a “critical period” for establishing long-term outcomes (Birchwood et al., 1998). This period represents an important opportunity for secondary prevention of impairments and disabilities associated with psychosis (Birchwood et al., 1998; Fusar-Poli et al., 2017). Early psychosis intervention services have been established worldwide to capitalize on this window of opportunity, with the aim of reducing treatment delays and providing comprehensive wraparound care to facilitate recovery in young people (McGorry et al., 2008). The advent of early intervention has led to an interest in pathways to care, and service use experiences that may impact care early in the course of illness. Psychiatric hospitalization, contact with emergency services, and coercive measures such as involuntary hospitalization, are common in early psychosis (Anderson et al., 2010). Meta-analytic evidence suggests that one in two people with early psychosis are hospitalized at least once (Ajnakina et al., 2020). A systematic review found that 22% to 62% of people with early psychosis experience involuntary hospitalization (Fainman-Adelman, 2020). Furthermore, people who are admitted involuntarily are more likely to experience seclusion or control interventions in hospital (Rodrigues et al., 2019). These coercive experiences can be distressing and traumatic to the point of developing posttraumatic stress disorder symptoms (Shaw et al., 2002). The type and quality of care received in early psychosis may have an impact on long-term trajectories (Harrison et al., 2001). Experiencing coercive interventions early in the course of psychotic illness may initiate people in a cycle of coercion, disengagement, and relapse (Compton, 2005; Morgan et al., 2004). While there is a substantial literature base on psychiatric hospitalization and involuntary admission in early psychosis, contact with the forensic mental health system is often overlooked. The “forensic mental health system” refers to the intersection of the mental health system and the criminal justice system (Bettridge & Barbaree, 2008). People entering the forensic mental health system include those who committed a crime and are found not guilty on the grounds of their mental illness, or are too unwell to stand trial, which often results in detention in a forensic hospital or ward (Bettridge & Barbaree, 2008). Forensic hospital populations may also include people who are transferred from general psychiatric units due to violent behaviour (Jones et al., 2010). Treatment received in the forensic mental health system may have considerable implications for experiences with services and outcomes. The aim of forensic psychiatric services is to balance treatment of people suffering from a mental disorder who have committed a crime, along with mitigating the risk to the public. As a result, people detained in forensic settings have more restrictions and intrusions on freedom than in general psychiatric services (Tomlin et al., 2018). People admitted to a forensic hospital also experience significantly more coercive events immediately and prior to admission, compared to people admitted to general psychiatry beds, such as being handcuffed and transferred to hospital by police (McKenna et al., 2003). Length of stay in a forensic hospital tends to be long, ranging from 1 year to 10 years on average across European countries (Tomlin et al., 2021), and may be inappropriately extended with some people getting “stuck” in the system (Sampson et al., 2016). In particular, people with psychotic disorders are more likely to experience longer lengths of stay relative to people without psychotic disorders (Crocker et al., 2015; Gosek et al., 2020, p. 202; Huband et al., 2018). Premature mortality, violent offending, and rehospitalization are prevalent outcomes following discharge from forensic hospital settings (Fazel et al., 2016). As well, forensic service users, encompassing people with both severe mental illness and criminal justice involvement, may be exposed to greater levels of social and structural stigma (Livingston et al., 2011). In early psychosis, forensic hospitalization may be a barrier to accessing early psychosis intervention services, as some services exclude people with forensic involvement (Edwards et al., 2019; Standards Implementation Steering Committee, 2015). Young people with early psychosis may be at high risk of contact with the forensic mental health services. People with psychotic disorders account for most forensic admissions, as high as 80% in Canada (Chaimowitz et al., 2022) and New Zealand (Geheran et al., 2022). Contact with the criminal justice system in early psychosis is high, with Canadian data showing half of people with early psychosis having police contact on the pathway to care (Anderson et al., 2015), which may result in a forensic hospitalization. Early psychosis is a high-risk time for violence (Large & Nielssen, 2011) and homicide (Nielssen & Large, 2010), suggesting that this period may also be a high-risk time for contact with the forensic mental health system. Furthermore, evidence from Denmark suggests that as many as one in five people have a history of offending prior to their first psychiatric contact for psychotic disorder (Stevens et al., 2012) – a risk factor for violence (Large & Nielssen, 2011) and forensic mental health system contact (Chaimowitz et al., 2022). While there has been reductions in the availability of psychiatric hospital beds internationally, a number of countries, including Canada, the United States, and countries in Western Europe, have reported an increased demand for forensic mental health services in recent years (Jansman-Hart et al., 2011). In particular, Canadian data note that the growth in forensic mental health service users can be attributed to people who are younger, abuse substances, are of diverse ethno-racial backgrounds, and have committed low-level violent offences (Penney et al., 2019). This growth may suggest that more people with early psychosis are in contact with forensic mental health services. While it is clear that involvement in the forensic mental health system may have a substantial impact on outcomes in early psychosis, and this may also be a high-risk time for forensic hospitalization, there is limited evidence available on this topic. Data on forensic mental health service use in this population may be included in some studies on pathways to care in early psychosis (Fusar-Poli et al., 2020), however, this type of contact is not commonly reported. It is unclear what evidence is available regarding forensic mental health service use in early psychosis, including basic epidemiological data on prevalence and risk factors, as well as the clinical needs and outcomes of forensic patients with early psychosis. Thus, there is a need to identify and synthsize the available evidence on this topic in order to inform future studies. Given the scant literature on this topic, a scoping review is the most appropriate approach to gather information on the available evidence, rather than a systematic review. A preliminary search of MEDLINE, the Cochrane Database of Systematic Reviews, PROSPERO and JBI Evidence Synthesis was conducted and no in progress systematic reviews or scoping reviews on the topic were identified. The objective of this study is to scope the extent and type of evidence available around contact with forensic mental health services in an early psychosis population. In particular, this study aims to identify whether there is evidence available on prevalence or incidence of contact with forensic mental health services, and associated risk factors and outcomes, within an early psychosis population. Review Question What evidence is available around forensic mental health service use in people with early psychosis? Sub-questions: - What evidence is available on the prevalence or incidence of contact with forensic mental health services in early psychosis? - What evidence is available on the risk factors for forensic mental health service use in early psychosis? - What evidence is available on outcomes associated with forensic mental health service use in early psychosis?

BACKGROUND: International evidence on the frequency of mood or anxiety disorders among migrant groups is highly variable, as it is dependent on the time since migration and the socio-political context of the host country. Our objective was to estimate trends in the prevalence of diagnosed mood or anxiety disorders among recent (Canada) and settled (5-10 years in Canada) migrant groups, relative to the general population of Ontario, Canada. METHODS: We used a repeated cross-sectional design consisting of four cross-sections spanning 5 years each, constructed using health administrative databases from 1995 to 2015. We included all Ontario residents between the ages of 16 and 64 years. We assessed differences in the prevalence of mood or anxiety disorders adjusting for age, sex, and neighbourhood-level income. We further evaluated the impact of migrant class and region of birth. RESULTS: The prevalence of mood or anxiety disorders was lower among recent (weighted mean = 4.10%; 95% confidence interval [CI], 3.59% to 4.60%) and settled (weighted mean = 4.77%; 95% CI, 3.94% to 5.61%) migrant groups, relative to the general population (weighted mean = 7.39%; 95% CI, 6.83% to 7.94%). Prevalence estimates varied greatly by region of birth and migrant class. We found variation in prevalence estimates over time, with refugee groups having the largest increases between 1995 and 2015. CONCLUSIONS: Our findings highlight the complexity of mood and anxiety disorders among migrant groups, and that not all groups share the same risk profile. These results can be used to help inform health service allocation and the development of supportive programs for specific migrant groups.

O presente estudo teve como objetivo investigar níveis de conteúdo musical implícitos nos procedimentos de ensino de dois eminentes professores de piano em uma aula inicial. O delineamento de pesquisa envolveu dois estudos multicascos, com abordagem mista (qualitativa e quantitativa). Nesse contexto, a interação de dois eminentes professores de piano da região sul do Brasil com seus respectivos alunos foi estudada em profundidade. As técnicas de pesquisas empregadas foram: (i) observação do registro das duas primeiras aulas, com obra ainda não trabalhada, com dois alunos do bacharelado em piano (um aluno de cada professor); e (ii) entrevista com os alunos logo após a aula recebida. A etapa qualitativa envolveu a identificação e a interpretação categórica dos comportamentos, assim como a identificação e o estabelecimento das nuances de conteúdos musicais empregados ao longo das duas aulas de piano. O procedimento quantitativo foi utilizado para mensurar mais objetivamente tais comportamentos e conteúdos musicais identificados; estatísticas descritivas e inferenciais foram utilizadas. No ensino dos dois eminentes professores investigados foram estabelecidos e categorizados três grandes procedimentos (processo de deliberação, correção e sugestão) que compreenderam as seguintes ações subsidiárias: demonstração, reforço, ajuste, suporte, feedback, exercício, desdobramento, delimitação, questionamento, testagem e sondagem. As ações vinculadas aos alunos em situação de aula de instrumento foram identificadas da seguinte forma: simulação de performance, tentativa, ensaio, autorregulação, demonstração espelho e oposta. Além disso, foram identificados quatro níveis ou dimensões de abordagem do conteúdo musical no ensino destes professores: Nível 1 – Básico Técnico Motor; Nível 2 – Técnico Expressivo Básico; Nível 3 – Idiomático Interpretativo; e Nível 4 – Simbólico/Referencial. Os procedimentos identificados nas duas aulas estudadas em profundidade parecerem ter sido utilizados para que os alunos pudessem estabelecer relações entre os quatro níveis de conteúdos musicais estabelecidos, de modo a ampliar seu escopo de conhecimentos musicais e performáticos sobre a obra em estudo. Isso reforça a ideia de que os conteúdos musicais se mostram intrínsecos aos comportamentos, pois depende destes para que haja seu aprimoramento. O presente estudo propõe, portanto, um modelo, com potenciais procedimentos e ações, sustentadas pelos níveis de conteúdos musicais, o que poderá auxiliar potenciais reflexões de professores de instrumentos, tanto na questão de autopercepção de seu modo de ensinar quanto em ser estudado em investigações futuras. The present study aimed at investigating levels of musical content implicit in the teaching procedures of two eminent piano teachers during an initial class. The research design involved two multi-case studies in a mixed approach (qualitative and quantitative). Thus, the interaction of two eminent piano teachers from the South of Brazil with their respective students was studied in depth. The employed research techniques were: (i) observation of the registration of the first two pieces not yet worked with the two students (bachelor's degree in piano - one student from each teacher); (ii) interview with the students, right after the class received. The qualitative stage involved the identification and categorical interpretation of behaviors as well as the identification and establishment of the nuances of musical content used throughout the two piano classes. The quantitative procedure was used aiming at an objective measurement of these behaviors and musical contents identified there. Descriptive and inferential statistics were used. In the teaching of the two investigated eminent teachers, three major procedures (deliberation process, correction and suggestion) were established and categorized, which comprised the following subsidiary actions: Demonstration, reinforcement, adjustment, support, feedback, exercise, deployment, delimitation, questioning, testing and probing. The following procedures were identified as actions linked to students in an instrument class situation: Performance simulation, attempt, rehearsal, self-regulation, demonstration (named mirror and opposite). In addition, 4 musical content levels in these teachers teaching were identified, namely: Level 1 - Basic Motor Technician, Level 2 - Basic Expressive Technician, Level 3 - Interpretive Language and Level 4 – Symbolic/Referencial. The procedures identified in the two classes studied in depth seem to have been used so that students could establish relationships between the four levels of musical content established to expand their scope of musical and performance knowledge about the work under study. This reinforces the idea that musical content is intrinsic to behaviors, since it depends on them for their improvement. The present study proposes a model, with potential procedures and actions, supported by the levels of musical content, which may assist potential reflections of instrument teachers, both in terms of self-perception of their teaching, as well as being studied in future investigations.

Supplemental material, sj-docx-1-cpa-10.1177_07067437211047226 for Examining Variations in the Prevalence of Diagnosed Mood or Anxiety Disorders Among Migrant Groups in Ontario, 1995���2015: A Population-Based, Repeated Cross-Sectional Study by Jordan Edwards, Maria Chiu, Rebecca Rodrigues, Amardeep Thind, Saverio Stranges and Kelly K. Anderson in The Canadian Journal of Psychiatry

Supplemental material, sj-docx-4-cpa-10.1177_07067437211047226 for Examining Variations in the Prevalence of Diagnosed Mood or Anxiety Disorders Among Migrant Groups in Ontario, 1995���2015: A Population-Based, Repeated Cross-Sectional Study by Jordan Edwards, Maria Chiu, Rebecca Rodrigues, Amardeep Thind, Saverio Stranges and Kelly K. Anderson in The Canadian Journal of Psychiatry

Supplemental material, sj-docx-3-cpa-10.1177_07067437211047226 for Examining Variations in the Prevalence of Diagnosed Mood or Anxiety Disorders Among Migrant Groups in Ontario, 1995���2015: A Population-Based, Repeated Cross-Sectional Study by Jordan Edwards, Maria Chiu, Rebecca Rodrigues, Amardeep Thind, Saverio Stranges and Kelly K. Anderson in The Canadian Journal of Psychiatry

Supplemental material, sj-docx-2-cpa-10.1177_07067437211047226 for Examining Variations in the Prevalence of Diagnosed Mood or Anxiety Disorders Among Migrant Groups in Ontario, 1995���2015: A Population-Based, Repeated Cross-Sectional Study by Jordan Edwards, Maria Chiu, Rebecca Rodrigues, Amardeep Thind, Saverio Stranges and Kelly K. Anderson in The Canadian Journal of Psychiatry

BackgroundThe family physician is key to facilitating access to psychiatric treatment for young people with first-episode psychosis, and this involvement can reduce aversive events in pathways to care. Those who seek help from primary care tend to have longer intervals to psychiatric care, and some people receive ongoing psychiatric treatment from the family physician.AimsOur objective is to understand the role of the family physician in help-seeking, recognition and ongoing management of first-episode psychosis.MethodWe will use a mixed-methods approach, incorporating health administrative data, electronic medical records (EMRs) and qualitative methodologies to study the role of the family physician at three points on the pathway to care. First, help-seeking: we will use health administrative data to examine access to a family physician and patterns of primary care use preceding the first diagnosis of psychosis; second, recognition: we will identify first-onset cases of psychosis in health administrative data, and look back at linked EMRs from primary care to define a risk profile for undetected cases; and third, management: we will examine service provision to identified patients through EMR data, including patterns of contacts, prescriptions and referrals to specialised care. We will then conduct qualitative interviews and focus groups with key stakeholders to better understand the trends observed in the quantitative data.DiscussionThese findings will provide an in-depth description of first-episode psychosis in primary care, informing strategies to build linkages between family physicians and psychiatric services to improve transitions of care during the crucial early stages of psychosis.Declaration of interestNone.

Four of Guarnieri’s Ponteios for piano (numbers 11, 31, 36, and 41) bearing the expressive indication of sadness were prepared by a pianist and performed live before audiences of graduate and undergraduate students (N = 63) or students belonging to a university music theory and perception extension course (N = 65). Two emotional terms were chosen by the interpreter that better described his/her conception of sadness in the piece. Categorical and prototype models were selected for guiding the selection of these terms. No strong correlation could be found between the intended terms and the emotions assigned by the listeners of both groups. Sound wave profile analysis and interpretative choices by the interpreter were employed to classify the assigned emotions in terms of the bidimensional categorical model of emotion, i.e., arousal polarized (flow of the events) and valence polarized (intensity of the signal). Interviews with the music students (N = 7), who were participants in the first data collection step, revealed a good perception of the intended expressive resources manipulated by the interpreter. Differences in timing highlighting (or not), dynamic contrast levels and the presence or not of a climax were shown to be characteristics that contributed to these distinctions into two groups: those bearing the composer’s indication of Triste (Sad) – Ponteios 11 and 21; and those bearing the indication of Tristemente (Sadly) – Ponteios 36 and 41, with the latter provoking relatively higher (more negative) arousal and valence.