Mental Health Services for Adults With Intellectual Disabilities: A Qualitative Study of Patient Characteristics, Associated Factors and Consequent Needs for Adaptation in Assessment and Treatment.

BACKGROUND: Individuals with intellectual disabilities are at increased risk of mental health disorders, but may struggle to access appropriate services. While assessment/treatment may need to be adapted, knowledge is limited about what such adaptations may entail. METHOD: During a service development project, the participants (33 professionals, 13 family members) were asked to identify the characteristics/associated factors of individuals with intellectual disabilities and co-occurring mental health disorders. Using thematic analysis, 1103 participant responses were analyzed to identify the needs for adaptation in assessment/treatment. RESULTS: Three core themes were identified: (1) A broader assessment: Gaining an accurate and comprehensive understanding of the individual's history, abilities and difficulties, (2) Adjusting/modifying existing treatment strategies, (3) Ensuring that the individual's day-to-day needs are met. CONCLUSIONS: According to the participants, assessment/treatment of mental health disorder in this population requires more time and broader assessments are necessary. Family/caregiver involvement and cross-service organisation/collaboration represent other important adaptations.

Preferences Regarding Information Strategies for Digital Mental Health Interventions Among Medical Students: Discrete Choice Experiment.

BACKGROUND: Digital mental health interventions (DMHIs) are capable of closing gaps in the prevention and therapy of common mental disorders. Despite their proven effectiveness and approval for prescription, use rates remain low. The reasons include a lack of familiarity and knowledge as well as lasting concerns. Medical students were shown to have a comparatively higher risk for common mental disorders and are thus an important target group for raising awareness about DMHIs. At best, knowledge is already imparted during medical school using context-sensitive information strategies. Yet, little is known about medical students' information preferences regarding DMHIs. OBJECTIVE: This study aims to explore information preferences for DMHIs for personal use among medical students in Germany. METHODS: A discrete choice experiment was conducted, which was developed using an exploratory sequential mixed methods research approach. In total, 5 attributes (ie, source, delivery mode, timing, recommendation, and quality criteria), each with 3 to 4 levels, were identified using formative research. Data were analyzed using logistic regression models to estimate preference weights and the relative importance of attributes. To identify subgroups of students varying in information preferences, we additionally performed a latent class analysis. RESULTS: Of 309 participants, 231 (74.8%) with reliable data were included in the main analysis (women: 217/309, 70.2%; age: mean 24.1, SD 4.0 y). Overall, the conditional logit model revealed that medical students preferred to receive information about DMHIs from the student council and favored being informed via social media early (ie, during their preclinic phase or their freshman week). Recommendations from other students or health professionals were preferred over recommendations from other users or no recommendations at all. Information about the scientific evidence base was the preferred quality criterion. Overall, the timing of information was the most relevant attribute (32.6%). Latent class analysis revealed 2 distinct subgroups. Class 1 preferred to receive extensive information about DMHIs in a seminar, while class 2 wanted to be informed digitally (via email or social media) and as early as possible in their studies. CONCLUSIONS: Medical students reported specific needs and preferences regarding DMHI information provided in medical school. Overall, the timing of information (early in medical education) was considered more important than the information source or delivery mode, which should be prioritized by decision makers (eg, members of faculties of medicine, universities, and ministries of education). Study findings suggest general and subgroup-specific information strategies, which could be implemented in a stepped approach. Easily accessible digital information may promote students' interest in DMHIs in the first step that might lead to further information-seeking behavior and the attendance of seminars about DMHIs in the second step.

Comprehensive synthesis of mHealth interventions in psychiatry: insights from systematic, scoping, narrative reviews and content analysis.

INTRODUCTION: Mobile health (mHealth) technologies, including smartphone apps and wearables, have improved health care by providing innovative solutions for monitoring, education and treatment, particularly in mental health. METHOD: This review synthesises findings from a series of reviews on mHealth interventions in psychiatry. Publications were systematically searched in PubMed, MEDLINE, PsycINFO, ScienceDirect, Scopus, Web of Science and Cochrane Library. RESULTS: Out of 2147 records, 111 studies from 2014 to 2024 focusing on anxiety and depression were included. These studies highlight the effectiveness of mHealth interventions in reducing symptoms through cognitive-behavioural therapy, mindfulness and psychoeducation, benefitting adolescents, perinatal women and marginalised groups. Additionally, mHealth shows promise in managing substance use disorders and severe mental illnesses like schizophrenia, bipolar disorder and psychosis. CONCLUSION: Despite positive outcomes, challenges such as data privacy, user engagement and healthcare integration persist. Further robust trials and evidence-based research are needed to validate the efficacy of mHealth technologies.

The notion and practice of psychotherapy in Polish psychiatry of the interwar period. Part 1. / Pojecie i praktyka psychoterapii w polskiej psychiatrii dwudziestolecia miedzywojennego. Czesc 1.

The paper explores the development of psychotherapy in Polish psychiatry in the interwar period from the perspective of Kurt Danziger's historical psychology. Firstly, the organizational and social context of the development of Polish psychiatric care in the interwar period and its impact on the development of psychotherapy is outlined. Then, the most influential in Poland, European psychotherapeutic developments in the interwar period are reconstructed. Finally, the views of psychiatric personnel of three psychiatric facilities proposing psychotherapy as one of the main means of treatment of mentally ill patients are introduced: Dziekanka Psychiatric Hospital, the Jewish Hospital in Warsaw and Psychiatry and Neuropathology Clinic of the Jagiellonian University in Krakow. Psychiatric personnel from Dziekanka Psychiatric Hospital, directed by Aleksander Piotrowski, understood psychotherapy broadly, as the influence of the environment on the patient's psyche. Psychiatrists of the Jewish Hospital in Warsaw, Adam Wizel, Gustaw Bychowski, Wladyslaw Matecki, and Maurycy Bornsztajn developed psychoanalytically influenced psychotherapy of schizophrenia. Bychowski also advocated for the application of psychotherapy in such neglected groups of patients as children and the intellectually disabled. Jan Piltz and Eugeniusz Artwinski pursued psychotherapy in the treatment of war neuroses at the Psychiatry and Neuropathology Clinic of the Jagiellonian University.

POLISH PSYCHIATRIC ASSOCIATION BOARD INFORMATION regarding Latuda and Rxulti reimbursement description of indications POLISH PSYCHIATRIC ASSOCIATION BOARD INFORMATION regarding Brintellix reimbursement description of indications. / KOMUNIKATY ZARZADU POLSKIEGO TOWARZYSTWA PSYCHIATRYCZNEGO Stanowisko Polskiego Towarzystwa Psychiatrycznego w sprawie opisu wskazan do refundacji leków Latuda oraz Rxulti Stanowisko Polskiego Towarzystwa Psychiatrycznego w sprawie opisu wskazan do refundacji leku Brintellix.

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The notion and practice of psychotherapy in Polish psychiatry of the interwar period. Part 2. / Pojecie i praktyka psychoterapii w polskiej psychiatrii dwudziestolecia miedzywojennego. Czesc 2.

The paper further explores the development of psychotherapy in Polish psychiatry in the interwar period. Jaroszynski attempted to sketch out the idea of "emotional psychotherapy". Stryjenski organized a counseling clinic for the mentally ill, using psychotherapy as one of the means of treatment. Bilikiewicz developed oneiroanalysis - a psychotherapeutic method of dream analysis based on modifications of psychoanalysis. Gottliebowa advocated for the use of psychoanalytically influenced psychotherapy in the gynaecologist practice. Markuszewicz considered psychoanalysis the only psychotherapeutic modality aimed at unearthing the real causes of mental illnesses. Henryk Higier proposed to consider psychoanalysis practically as a method of psychotherapy and saw its heterogeneity as its advantage. Critical views on psychoanalysis as a psychotherapeutic method were delivered by Wirszubski and Mikulski. In general, psychotherapy in Polish psychiatry of the interwar period was highly influenced by psychoanalysis. Moreover, the understanding and practice of psychotherapy in public psychiatric facilities differed from that in private practice. In public psychiatric facilities, it was used mainly to deal with psychoses, so it urged clinicians to modify the classic psychoanalytic approach. In private practice, psychiatrists were dealing mainly with cases of neuroses and therefore could apply standard psychoanalytic procedures. Methods of suggestion, persuasion and hypnosis, characteristic of nineteenth-century psychotherapy, were still in use in Polish psychiatry of the interwar period. The main obstacles to the development of Polish psychotherapy in the interwar period were antisemitic attitudes contributing to hostility towards psychoanalysis, as well as the biological orientation of the majority of the Polish psychiatric society.

Brave New Psychiatry: Culture of Empathy and Mental Health for All.

Psychiatry has the historical opportunity to shape the future of mental health care, medicine, and society. The term New Brave Psychiatry refers to challenges to psychiatry in our volatile, uncertain, complex and ambiguous (VUCA) world. The present and the future of psychiatry lie on the recognizing these challenges and resolving them. Transdisciplinary multiperspective integrative view on psychiatry (TIP) involving creative, person-centered narrative psychopharmacotherapy (CP-CNP) and empathization-based cognitive-emotional-behavioral therapy (EB-CEBT) as an art and practice of the empathic learning organization are presented in this article as well as the culture of empathy as a cornerstone of good clinical practice and mental health. We should all be driven by the vision of psychiatry and other mental health disciplines for a better world and promotion of mental health for all as a part of the Global Enlightenment 2.0 for Sustainability of the Earth System.

Epistemic Trust: a Keyword for Contemporary Clinical Practice and Psychopathology.

The increasing integration of eclectic knowledge from fields not directly related to clinical psychology is coherent with a current tendency to employ alternative ideas to investigate psychopathology in the light of a more phenomenological perspective. The concept of epistemic trust may provide the gateway to alternative causal models for personality psychopathology that links poor mentalizing environment to a more general lack of social support. People who have been denied the ability to trust the information circulating in their more proximate environment may showcase a remarkable disadvantage in terms of social adjustment that relate to early insecure attachment experiences. Research assumes that patients who have been suffering an epistemic deficient environment in infancy could be trapped into a vicious cycle of suffering, loneliness and inability to seek or accept help. Although most contributes cited in this brief article deal with epistemic trust as potential tool for social learning from a theoretical point of view, the recent introduction of systematic measures of epistemic trust as a dimensional personality variable outlines a likely future increase in the use of new questionnaires and protocols for clinical assessment and treatment monitoring expressively focused on epistemic trust. The benefits of adopting such a holistic etiological paradigm in personality pathology are outlined, as proposed by the many works that advocate a more equitable clinical practice that assume individual development in the context of an unequal social world, that is believed to determine the child's evolutionary trajectory from the very first stages of life. In the same vein, the importance of fostering an authentic relationship of trust between patient and therapist as a fundamental element of the therapeutic alliance, as well as a driving force for salutogenesis at the community level, is vividly highlighted.

Management Strategies for Psychiatric Emergencies in a Community Setting. The Role of the Crisis Team at the Trento Mental Health Centre.

The Mental Health Service of Trento has consistently adopted a community-based, recovery-oriented approach. Adhering to these paradigms, and aiming to facilitate an intervention centred on the individual and their needs within their familial and social context, it is imperative to ensure a prompt and effective response to crises at the community level. Psychiatric emergencies present a significant challenge for health systems globally. Timely and appropriate management of these crises is crucial to prevent negative short and long-term outcomes. Providing such management in an extra-hospital setting, adaptable to the situational needs, can enable the individual to better achieve their recovery goals. Trento, with its dedicated Crisis service and the active involvement of Peer Support Specialists ("ESP" in italian), exemplifies how an integrated, multidisciplinary territorial approach that values the role of the socio-family context can enhance the outcomes of acute psychopathological crises and user engagement. This article discusses the organisation, advantages, and challenges compared to intra-hospital management, and the impact this intervention can have on public stigma regarding mental health.

"New" Psychiatric Emergencies Between Hospital and Territory. Survey Results on the Innovative Protocol Between the Emergency Department and Mental Health Center in Trento.

In 2022, psychiatric condition-related admissions constituted 3.2 per cent of all emergency room admissions in Italy, according to the Ministry of Health's latest mental health report. Psychiatric crises are an increasingly significant portion of emergency department (ED) visits nationwide, with around 1 in 8 visits involving mental health and substance use disorders. Patients facing psychiatric emergencies tend to experience longer lengths of stay and boarding times in the ED, along with higher admission rates compared to those with other medical conditions. Extended boarding times for psychiatric patients in the ED increase their vulnerability to adverse events, such as medication errors, the use of restraints, and assaults. Moreover, the prolonged boarding of psychiatric patients contributes to ED overcrowding, which negatively impacts all ED patients, leading to increased morbidity and mortality due to delays in treatment and preventable errors. One of the most effective strategies to counteract this phenomenon has been the choice of directing psychiatric emergencies that are deferrable or compatible with a territorial crisis management from the Trent ED to the Mental Health Center in the territory. This option, promoted through the application of experimental procedures that are currently in the process of being definitively ratified as official company procedures, has, first and foremost, numerous advantages for psychiatric users, who are received in less medicalized settings that are more attentive to the relational and psychological component, while still having suitable medical and nursing equipment. It also fosters continuity of care with the territorial therapeutic network, allows early interception of situations that are promptly taken care of by the territorial specialist center, and more easily offers treatment alternatives to hospitalization. This approach allows for the optimal utilisation of resources and expertise available at Mental Health Centres within the community, thereby preventing the overcrowding of hospital emergency departments.

Mental Health Literacy Interventions in Young People: a Narrative Review.

INTRODUCTION: Health literacy is defined as the "ability to obtain, process and understand basic health information and to access health services in order to make informed choices". The concept of Mental Health Literacy (MHL) has been introduced in recent years in order to promote mental health. MHL refers to knowledge and beliefs about mental disorders that facilitate their recognition, management, and prevention. A low level of MHL represents a fundamental barrier to seeking mental health care. METHODS: For this review we followed a narrative approach. Papers published between 2013 and 2024 were screened for inclusion. Only 24 articles met the inclusion criteria, all of them were included in the review. RESULTS: Among the 24 articles included, schools represented a particularly important context for interventions, as adolescents spend much of their time in school and school staff are often the point of reference for young people seeking help and advice. School-based interventions aimed at improving MHL and reducing stigma have the potential to prevent mental disorders and promote mental well-being, ultimately reducing their health, social, and economic burden. CONCLUSIONS: Schools are a key setting for mental health interventions, given the significant time adolescents spend there and their reliance on school staff for support. Enhancing MHL and reducing stigma through school-based programs can prevent mental disorders and promote well-being. Both live and digital interventions have shown effectiveness, though long-term impacts need more study.

The Safewards Model and I.R.O.N. Interventions in a No-Restraint Ward.

The psychiatry inpatient ward of Trento (SPDC: italian acronym for Servizio Psichiatrico di Diagnosi e Cura - i.e. Psychiatric Service for Diagnosis and Treatment) operates with an open-door policy, emphasising a recovery-oriented approach. The professionals are capable of adopting the patient's perspective as a "person" rather than seeing them as a "patient", allowing them the freedom and responsibility to make decisions about their own lives. The SPDC of Trento is a no-restraint psychiatric ward, where relational restraint is prioritised, and patients' responsibility is maximised, avoiding, where possible, the use of physical restraint. In 2022, our SPDC introduced the so-called I.R.O.N. interventions (Italian: Interventi Relazionali prolungati ad Orientamento No restraint - no-restraint-oriented relational interventions). These interventions are used in situations of patient agitation to ease tension and resolve crises by employing methods that are both "gentle" and "iron" at the same time, highlighting the determination, patience, and 'relational time' required from the work team. At the end of the intervention, the strategies implemented are described in a register and later shared with the work team. At the end of the year, individuals who have demonstrated their commitment to supporting their colleagues will be awarded an "IRON parchment". A special "Talk Down Champion" parchment will be awarded to the person who manages to consistently maintain this style of work, always in agreement with the team and the safety of all (operators and patients).

Young adults, particularly young women, account for an increasingly large share of Dutch mental healthcare expenditure over the period between 2015 and 2021.

AIMS: There is increasing concern over the mental distress of youth in recent years, which may impact mental healthcare utilisation. Here we aim to examine temporal patterns of mental healthcare expenditures in the Netherlands by age and sex in the period between 2015 and 2021. METHODS: Comprehensive data from health insurers in the Netherlands at the 3-number postal code level were used for cluster weighted linear regressions to examine temporal patterns of mental healthcare expenditure by age group (18-34 vs 35-65). The same was done for medical specialist and general practitioner costs. Additionally, we examined interactions with gender, by adding the interaction between age, year and sex to the model. RESULTS: Mental healthcare costs for younger adults (18-34) were higher than those for older adults (35-65) at all time points (ß = 0.22, 95%-CI = 0.19; 0.25). Furthermore there was an increase in the strength of the association between younger age and mental healthcare costs from ß = 0.22 (95%-CI = 0.19; 0.25) in 2015 to ß = 0.37 (95%-CI = 0.35; 0.40) in 2021 (p < 0.0001) and this was most evident in women (p < 0.0001). Younger age was associated with lower general practitioner costs at all time points, but this association weakened over time. Younger age was also associated with lower medical specialist costs, which did not weaken over time. CONCLUSIONS: Young adults, particularly young women, account for an increasing share of mental healthcare expenditure in the Netherlands. This suggests that mental distress in young people is increasingly met by a response from the medical system. To mitigate this trend a public mental health approach is needed.

Measuring fidelity to manualised peer support for people with severe mental health conditions: development and psychometric evaluation of the UPSIDES fidelity scale.

BACKGROUND: Peer support workers provide support for people experiencing mental health conditions based on their own lived experience of mental health problems. Assessing fidelity to core ingredients of peer support is vital for successful implementation and intervention delivery. Modifications to its implementation are needed when scaling up to different socio-economic settings, raising further uncertainty about fidelity. As part of a large multi-centre study on peer support called Using Peer Support In Developing Empowering Mental Health Services (UPSIDES), we developed and evaluated the psychometric properties of the UPSIDES Fidelity Scale. METHODS: We constructed the fidelity scale based on an initial item pool developed through international expert consultation and iterative feedback. Scale refinement involved site-level expert consultation and translation, resulting in a service user-rated 28-item version and a peer support worker-rated 21-item version assessing receipt, engagement, enactment, competence, communication and peer support-specific components. Both versions are available in six languages: English, German, Luganda, Kiswahili, Hebrew and Gujarati. The scale was then evaluated at six study sites across five countries, with peer support workers and their clients completing their respective ratings four and eight months after initial peer support worker contact. Psychometric evaluation included analysis of internal consistency, construct validity and criterion validity. RESULTS: For the 315 participants, item statistics showed a skewed distribution of fidelity values but no restriction of range. Internal consistency was adequate (range α = 0.675 to 0.969) for total scores and all subscales in both versions. Confirmatory factor analysis indicated acceptable fit of the proposed factor structure for the service user version (χ2/df = 2.746; RMSEA = 0.084) and moderate fit for the peer support worker version (χ2/df = 3.087; RMSEA = 0.093). Both versions showed significant correlations with external criteria: number of peer support sessions; perceived recovery orientation of the intervention; and severity of illness. CONCLUSIONS: The scale demonstrates good reliability, construct and criterion validity, making it a pragmatic and psychometrically acceptable measure for assessing fidelity to a manualised peer support worker intervention. Recommendations for use, along with research and practical implications, are addressed. As validated, multi-lingual tool that adapts to diverse settings this scale is uniquely positioned for global application. TRIAL REGISTRATION: ISRCTN, ISRCTN26008944. Registered on 30 October 2019.