Mental Health Services Research Articles

A systematic review of training for mainstream mental health professionals working with people with intellectual disabilities and mental health needs

Purpose Policy in the UK and many other countries states that mainstream mental health services should be accessible to people with intellectual disabilities (ID). The purpose of this paper is to systematically review training and development needs assessments and delivered training and development for professionals working in mainstream mental health services who may work with people with IQ. Design/methodology/approach A systematic search of four databases (Web of Science; PsychInfo; PubMed; CINAHL) over the period of 2011–2023 was used. Papers were included if they described training or development delivered to, or specific training or development needs analyses of, mainstream qualified staff to support working with adults who have an ID. Findings Two papers were found that described training and development initiatives and six that described training and development needs analysis, five of these papers originated from Australia and were part of the development of a comprehensive workforce competency framework. Research limitations/implications Training and development approaches for mainstream mental health services to facilitate the support of people with IQ should be systematically developed and trialled. Originality/value To the best of the authors’ knowledge, this is the first study to review training and training needs analysis in this area since 2012. The review finds only a small number of papers in what is an important area for service development.

Service and Treatment Factors as Predictors of Satisfaction with Mental Health Services Among Service Users with Psychosis.

Satisfaction with services among service users is an important aspect of quality in mental health care. This prospective study investigated associations between service and treatment factors at baseline and satisfaction with services at 18-month follow-up among service users with psychosis in specialist mental health services. Data were collected from 119 service users with psychosis and their clinicians from 26 clinical sites across Norway at baseline and after 18 months. Satisfaction with services was measured using the Client Satisfaction Questionnaire-8 (CSQ-8). Linear mixed models with random intercepts for units were estimated to test the association between service- and treatment-related predictors and the CSQ-8. Participating in the Individual Placement and Support program or other interventions to promote work or study, receiving well-coordinated services, and receiving helpful assistance from a general practitioner at baseline were positively associated with satisfaction with services at 18-month follow-up. The present results suggest that receiving integrated and well-coordinated services and targeting the goal of facilitating employment and study opportunities is important for satisfaction with services among service users with psychosis.

Designing recovery-oriented care: a qualitative study to inform service design at Kyrie Therapeutic Farm in Ireland.

Recovery-oriented approaches are gaining increased attention in the mental health sector, including from the World Health Organization and the United Nations, for their potential to support people in recovering and building meaningful lives through strengths-based, person-centered principles. Kyrie Therapeutic Farm (KTF) is a new initiative in Ireland that seeks to develop recovery-oriented model of adult mental health care. The aim of this study was to explore the barriers and facilitators of recovery-oriented models of practice in a small number of therapeutic farm settings across the world in order to inform service design at KTF whilst also addressing a gap in research on this topic. Three semi-structured focus-group interviews were conducted online via MS Teams with ten staff members in different roles and years of experience from three existing therapeutic community farms. reflexive thematic analysis was employed for data analysis. Four themes emerged that illustrate how therapeutic farm communities operate in general and specifically in relation to recovery: 1. common humanity, 2. freedom and responsibility, 3. interdependence and community living, and 4. learning organisations. This study demonstrates the viability of recovery-oriented practices in community therapeutic farms, including KTF, thereby contributing to the broader trend toward more person-centered mental health services. The values inherent in the recovery-oriented approach - such as community, empowerment, and close, equitable, non-hierarchical relationships - act as facilitators. However, embedding these values in practice can generate tensions for staff which warrant attention. Implications for the integration into service design of KTF and further research are offered.

Experiences of Communities Living in Shelters During the 2022 Eastern Kentucky Floods.

On July 28, 2022, floods in eastern Kentucky displaced over 600 individuals. With the goal of understanding mental health needs of affected families, we surveyed households living in flood evacuation shelters after the 2022 Kentucky floods. Families experiencing displacement from the 2022 Kentucky floods currently living in three different temporary shelter locations were surveyed via convenience sampling. A rapid community needs assessment involving in-person interviews using modified two stage cluster methodology (CASPER) was conducted between September 6-9, 2022. Teams conducted 61 household interviews. Since the flood, 27.7% reported that their household received services from behavioral health and 19.6% received grief counseling. Experiencing agitation (36.7%), difficulty concentrating (47.5%), nightmares (62.3%), or suicidal thoughts/self-harm (6.6%) were reported by households surveyed. Over one-fourth (27.0%) of individuals surveyed reported being depressed nearly every day. Over 20% reported anhedonia (inability to feel pleasure) nearly every day. Over 75% of individuals surveyed reported being anxious several days or more over the last two weeks. Over one-third of individuals (34.0%) reported being unable to stop worrying nearly every day. Of those individuals surveyed, 36.1% reported barriers to mental health services. Symptoms of depressed mood, anhedonia, anxiety, and nightmares were prevalent in displaced families six weeks after the 2022 Kentucky floods. Providing and encouraging access to mental health services are important priorities during disaster recovery.

Health Insurance Payment for Telehealth Services: Scoping Review and Narrative Synthesis.

As telehealth services have demonstrated significant advantages in providing qualified and accessible care, health insurance payments for telehealth services have been issued by various countries. However, the optimization of health insurance payments for telehealth services remains uncertain. We conducted a scoping review of the current situation regarding health insurance payments for telehealth services, with the aim of providing evidence to enhance policies related to health insurance payments for such services. This scoping review was conducted by comprehensively retrieving data from 6 electronic bibliographic databases from inception to October 2023. The databases included China National Knowledge Infrastructure, Wan Fang, Weipu, Web of Science, PubMed, and Embase, following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Two authors independently assessed search results, extracted data, and evaluated the quality of the included studies using the Critical Appraisal Skills Programme checklist. After the initial screening of titles and abstracts, full texts were obtained and examined. The data regarding the first author, date of publication, country, type of telehealth services introduced in health insurance, health insurance reimbursement providers, reimbursement standards for telehealth (eg, the condition for the reimbursement and reimbursement rate), and key findings of studies were extracted and analyzed. Moreover, we also conducted a narrative synthesis to summarize and report the findings. A total of 7232 papers were retrieved. Following quality assessment, 23 papers were finally included, with the covered countries including China, the United States, Australia, France, Japan, the United Kingdom, and Germany. The forms of the services vary across different regions, mainly including consultation services, medical monitoring services, mental health services, health education services, and other services. Payment standards are generally categorized into fee-for-service and global budget payment, with clear health insurance payment quotas or proportions and certain restrictions (eg, specifying the location of medical visits and setting the limitation on distance from home to hospitals). The paying entities for health insurance payment include national health insurance and commercial health insurance. In addition, there are 2 kinds of reimbursement rates-a comparable rate for both telehealth and in-person health care services, and a lower rate for telehealth services compared to in-person health care services. To enhance the accessibility of telehealth services through health insurance payment, it is crucial to further refine the design of health insurance payment for telehealth and strengthen the supervision of services quality, bridging the gap between telehealth and in-person health care services. Additionally, this review did not include studies from all countries, and we recommend that future reviews should include a broader range of countries to provide a more comprehensive view of global telehealth insurance systems.

What’s the Matter? Alcohol Use Risk Among Relatives of People with Mental Illness

Family members who live with relatives with serious mental illness face unique mental health risks, which become worse with alcohol use and without social support. Research has highlighted the damaging effects of harmful substance use among people who feel like they do not matter to others, but few studies have assessed links between mattering and alcohol use within marginalized populations. In the present study, a sample of family members who reside with a relative with mental illness completed an online survey. Using the AUDIT alcohol screening measure, participants were classified into a No–Low Risk Alcohol Use (n = 52) or a Hazardous Drinking (n = 28) group. Hazardous alcohol use was alarmingly high, reaching triple the rate of the general population and categorized at the most severe level of harm. Those who drank hazardously felt like they mattered less to others (p < 0.001), felt like they mattered less to their relative with mental illness (p = 0.035), had greater anti-mattering (e.g., they felt invisible and unheard) (p = 0.008), experienced more hopelessness (p < 0.001), felt less supported by significant others (p = 0.003), endorsed having more problems with mental health services (p = 0.017), had higher stigma (p < 0.001), and had lower psychological well-being (p < 0.001). Findings highlight under-recognized public health risks, implications for public health initiatives, and the need for tailored interventions that boost mattering and reduce harmful alcohol use in this vulnerable family member population.

Brief Video-Delivered Intervention to Reduce Anxiety and Improve Functioning in Older Veterans: Pilot Randomized Controlled Trial.

Older veterans with anxiety disorders encounter multiple barriers to receiving mental health services, including transportation difficulties, physical limitations, and limited access to providers trained to work with older persons. To address both accessibility and the shortage of available providers, evidence-based treatments that can be delivered via guided self-management modalities are a potential solution. This study aims to determine the feasibility and acceptability of a randomized controlled trial of 2 guided self-management interventions. This study compared the treatment effects of these 2 interventions (relaxation and health psychoeducation) on anxiety symptom severity and functioning in older veterans with anxiety disorders. Our exploratory aims examined factors related to home practices and treatment engagement and perceptions of the practices. Participants were randomized to one of two video-delivered interventions: (1) Breathing, Relaxation, and Education for Anxiety Treatment in the Home Environment (BREATHE)-breathing and progressive relaxation or (2) Healthy Living for Reduced Anxiety-psychoeducation about lifestyle changes. Telephone coaching calls were conducted weekly. Measures of anxiety, depression, and functioning were obtained at baseline, week 4 (end of treatment), week 8, and week 12. Participants completed a semistructured interview at week 12. Analyses included descriptive statistics to summarize measures of intervention engagement; mixed-effects models to characterize symptom change, and qualitative analyses. Overall, 56 participants (n=48, 86% men; n=23, 41% from ethnic or racial minority groups; mean age 71.36, SD 6.19 y) were randomized. No difference in retention between study arms was found. The Healthy Living group (29/56, 52%) completed significantly more lessons (mean 3.68, SD 0.86) than the BREATHE group (27/56, 48%; mean 2.85, SD 1.43; t53=2.60; P=.01) but did not differ in completion of coaching calls. In the BREATHE group, greater baseline anxiety scores (r=-0.41; P=.03) and greater severity of medical comorbidity (r=-0.50; P=.009) were associated with fewer completed practices. There was no effect of intervention on change in total anxiety scores or functioning. For specific anxiety subtypes, Healthy Living produced a greater decline in somatic anxiety compared with BREATHE. Qualitative analyses found barriers to practicing, including difficulty setting time aside to practice, forgetting, or having other activities that interfered with BREATHE practices. Some participants described adapting their practice routine to fit their daily lives; some also used relaxation skills in everyday situations. These findings suggest that a larger randomized controlled trial of guided self-management approaches to treating late-life anxiety is feasible; however, BREATHE was not effective in reducing anxiety compared with Healthy Living. Possible contributing factors may have been the reliance on a single technique. Progressive relaxation was reported to be enjoyable for most participants, but maintaining home practices was challenging. Those with milder anxiety severity and fewer health problems were better able to adhere to practices. ClinicalTrials.gov NCT02400723; https://clinicaltrials.gov/study/NCT02400723.

Scoping Review of Naturalistic Decision Making Studies Among Mental Health Professionals: Coverage of Characteristics and Contexts

The Naturalistic Decision Making (NDM) paradigm is an emerging shift in how researchers study decision making in complex, real-world situations and design decision supports. The purpose of this scoping review was to describe how the NDM paradigm was applied in studies of mental health professionals. Six bibliographic databases were searched to identify NDM studies. Each study was charted for study features, participant demographics, decision contexts, and the essential characteristics of NDM research. The search identified 26 studies published from 1989 to June 2023. Approximately 35% of studies were published in a peer-reviewed journal. Quantitative (30.8%), qualitative (34.6%), and mixed (34.6%) methods were utilized in similar percentages of studies, with social workers (61.5%) most frequently represented in these studies. Approximately 69% of studies examined assessment decisions (versus diagnosis or treatment) and roughly 96% of studies examined individuals (versus teams). Most studies explored professionals’ decision making process (73.1%) and how proficient decision makers utilized their experience to make decisions (38.5%). The NDM literature among mental health professionals is growing, with many opportunities to understand clinical decision making using well-established NDM concepts and methods. The review concludes with recommendations for both NDM and mental health services researchers.

Community Participation in the Delivery of Mental Health Services in a Rural District in South India: Experiences from the STEP Program of SCARF

Community Participation in the Delivery of Mental Health Services in a Rural District in South India: Experiences from the STEP Program of SCARF

Balancing privacy and public health: The impact of South Africa's cannabis legalization

The Cannabis for Private Purposes Act, enacted in South Africa in 2024, marks a significant shift in national drug policy by legalizing private cannabis use while aiming to balance individual privacy rights with public health and safety. This paper examines the Act’s impacts on socioeconomic dynamics, public health, and crime within South Africa, a context shaped by poverty, inequality, and strained healthcare resources. The study highlights potential economic benefits, such as job creation and formal market opportunities, alongside risks, including increased pressure on mental health services and complex implications for crime and gender-based violence. Drawing from government reports, recent studies, and international case comparisons, the analysis reveals how legalization might reduce the burden on the criminal justice system while also introducing challenges in public safety and healthcare capacity. The findings emphasize the need for robust governance frameworks that prioritize health system preparedness, social protections, and crime prevention. The discussion provides targeted policy recommendations for government agencies, healthcare providers, and law enforcement, addressing the importance of public education, regulatory oversight, and mental health support. This study offers valuable insights into the nuanced consequences of cannabis legalization in an emerging economy, contributing to global discussions on drug policy. By aligning policy with the realities of public health and safety, South Africa can leverage the potential benefits of legalization while mitigating its social costs.

Biden‐Harris administration releases resources to address trauma, gun violence impact

The Substance Abuse and Mental Health Services Administration (SAMHSA), announced Nov. 25 the release of resources intended to help communities address the trauma and mental health impacts of gun violence. These resources are part of additional executive actions announced by the Biden‐Harris administration in September to reduce gun violence and save lives, and part of the larger Biden Unity Agenda for the Nation, a U.S. Department of Health and Human Services (HHS) news release stated.

Exploring university staff experiences gained during COVID-19 in the provision of digital mental health services through e-health tools: A case of a selected South African University

The recent COVID-19 pandemic significantly exacerbated mental health issues worldwide, with South African university staff facing unique stressors that led to the adoption of e-health tools for digital mental health services. This study explores the university staff experiences gained during COVID-19 pandemic in the provision of digital mental health services through e-health tools. We conducted a case study at a public university in Cape Town, South Africa complemented by a survey using quantitative methods. Data from 348 respondents were collected via voluntary response sampling and analysed with Statistical Software Package for Social Sciences (SPSS) version 28, employing exploratory factor analysis. High factor loadings above 0.4 confirmed significant contributions from seven items: perceived usefulness of e-health tools, perceived usefulness of social media, user experience and satisfaction, university commitment, variety of digital mental health services, post-COVID-19 delivery mode preference and ethical considerations. These seven items revealed that during COVID-19, e-health tools provided significant benefits to university staff including increased access to digital mental services. However, the study findings revealed that university staff were concerned about the lack of a legal framework during COVID-19, and the role of AI-powered mental health applications did not significantly influence their experiences during the pandemic. Our study provides theoretical insights into the effectiveness and perceived usefulness of e-health tools for digital mental health services during COVID-19, reinforcing their significance in reducing anxiety, stress, and depression while enhancing emotional resilience. Practically, our study findings suggest that universities should integrate e-health tools into the provision of digital mental health services given that these tools proved effective during COVID-19.

Barriers to Mental Health Services Utilization

The use of health services is defined as the process of seeking professional healthcare and submitting oneself to the application of regular health services with the purpose to prevent or treat health problem .Person suffering from mental illness usually face different barriers . The problem of underutilization of mental health services may be due to: (1) barriers to initiation of mental health services and (2) barriers to persistence in treatment once it is sought. People with a number of unmet needs are likely to experience poor quality of life as well. Any mental health service that aims to improve the quality of life of patients’ needs to actively assess for these factors as early recognition can help in optimizing planning of treatment and implementation of care ensuring effectiveness of psychiatric care. It also plays a critical role in mental health rehabilitation Such an identification could lead to implementation of targeted stigma reduction strategies in addition to regular management plan. Methodology A cross sectional study was performed in Mental Hospital, Lalitpur, Nepal. People suffering from mental illness who fulfilled the inclusion criteria were recruited and BACE scale was administered along with relevant details of participants . Results Most of the participants were from Bagmati Province (65.1%, n=192) whereas least participation was from Sudurpaschim Province (2.1%, n=6). The mean age of participants was 35 years with majority belonging to the age group of 26-35 years (37.3%, n=109). The participation of males (54.5%, n=159) was greater than that of females (45.5%, n=133). The participation of divorced and widow/er was very less (2.4%, n=7) compared to those who were married (71.2%, n=208) or unmarried (26.4%, n=77). A vast majority were Hindus (77.4, n=226) followed by Buddhist (12%,N=35 and Christians (9.6%, n=28 ) and others (1%,n=3). Majority of the participants had completed their higher secondary (38.4%, n=112) and secondary (19.5%, n=57) education followed by no formal education (13.4%,n=39) and those with post graduate education and above (1.7% ,n=5). Regarding occupation, the number of unemployed (36.6%, n=107) was highest followed by service holders (17.8%, n=52), others (16.1%, n=47 ),farmer (15.8%,n=46) and business owners (13.7%, n=40) respectively. Socioeconomic status was measured using Kuppuswamy scale and it was found that most of the participants belonged to middle (63.4%, n=185) followed by upper (22.6%, n=66) and lower (14%, n=41) socioeconomic status. Among the patient reported barriers related to stigma ,the most reported concern was “ concerned that I might be seen as weak for having a mental health problem “(33.6 %),followed by “concern that I might be seen as crazy “ (26.4%) ,followed by “Concern that my children may be taken into care or that I may lose access or custody without my agreement “ (22.6%) and ” feeling embarrassed or ashamed “ (21.6 %) . Among the reported instrumental barriers in BACE scale , “having no one who could help me get professional care (18.2)“ was the most reported major barrier followed by “ being unsure where to get professional care “(17.8)“ followed by being too unwell to ask for help “ (14.4%). Among the different attitudinal components in BACE scale “wanting to solve problem on my own” (21.9%) was the most reported barrier followed by “dislikes of talking about my feelings, emotions or thought “(19.5%) and “thinking that I don’t have problem”(17.8%). Conclusion Thus, it can be concluded that people people suffering from mental illness also experience different barriers during help seeking . This barriers is found more on people below 45 years of age and people with low socio economic status . This barriers influences the quality of life in terms of decline in physical health and environment.

Perspectives of healthcare professionals on cross-sectoral collaboration between mental health centers and municipalities: A qualitative study.

This paper aims to explore the intricacies of cross-sectoral collaboration in mental health care, focusing on the perspectives of health professionals across various disciplines. It seeks to understand how collaboration can enhance service delivery and patient outcomes while identifying existing challenges. The evolving healthcare landscape emphasizes the importance of integrating services across sectors, particularly in mental health care, to improve continuity and efficiency of care. The study utilizes qualitative methods to investigate health professionals' experiences with cross-sectoral collaboration in mental health services. Purposive sampling was used to select 21 health professionals for focus group discussions held at a mental health center in Region Zealand, Denmark. Data was collected through these discussions, and content analysis was performed to extract key themes. The data collection took place in 2022. Health professionals recognized the potential benefits of cross-sectoral collaboration, such as enhanced service delivery and improved patient outcomes. However, significant barriers were identified, including bureaucratic obstacles, communication gaps, and insufficient organizational support. Cross-sectoral collaboration in mental health care offers significant advantages, but challenges must be addressed to fully realize its potential. Efforts should focus on policy reforms, organizational support, and fostering interdisciplinary communication to improve care delivery.

A Preliminary Investigation into the Use of Cannabis Suppositories and Online Mindful Compassion for Improving Sexual Function Among Women Following Gynaecological Cancer Treatment

Background and Objectives: The impact of gynaecological cancer and its treatments on sexual intimacy can be profound on female sexuality. However, very few registered clinical trials have addressed sexual intimacy among this cohort. Materials and Methods: This preliminary randomised control trial (RCT) and content analysis assessed the effectiveness of a brief online mindful compassion group intervention adjunct with cannabis suppositories. Eighty-three participants aged between 18 and 50+ years who were at least six months post-cancer treatment were randomly allocated to one of four groups, depending on whether they were already using cannabis suppositories. These included a cannabis-only group (CO), a mindful-compassion group (MC), a combined mindful-compassion and cannabis suppositories group (COCM) and a care-as-usual group (CAU). Measurements of sexual function, sexual self-efficacy, mindful compassion, well-being and quality of life were taken at weeks 0, 4 and 12. Results: Sexual function, including arousal, lubrication and orgasms, improved for both the MC p = 0.002 and COCM p ≤ 0.001 groups; in addition, sexual pain was reduced in the COCM p = 0.008 and CO p ≤ 0.001 groups compared to the CAU and MC groups, where p ≥ 0.05. Feedback suggested that cannabis mediated the effects of mindful compassion and supported well-being, sexual self-efficacy, and quality of life. Participants also voiced a preference for cannabis suppositories when using dilators as part of their treatment and the use of sex toys instead of dilators, suggesting that dilators had negatively impacted their sexuality. Conclusions: These preliminary and exploratory outcomes look promising and provide a foundation for future research to develop varied healthcare options to improve mental health service delivery and quality of life for this cohort.

Roles, responsibilities and role challenges of lived experience workers in a regional mental health service: a qualitative study

ABSTRACT Objective The purpose of this study is to determine the views of Lived Experience Workers (LEWs) and Mental Health Clinicians (MHCs) from a regional mental health service in Victoria on the perceived roles, responsibilities and role challenges of LEWs. Methods This was a qualitative study that employed one-to-one interviews with LEWs and MHCs from a regional hospital in Victoria, Australia. Data were analysed thematically. Results Eight participants were interviewed for the study (5 LEWs and 3 MHCs). Five categories emerged from the data. They were: Views of mental health clinicians on the roles and responsibilities of LEWs, Views of a Peer Support Worker (PSW) on their roles and responsibilities, Roles and responsibilities of Consumer Consultants, Views of a Carer Consultant on their roles and responsibilities, and LEW role challenges. Some key findings were: PSWs also helped close the communication gap between the clinician and the consumer and helped in the education of medical students; Consumer and carer consultants had more advisory and leadership roles in the organisation; LEW roles were not formalised by the organisation resulting in some confusion. Conclusion Standardisation of the roles of the lived experience workforce in Victorian mental health services will require larger studies.

A Qualitative Analysis of Trialogues Between People with Lived Experience, Their Relatives, and Mental Health Professionals.

Trialogue meetings, aligned with the Recovery model in mental healthcare, foster the development of a shared language and mutual understanding among persons with lived experience, their relatives, and professionals. This study analysed the first mental health trialogue experience in Barcelona, involving six meetings with thirteen voluntary participants over three months. Using qualitative methods for data collection and reflexive thematic analysis, three main themes emerged: Recovery process, Interaction with mental health services, and Trialogue dynamics. Benefits included open dialogues in a safe space, learning from diverse perspectives, and sharing expertise. The meetings created an environment of empathy and respect while promoting open communication. This approach holds substantial potential for transforming mental healthcare systems, suggesting trialogues can be an effective tool for enhancing communication within community-based mental health initiatives. The findings provide a comprehensive picture of the trialogue process, highlighting its potential to foster mutual understanding among participants.

Six Month Follow up of the one of the First Patients to Complete MDMA-Assisted Therapy for PTSD Outside of Clinical Trials in Australia: Implications for Translating Clinical Research to Clinical Practice

Purpose: The goal of this case report is to illustrate the implementation of 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy for posttraumatic stress disorder (PTSD) and learning points for health professionals in the translation of psychedelic assisted therapy research into clinical practice. We present our key learnings and 6-month follow up data from one of the first patients to complete MDMA-assisted therapy for PTSD outside of clinical trials, in an Australian outpatient clinic setting. Methodology: The patient described in this case report had chronic PTSD, depression and anxiety due to experiencing domestic violence, including sexual, physical, and psychological abuse in her adolescence. Treatment was informed by the Multidisciplinary Association of Psychedelic Studies (MAPS) MDMA-assisted therapy manual. After completing treatment, she enrolled in our weekly integration peer support group, including meditation workshops and family support sessions. Data was gathered using the Australian National University (ANU) Psychedelic-assisted therapy Australian national outcome database (https://medicine-psychology.anu.edu.au/research/research-projects/australian-interventional-pharmacotherapy-psychedelic-assisted-psychotherapy), which collates de-identified questionnaire data and outcomes from MDMA, psilocybin and ketamine assisted psychotherapy. Outcome data was gathered at baseline, the beginning of preparation, in the week after each dosing session, at the end of the program. Follow up data is collected at 3-, 6-, 9- and 12-months post-treatment. At the time of writing, she had completed 3 and 6 month follow up. Tables and figures are used to present the outcome data. Findings: Our patient no longer met DSM-V criteria for PTSD or major depressive disorder at the end of treatment, and at 6-month follow up. Her Impact of Events Scale – Revised (IES-R) score was 61 at intake, reduced to 0 after the second dosing session and remained 0 at 3 and 6-months follow up. There were no adverse events, with the only side effect reported being loss of appetite in the first 24 hours after each dosing session. All scores on depression and anxiety measures reduced to the normal ranges after the second dosing session and remained in the normal ranges at her six month follow up. After the second dosing session reported having greater self-compassion and being less troubled by the trauma memories. After the third dosing session, she began to feel comfortable leaving her children with their father or trusted family member to run errands for the first time, and an increased sense of connectedness with herself and with others. All these gains were maintained at three- and six-months post-treatment, illustrating a case of safe and effective implementation of MDMA-assisted therapy for PTSD in an outpatient mental health service. Unique Contribution to Theory, Practice and Policy: Our case study offers one model of clinical practice, contributing to Australian practitioner’s implementation of safe and effective MDMA-assisted therapy in mental health services. We reflect on learning points for practitioners such as whether MDMA or psilocybin would be the most effective treatment, for a patient with both PTSD and treatment resistant depression. Recommendations for practitioners include the importance of working in a dyad, accessing ongoing supervision in the early stages of implementation, and the benefits of the having had legal experience with psychedelic medicines as part of therapist training.

A Comparative Analysis of the Indian Lunacy Act 1912 and Pakistan's Mental Health Ordinance 2001

ABSTRACTThis study compares the Indian Lunacy Act (ILA) 1912 with the Mental Health Ordinance (MHO) 2001 to demonstrate the (dis)continuity of colonial practices in the context of postcolonial Pakistan. This analysis is informed by Foucauldian power/knowledge nexus making a unique contribution to the broader field of mental health policy. The discursive continuity of the colonial legacy involving the legal structures in the mental health system, where the state uses psychiatric knowledge to legitimize the detention of individuals, echoes the Foucauldian concept of the power/knowledge nexus. Scrutinizing the words used in both legislations, it has been understood that language is not neutral; rather it is suffused with meaning, creating knowledge and truths. This is seen through the offensive words used in the ILA 1912 that denote degradation, disdain, and contempt toward the “insane,” “dangerous,” and “lunatics.” Although MHO 2001 adopted a more neutral language, a continuation of the mechanism of control is seen during the admitting process, in which the opinions and statements of medical professionals play an important role. The marginalization of alternative mental health practices, in the form of indigenous and communal mental health practices in both mental health legislations, showcases the dominance of the biomedical model, enforcing a particular form of epistemic control. Nonetheless, the relative improvement of the MHO 2001, as opposed to the ILA 1912, has been seen in terms of the language used and the inclusion of community‐based mental health services.

Mental Health Care Needs and Access to Care for Adults With Intellectual Disabilities.

Adults with intellectual disabilities (IDs) are at greater risk for psychiatric disorders than the general population. Yet, they have limited access to mental health services. To examine the prevalence of psychiatric disorders in adults with ID. To describe evidence-based interventions for this population, their access to mental health care, and outline opportunities for improved access. This manuscript summarizes literature regarding psychiatric disorders in adults with ID and their access to behavioral health care. We considered articles referencing mental health care for adults with ID. PubMed and a variety of search terms were used. Studies published in English from 2010 to the date of the searches were included. Quantitative and qualitative study designs, review articles, program descriptions, and opinion papers were considered for inclusion. Additional references from the selected articles were also considered. We identified 2864 records. One hundred two records were included, consisting of work commenting on mental health and ID and access to care in the United States. The articles describe increased psychiatric comorbidities in adults with ID. They highlight the few evidence-based interventions for psychiatric comorbidities and the limited access to care. Our mental health care providers generally have minimal training and experience with people with ID, limiting access to appropriate care for these individuals. Improved access could be created by increasing education and experiences with these populations for mental health providers. Aligning policies, financing, and adequate insurance reimbursement to develop a continuum of care will be critical for these individuals.