Mental Health System Research Articles

2.M. Scientific session: Economics of Mental Health in the interplay between health systems and public health

Abstract Mental health systems and services are essential components of the public health infrastructure, serving as frontline for prevention and intervention for health overall. Despite this, access to mental health services remains largely inadequate, with the OECD calculating that only about one in three people with mental health problems has access to quality treatment across 19 EU Member States. The economics of mental health play an important role in determining the allocation of resources, the accessibility of services and the overall effectiveness of interventions. Effective planning requires an understanding of population needs, service gaps and utilization patterns, in order to ensure equity and health improvement. In fact, the conceptualisation of the economic dimensions of mental health enables policymakers, practitioners, and stakeholders to make informed decisions that optimize resource utilization and maximize societal benefits. The proposed workshop will build on previous activities of the EUPHA Section on Public Health Economics at EPH, including the recent establishment of a working group on the economics of mental health. The aim of the meeting is to promote the adoption of best practices and methodologies in the conduct of economic studies on mental health. As such, the workshop will provide an opportunity to discuss the unique challenges of economic evaluation in this field and to present relevant ongoing activities by members of the Section and other invited experts. Key messages • Mental health, its distribution and at-risk populations influence resource allocation and policy decisions within mental health systems. • Tackling inequalities in mental health is essential for promoting health equity and social justice, requiring evidence-based interventions and policy initiatives to empower marginalized communities.

Making it real: Actioning the mental health strategy with Pacific Island communities.

This paper explores the practical implications of the World Health Organization strategy of focussing on community-based mental health and wellbeing ecosystems in the context of the Pacific Island Countries. It draws on the expertise of the participants of a collaborative workshop held during the Creating Futures conference in 2023 to discuss successes, challenges, barriers, opportunities in the implementation of the framework and to examine potential future actions. Some of the significant factors that make for effective and sustained community-based mental health systems include appropriate central coordination and oversight of community-based services, adequate frameworks for quality assurance, meaningful data collection and sustained long-term funding, as well as a range of workforce factors. Flexible and place-based approaches also need to be considered in effective implementation, moving away from Western diagnostic 'labels' to communication that is effective at the local level. Positive community resources as well as the relative youth of the mental health sector in the Pacific Island Nations are huge opportunities to develop affective and appropriate community mental health systems.

The relationship between mental health and employment: a systematic review of cohort studies

Abstract Background Knowledge on the bi-directional association between employment status and mental health is important, as it affects multiple dimensions of our daily lives, both at the individual and societal level. Given that the mental health status and employment situation of individuals are likely to change over time, there is an important need for longitudinal data to better understand causality patterns in this association and the underlying mechanisms. Methods A systematic review was carried out based on the PRISMA guidelines in 3 electronic databases: PubMed, Embase, and PsycInfo. Studies eligible for inclusion were cohort studies, involving the general population, and assessing the relationship between employment status and mental health longitudinally. Results In total, 3,733 studies were identified and 36 met the inclusion criteria. The eleven studies focusing on the social causation hypothesis highlighted the negative long-term impact of unemployment and unstable employment on mental health. Four studies observed mental health improvements upon re-entering employment, although limited and in more specific contexts. The fourteen studies focusing on the health selection hypothesis found a lower probability for individuals with mental health problems in finding and maintaining employment. Finally, the eleven studies assessing the two hypothesis simultaneously found that mental health problems were both a consequence of and risk factor for poor employment status, although some important moderating factors, such as gender differences, influence the direction and strength of the association. Conclusions This review underscores the bi-directional association between the employment status and mental health of individuals, highlighting the need to develop targeted prevention (e.g. mental health support in the workplace) and interventions strategies (e.g. supported employment programs) in both the mental health and labor market systems. Key messages • The bidirectional link between employment and mental health highlights the need for concurrent responses to break the vicious cycle between poor mental health and social exclusion. • To reduce the clinical and social burden of mental health problems, gender differences must be taken into account in mental health and employment support practices and policies.

6.M. Scientific session: Risk And Resilience Factors Of Mental Health During COVID: European Multi-country Data Findings

Abstract The COVID-19 pandemic significantly affected mental health. It worsened the mental health and well-being of those already vulnerable or exposed to excess pandemic-related stress. In addition, lockdowns and other measures created additional obstacles to mental health support access. In response, the European Commission funded the RESPOND project in 2020, aimed at enhancing the preparedness of mental health systems for pandemics and global crises. As part of the RESPOND project, (meta-)analyses were conducted on prospective cohort datasets, national health register data, and multi-country individual participant data (IPD). The aim was to examine whether there was a change in prevalence rates of mental health conditions (e.g., anxiety and depression) in the general adult population of the EU during, compared to before and in between, the COVID-19 pandemic waves. Analyses on risk factors (e.g. sociodemographic- and economic factors, severity of COVID-19 infection, (lack of) social activity and support, and loneliness) associated with psychological distress and mental disorders as well as resilience and well-being (coping strategies and core value orientations) in the general population or specific vulnerable groups were conducted as well. This workshop will feature five talks covering various aspects of the RESPOND epidemiological analyses. First, an introduction and rationale of the RESPOND study on short- and long-term impacts of the COVID-19 pandemic and outbreak response, will be provided. Subsequently, findings from the multi-country longitudinal COvid MEntal healTh Survey (COMET) on forecasting psychological distress throughout the pandemic will be presented. Second, findings from the French TEMPO (Trajectoires EpideMiologiques en POpulation) cohort and merged datasets will be presented indicating associations and interactions between socioeconomic factors, mental health, and public health behaviours during the pandemic. Third, using data of a large Belgian prospective cohort, fluctuations in risk of psychological distress across study waves and the factors associated with individual trajectories of psychological distress during the COVID-19 pandemic will be presented. Fourth, the risk of SARS-CoV-2 infection, severe COVID-19 outcomes, and death among individuals with various mental disorders, based on Spanish health records, will be presented with specific attention to sex differences. Finally, based on the IPD meta-analyses of 9 European cohorts, findings on stressor reactivity, resilience trajectories, and factors associated with resilient outcomes and vulnerability are presented. By presenting a selection of findings from large datasets together, we aim to facilitate discussions on critical topics such as vulnerability and resilience to mitigate mental health impacts in future public health crises. Key messages • Targeting specific individual vulnerabilities appears to be more effective in reducing the pandemics’ mental health impact than solely responding to pandemic-related fluctuations. • Research and harmonised data on vulnerability and resilience factors are essential for guiding the development of targeted interventions and support systems for vulnerable populations during crises.

10.M. Scientific session: JA ImpleMENTAL Abstract Workshop

Abstract JA ImpleMENTAL is major initiative across Europe and was initiated on the request of Member States, on October 2021 under the European Union 3rd Health Programme. The workshop is organized by JA ImpleMENTAL in partnership with EUPHA Mental Health Section, a member of the JA ImpleMENTAL Stakeholder Forum. It will include four presentations that will contribute to an interesting discussion about the future of community mental health services that are user-centered, recovery-oriented and human rights based as well as about the synergies with national strategies and the EU Initiatives. Vasileia Konte the JA ImpleMENTAL Coordinator will provide an overview of the Mental Health System Reforms based on the Belgian Best Practice model, which is implemented in 11 countries. It will elaborate on key activities and prioritized key areas of mental health system transformation as well as enablers, barriers and key lessons learned from the implementation process. Danijela Štimac Grbić from Croatia will present the Croatian experience in the implementation of a mobile rehabilitation team for providing psychosocial interventions in the community in which peer workers are employed for the first time. Based on the successful work of the mobile team, Croatia has included 30 new mobile teams in its network of public health services that will operate throughout Croatia. Teresa Nicolas Lopez from Murcia Spain will present the project “Inclusive Life Projects” which offers comprehensive community care to adults with severe mental illness within projects of autonomous living and provides a concrete and real response to their needs, with the ultimate objective of avoiding the risk of institutionalization. Anna Paradesioti from Cyprus will focus on how to achieve a smooth transition from inpatient to community mental health services promoting collaboration among those services and professionals, by adopting an intersectoral approach. Jutta Lindert will provide valuable comments by bringing helpful insights and views of the Stakeholder Forum. Key messages • Transformation towards community based care increase availability and efficiency of services. • User’s centered human rights based recovery approach care with engaging stakeholders including people with lived experience.

Implementing mental health quality practices for vulnerable populations in five EU countries

Abstract Issue Mental ill-health has been a leading cause of disability in Europe for many years, with the COVID-19 pandemic increasing incidences of both poor mental health and mental disorders. Vulnerable groups such as children, migrants, individuals with existing mental health issues, and healthcare workers are particularly affected but often lack tailored mental health support. Description of the problem The MENTALITY project aims to alleviate mental health distress worsened by the COVID-19 pandemic focusing on vulnerable groups. It also involves developing capacity-building tools and disseminating research results to increase awareness and knowledge sharing. Five EU countries are currently piloting four distinct good practices to address mental health issues among vulnerable populations. Specifically, Poland is aiming to support migrants (including Ukrainian and Spanish-speaking populations), Latvia is focusing on the healthcare workforce, and Romania and Slovakia are concentrating on users and community services. Meanwhile, Greece and Slovakia are implementing initiatives for children. The implementation phase began in January 2024 with a duration of 6 months. Results By consulting with relevant stakeholders, a Situation Analysis and Needs Assessment framework has been conducted, allowing for informed decisions regarding the elements to be pilot. Partners have developed country specific piloting plans and external evaluators are leading a common framework for monitoring and evaluation, ensuring regular assessment of the project’s progress. Lessons The innovative MENTALITY project aspires to enhance community-based mental health systems and promote improved mental health services across EU Member States during crises by adopting a preventative approach. Preliminary results show that the initiatives within the project were much needed and have already begun to demonstrate promising outcomes in addressing mental health challenges at both individual and community levels. Key messages • The MENTALITY project aims to address mental health distress of vulnerable populations in times of crisis. • The project seeks to advance equality in health and social rights for all individuals living in the EU.

JA ImpleMENTAL Implementing the Belgian Best Practice on Community Mental Health system Reform

Abstract Mental health challenges affect more than one in six people across the EU. In order to support Member States to proceed with mental health care system transformation and suicide prevention JA ImpleMENTAL, was initiated on the request of Member States, on October 2021 under the European Union 3rd Health Program. The JA consists of 39 organizations from 21 countries, more than 180 persons are working. Two advisory bodies support the consortium and provide their insights and expertise, a stakeholder forum with 10 key European Organizations in Mental Health including EUPHA Mental Health Section and WHO Europe and OECD, and the Member State Policy Committee which ensures the involvement of ministries and enables the practices to be embedded in health systems. Within the 11 countries implementing pilots under the Belgium model using a common Implementation Strategy, a total 163 activities are implemented under the 5 following key areas: 62 on structural measures needed for the establishment of local networks promoting a user’s centered, human’s right based recovery approach, 43 for the development and/or transformation of mental health services, 22 on training & capacity building in support of the reform and cultural change, 22 on continuous communication, information and awareness raising, and 13 on data collection, monitoring and evaluation. An analysis of MS pilot action plans shows that most service transformation efforts have concentrated on: defining care pathways for people at risk and for those with mild to severe mental health conditions including smooth transition from child and adolescent to Adult Mental Health services, as well as from inpatient to community services, the nomination of case managers for assisting individuals to their recovery process the development of individual service plans, the Involvement of users in various layers of service delivery including peer support and the provision of assertive treatment through mobile units.

AUMENTO DO USO DE ANSIOLÍTICOS APÓS A PANDEMIA – REVISÃO DA LITERATURA

Introduction: Anxiety disorders are significant areas of research due to the high incidence of anxiety being diagnosed in the population, leading to temporary or permanent disability. Investigations conducted on the mental health of Brazilian residents during the COVID-19 outbreak indicate an increase in diagnoses of anxiety, depression, and stress. The deterioration of mental well-being was influenced by multiple factors, including the absence of proper funeral ceremonies, the escalation of unemployment, and the decline in financial capacity, which heightened tension and anguish among those needing a source of income to support their families. This scenario significantly contributed to the increase in the use of anxiolytics, as many individuals resorted to these medications as a form of immediate relief for the symptoms of anxiety and stress exacerbated by the pandemic, highlighting the need for a broader and more integrated approach to mental health treatment in the current context. Objectives: To analyze the increase in the use of anxiolytics after the COVID-19 pandemic and its implications for public health. Methodology: This study is structured as a literature review, aiming to compile and analyze existing information on the topic. Additionally, the research is exploratory and descriptive, with the objective of mapping existing knowledge on the subject and outlining its nuances. The platforms Scielo, Portal de Periódicos CAPES, and Medline were used. The period considered was from 2018 to 2023, with texts fully available online, in Portuguese. Results: The results indicate a significant increase in the use of anxiolytics during and after the COVID-19 pandemic, especially among more vulnerable groups, such as the elderly and people with pre-existing health conditions. The use of medications like Alprazolam increased by 35% in 2020, reflecting the intensification of anxiety in the population. Conclusion: The pandemic exposed the fragility of mental health systems, highlighting the need for public policies that combine pharmacological treatment with continuous support. Future research is essential to monitor the long-term effects of anxiolytic use in the post-pandemic period.

Choice Matters: The Moderating Effect of Choice on the Relationship Between Mental Health Personal Recovery and Symptomatology

PurposeLimited research examines how choice surrounding treatment impacts mental health recovery among young adults with serious mental illness (SMI) who are navigating symptom management, complex mental health systems, and developmental expectations of increased independence. This study examines whether perceived choice related to mental health treatment impacts the relationship between symptomatology and personal recovery among Black, Latino/e, and multiracial young adults with SMI. MethodsSurveys were conducted with 121 young adults with SMI attending a community-based personal recovery-oriented program. Data included covariates (demographics and social support), psychiatric symptomatology, personal recovery, and choice. Ordinary least squares regressions tested whether choice predicts symptomatology and personal recovery, and whether choice moderates the relationship between symptomatology and personal recovery. ResultsMost participants were Black, Latino/e, or multiracial (96%) and male (67%) with an SMI diagnosis receiving services through Medicaid. Holding demographics and social support constant, a strong sense of choice was positively associated with personal recovery, (χ2 (7, N = 112) = 17.5, p = .01), but not symptomatology (χ2 (7, N = 112) = 12.5, p = .09). Furthermore, perceived choice moderated the relationship between symptomatology and personal recovery (β = −0.48, 95% CI [-0.79, −0.17], p = .012), where the association between symptomatology and personal recovery ceased to exist at lower levels of perceived choice in treatment. DiscussionThis study suggests perceived choice can influence the relationship between symptomatology and personal recovery among Black, Latino/e, and multiracial young adults with SMI. Implications for clinical practice include further evidence for enhancing shared decision-making and transition-focused care for young adults of color.

26 Culturally informed developmental paediatric care: A qualitative study

Abstract Background Paediatricians provide developmental care through developmental surveillance, identification and management of specific developmental disorders, and health advocacy. Despite being one of the most common reasons to visit a paediatrician, the provision of care in this field is challenging as it intersects with medical, mental health, and educational systems. Additionally, the rise of international migration, inequities in health systems, and unique culturally based concepts of child development require paediatricians to have unique skills for culturally informed care provision in this area. Objectives A qualitative study was conducted to describe the perceptions of paediatricians on providing culturally informed developmental paediatric care to diverse populations. Design/Methods Semi-structured interviews were completed with paediatricians who primarily provide developmental care to understand the challenges, opportunities, and potential educational enhancements to improve culturally informed care for developmental paediatrics. Thematic analysis was used to analyze the transcribed interviews using inductive and deductive approaches. Results Three major themes emerged from 18 individual semi-structured interviews. The first theme, “cultural translation,” described language differences, interpretation, and trust-building between discordant physician/family dyads. The second theme, “inequity,” described systemic barriers that diverse populations experience, power distance in healthcare relationships, and pandemic-related amplifications of inequity. The third theme, “educational opportunities,” highlighted reflective practice opportunities, immersive experiences in diverse settings, and building a community of practice for paediatricians to build their knowledge base. Paediatricians practicing developmental paediatric care highlighted unique elements to the practice which may benefit from practice changes and curricular reform. Integration of meaningful training in the use of interpretation services, multicultural health brokers, and care coordination teams is a recommended intervention which is transferable to many disciplines. Peer-mentorship from colleagues of differing cultural backgrounds may help reduce race-based stereotypes and enhance perspective taking. Conclusion Paediatricians had a variety of perspectives on the provision of developmental paediatric care to diverse populations within Canada. There were a range of perceived opportunities for improvements in care noted on individual and systems levels. The development of infrastructure to build capacity in culturally informed developmental paediatric care to reduce culturally based health gaps is a needed future direction for developmental paediatrics.

Evaluating Pakistan’s mental healthcare system using World Health Organization’s assessment instrument for mental health system (WHO-AIMS)

BackgroundPakistan faces profound mental health challenges, which necessitate the urgent need for a comprehensive assessment of its mental healthcare system. A holistic understanding of the mental health landscape is essential to identify strengths, weaknesses, and existing gaps within the system, which can inform targeted interventions and policy enhancements to improve mental healthcare accessibility.ObjectiveThe primary objective of this desk research is to conduct an in-depth analysis of Pakistan’s mental healthcare system across various dimensions, guided by the World Health Organization’s Assessment Tool for Mental Health Systems (WHO-AIMS).MethodsData for this desk research and scoping was obtained through desk research, including an examination of existing policies and legislation and consultations with various health facilities across Pakistan. This comprehensive analysis focused on six critical domains within the WHO-AIMS framework: policy and legislation, mental health services, integration of mental health into primary care, public awareness and collaboration with other sectors, human resources, and monitoring and research initiatives.ResultsThe findings provides a snapshot of strength and opportunities for improvement in Pakistan’s mental healthcare system that can serve as the foundation for revising and updating national priorities. Key areas of focus include enhancing policy and legislation, expanding access to mental health services, improving existing initiatives for better integration of mental health into primary care, improving public awareness and sector collaboration, addressing human resource challenges, and strengthening monitoring and research initiatives.ConclusionThis desk research provides a roadmap for refining and enhancing Pakistan’s mental health ecosystem and informs the prioritization of mental health campaigning efforts.

A process study of early achievements and challenges in countries engaged with the WHO Special Initiative for Mental Health

BackgroundThere is increasing awareness of the importance of the transformation of mental health systems. Launched in 2019, the WHO Special Initiative for Mental Health seeks to accelerate access to quality and affordable care for mental health conditions as an integral component of Universal Health Coverage. Nine countries are currently engaged with the initiative.MethodsThis study reviewed processes of implementation—and progress achieved—across all settings by late 2022. It involved review of 158 documents provided by WHO relating to Special Initiative activities and 42 interviews with country-level stakeholders, WHO Regional and HQ personnel engaged with the initiative, and core donors. Documents were thematically coded using a template based upon the WHO framework of health system building blocks. Responses to structured interviews were coded based on an emergent thematic framework.ResultsDocumentation reported similar achievements across all domains; however challenges were reported most frequently in relation to service delivery, leadership and governance, and workforce. Issues of financing were notable in being twice as likely to be reported as a challenge than a success. Interviews indicated four major areas of perceived achievement: establishing a platform and profile to address mental health issues; convening a multi-stakeholder, participatory engagement process; new, appropriate services being developed; and key developments in law, policy, or governance around mental health. The planning process followed for the initiative, senior country-level buy-in and the quality of key personnel were the factors considered most influential in driving progress. Ambivalent political commitment and competing priorities were the most frequently cited challenges across all interviewees.ConclusionsThe role of the Special Initiative in raising the profile of mental health on national agendas through a participatory and inclusive process has been widely valued, and there are indications of the beginnings of transformational shifts in mental health services. To secure these benefits, findings suggest three strategic priorities: increasing political prioritisation and funding for systems-level change; clearly articulating sustainable, transformed models of care; and promoting feasible and contextualised measures to support accountability and course correction. All are of potential relevance in informing global strategies for mental health systems transformation in other settings.

Meta-analysis reveals low language capacity in childhood is associated with mental health problems in adulthood.

Children and adolescents with language problems have poorer mental health compared with their non-language impaired peers. Less is known about mental health in adults with a history of language problems. This paper presents a systematic review and meta-analysis that addresses this gap in the literature. Specifically, it summarisesthe results from studies examining anxiety and depression in adults (aged 18 years and over) who were identified with language impairments or problems earlier in development. Five electronic databases (PsycINFO, ERIC, CINAHL, EMBASE and PubMed) were searched for studies comparing anxiety and/or depression in a sample of adults with and without a history of language problems. Nine studies were found that met the inclusion criteria. From each, an odds ratio (OR) was computed measuring the relationship between childhood language problems and anxiety or depression in adulthood. The OR was computed so values > 1 which indicated anxiety/depression were associated with a history of language problems. ORs were averaged using multilevel random effects meta-analysis. Averaging the study's findings across both anxiety and depression outcomes, we found that a history of childhood language problems was associated with poorer mental health in adulthood (OR = 1.79, p = 0.004). The association for anxiety was also significant (OR = 1.80, p = 0.012) and close to statistical significance for depression (OR = 1.60, p = 0.054). This review reveals that adults with a history of language problems are more likely to experience poorer mental health outcomes compared with controls. These findings demonstrate childhood language problems affect not only communication but also mental health and well-being in the long term. What is already known on the subject Prior research examining mental health in children and adolescents with language problems reveals a twofold increased risk of internalisingproblems, including anxiety and depression. However, little is known about mental health outcomes in adults with a history of language problems. What this paper adds to the existing knowledge The main finding was that childhood language problems are associated with increased risk of anxiety and depression in adulthood. What are the practical and clinical implications of this work? First, the study demonstrates childhood language problems increase the risk of poor mental health in adulthood. Second, in adult mental health settings there is a need to screen for language problems and, where applicable, adjust interventions to accommodate communicative needs for patients/clients. Solving these issues requires integration and recognition of the importance of speech-language therapy in the adult mental health system.

“Do I feel safe here?” Organisational climate and mental health peer worker experience

BackgroundIn Australia, lived experience peer support workforces are expanding making it one of the fastest growing emerging disciplines in transdisciplinary mental health settings. This article provides insight for organisations on the contextual realities peer workers face, increases understanding of peer support services to improve service delivery environments and contributes to mental health systems reform. This study aimed to qualitatively explore peer support workers experience integrating into and working within transdisciplinary mental health service teams.MethodSemi-structured interviews were undertaken with 18 peer support workers currently working in mental health services in Australia. The research was a qualitative descriptive study design. All data collected were analysed utilising thematic analysis.ResultsPeer workers found their experience in the workplace was influenced by their colleagues and the organisation’s understanding of the peer role. Factors relating to organisational culture and climate were a central theme throughout discussions noting that a negative climate was perceived as harmful to peer workers. Themes established through results include (1) the role of leadership, (2) attitudes and behaviours of colleagues, (3) provision of psychologically safe environments, (4) the organisations messaging and use of language and (5) organisational structures and policy.ConclusionThis study contributes to evidence for the impact of organisational culture on integrating and supporting peer support workers in mental health service delivery. This study provides insights into peer worker experiences integrating into transdisciplinary teams, confirming findings established in previous studies, highlighting a lack of movement or change in workplace culture to support peer worker integration into mental healthcare settings.

'Oevaru' 2023: Ocean currents and the journey of an inaugural mental health conference in the Maldives.

This paper describes an important mental health initiative in Maldives - the inaugural national mental health research conference. Amid socio-cultural challenges in the background of climate change, amplified by COVID-19, mental health issues in Maldives surged. National Centre for Mental Health (NCMH), acknowledging data gaps, has prioritized evidence-based care since 2019 with a vision of building a research culture. Oevaru 2023, Maldives' inaugural mental health research conference, was convened by NCMH and held on October 15-16, 2023, addressing holistic care, prevention, innovation, and investment in mental health as sub-themes. Pre-conference sessions provided skill-building, followed by workshops on specialized topics. Oevaru featured keynotes, expert talks, panel discussions, and poster presentations, including a hybrid session with the Creating Futures Conference. It culminated in a white paper, emphasizing research-driven strategies for a resilient mental health system in Maldives.

Use of AI in Mental Health Care: Community and Mental Health Professionals Survey.

Artificial intelligence (AI) has been increasingly recognized as a potential solution to address mental health service challenges by automating tasks and providing new forms of support. This study is the first in a series which aims to estimate the current rates of AI technology use as well as perceived benefits, harms, and risks experienced by community members (CMs) and mental health professionals (MHPs). This study involved 2 web-based surveys conducted in Australia. The surveys collected data on demographics, technology comfort, attitudes toward AI, specific AI use cases, and experiences of benefits and harms from AI use. Descriptive statistics were calculated, and thematic analysis of open-ended responses were conducted. The final sample consisted of 107 CMs and 86 MHPs. General attitudes toward AI varied, with CMs reporting neutral and MHPs reporting more positive attitudes. Regarding AI usage, 28% (30/108) of CMs used AI, primarily for quick support (18/30, 60%) and as a personal therapist (14/30, 47%). Among MHPs, 43% (37/86) used AI; mostly for research (24/37, 65%) and report writing (20/37, 54%). While the majority found AI to be generally beneficial (23/30, 77% of CMs and 34/37, 92% of MHPs), specific harms and concerns were experienced by 47% (14/30) of CMs and 51% (19/37) of MHPs. There was an equal mix of positive and negative sentiment toward the future of AI in mental health care in open feedback. Commercial AI tools are increasingly being used by CMs and MHPs. Respondents believe AI will offer future advantages for mental health care in terms of accessibility, cost reduction, personalization, and work efficiency. However, they were equally concerned about reducing human connection, ethics, privacy and regulation, medical errors, potential for misuse, and data security. Despite the immense potential, integration into mental health systems must be approached with caution, addressing legal and ethical concerns while developing safeguards to mitigate potential harms. Future surveys are planned to track use and acceptability of AI and associated issues over time.

Challenges and opportunities in the mental health landscape of the Maldives.

This article outlines the history of mental health service delivery with contemporary challenges and opportunities in the Maldives. Mental health has been traditionally the domain of faith healers in the Maldives. This changed gradually with the availability of treatments as well as increased public awareness, and mental health is now recognized as an emerging health issue. The current challenges for the mental health system include governance issues, access to services, human resource limitations, poor prevention efforts, and lack of research. These challenges may be overcome by focussing on opportunities through strengthened governance, intersectoral collaboration, mainstream integration of mental health, and local research.

Building a recovery-oriented mental health system in Ukraine: lessons from implementation science.

Building a recovery-oriented mental health system in Ukraine: lessons from implementation science.

Ukrainian mental health in transition: from totalitarianism towards a modern mental health system.

Ukrainian mental health in transition: from totalitarianism towards a modern mental health system.

Reductions in inpatient and outpatient mental health care in germany during the first year of the COVID-19 pandemic - What can we learn for a better crisis preparedness?

During the COVID-19 pandemic, reports from several European mental health care systems hinted at important changes in utilization. So far, no study examined changes in utilization in the German mental health care inpatient and outpatient mental health care system comprehensively. This longitudinal observational study used claims data from two major German statutory health insurances, AOK PLUS and BKK, covering 162,905 inpatients and 2,131,186 outpatients with mental disorders nationwide. We analyzed changes in inpatient and outpatient mental health service utilization over the course of the first two lockdown phases (LDPs) of the pandemic in 2020 compared to a pre-COVID-19 reference period dating from March 2019 to February 2020 using a time series forecast model. We observed significant decreases in the number of inpatient hospital admissions by 24-28% compared to the reference period. Day clinic admissions were even further reduced by 44-61%. Length of stay was significantly decreased for day clinic care but not for inpatient care. In the outpatient sector, the data showed a significant reduction in the number of incident outpatient diagnoses. Indirect evidence regarding the consequences of the reductions in both the inpatient and outpatient sector of care described in this study is ambiguous and direct evidence on treatment outcomes and quality of trans-sectoral mental healthcare is sparse. In line with WHO and OECD we propose a comprehensive mental health system surveillance to prepare for a better oversight and thereby a better resilience during future global major disruptions.