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The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.
The Safewards model and its ten interventions have been effective in reducing restrictive practices and preventing conflict within acute inpatient mental health units. However, few studies in the current literature explore the consumers' experiences of Safewards. This exploration also needs to consider the views of Mental Health Nurses and the Lived Experience Workforce, who are both important stakeholders in the application of Safewards and how it impacts on consumers' experiences. Despite this, the views of Mental Health Nurses and the Lived Experience Workforce about consumers' experiences of Safewards are limited. This qualitative study explored the views of Lived Experience Workforce leaders about consumers' experiences of Safewards, and Mental Health Nurses' responses to these experiences in acute inpatient mental health units in Australia. Six Lived Experience Workforce leaders participated in individual interviews. Data were analysed using thematic analysis, revealing four themes: (1) consolidating Safewards through understanding consumers' experiences, (2) consumers as leaders in Safewards, (3) acknowledging the realities of acute inpatient mental health units and (4) practice foundations underpinning Safewards. Results highlighted the positive impact of improved consumer involvement in Safewards. Additionally, mechanisms to develop strategic partnerships between Lived Experience Workforce leaders and mental health nurses warrant further investigation. This study highlighted the restrictive nature of acute inpatient mental health units and the need to acknowledge the impact this has on consumers. Further embedding of foundational approaches, such as trauma-informed and recovery-oriented practice within Safewards, is also required to align with consumers' expectations. Greater recognition of consumers' experiences and their agency within the model, and consideration of other Safewards interventions, is also needed. This is required to increase safety, reduce harms associated with restrictive practice, and enhance Safewards effectiveness.
Mental health reform represents a sustained effort to improve the accessibility, quality and human rights orientation of mental health systems through changes to policy, legislation and service delivery. The scale and pace of growth in the lived and living experience workforce (LLEW) is unprecedented within mental health services, with a marked increase in roles representing a significant shift in the contemporary mental health landscape. In Australia, the state of Victoria is currently undergoing the most significant mental health reform in its history. This study aimed to explore mental health nurses' perceptions of the impacts of mental health reform on (1) their delivery of care in relation to consumer and carer safety and wellbeing and (2) their experiences of working alongside lived experience workers within reformed service contexts. This study employed a qualitative descriptive design, with secondary analysis of existing qualitative data (Szabo and Strang 1997), which were thematically analysed using Braun and Clarke and reported in accordance with CORE-Q guidelines. Semi-structured interviews were conducted with mental health nurses working in Victoria (N = 14), Australia, with three themes generated through reflexive thematic analysis: (1) Mind the gap: Reform impacts to safety and risk; (2) When care comes too late: reform impacts to care and treatment; and (3) Between sympathy and resistance: ambivalent attitudes towards LLEW roles. Persistent integration challenges related to LLEW influenced nurses' perceptions of usefulness. Nurses also described that an increased legislative emphasis on consumer choice, relative to clinical decision-making, contributed to uncertainty and hesitancy in intervention, which nurses perceived as negatively affecting care outcomes in some situations.
Physical restraint is a highly controversial intervention in psychiatric nursing. While the prevalence and policies of physical restraint vary significantly worldwide and across China's diverse regional healthcare systems, the overall rate in Chinese mental health settings remains notably higher. However, the lived experiences and cognition of both patients with mental disorders and healthcare professionals remain underexplored in existing literature. This study adopted a multi-perspective interpretative phenomenological analysis to investigate the experiences, perceptions, and relational tensions regarding physical restraints among inpatients and healthcare professionals in Chinese mental health settings. A total of 21 participants were recruited from a mental health hospital in Shanghai, comprising nine patients with mental disorders in the recovery phase, seven mental health nurses, and five psychiatrists. In-depth semi-structured interviews were conducted individually with all participants to explore their lived experiences, perceptions, and perspectives related to physical restraint. The interview transcripts were analysed using multi-perspective interpretative phenomenological analysis (IPA). Three themes were extracted: (1) embodied experiences during physical restraint, (2) cognitive biases arising from diverse perspectives, and (3) the trust crisis and reconstruction between healthcare professionals and patients. Physical restraint in Chinese mental health settings is shaped by a complex interplay of power, culture and resource factors. To achieve a balance between safety and patient dignity, it is imperative to enhance communication, implement trauma-informed care and establish support systems.
Emergency departments (EDs) are often the first point of contact for individuals in mental health crisis. In rural Australia, health professionals face distinctive challenges shaped by limited resources, workforce shortages and overlapping professional and community roles. These conditions influence how health professionals perceive, engage with and respond to people experiencing mental health crisis. To explore how health professionals working in a rural emergency department perceive their work with people presenting with mental illness. A qualitative design using semi-structured interviews was employed with nine participants (six nurses and three medical officers) from a rural ED in South West Queensland. Data were analysed using Braun and Clarke's Reflexive Thematic Analysis. Three interrelated themes captured participants' perceptions: safety as relational and negotiated practice, education and training as relational and experiential learning and small-town mentality. Findings suggested that care in rural EDs is sustained less by systems and protocols than by human connection, local knowledge and moral endurance. Participants described navigating safety through empathy and teamwork, constructing learning through shared experience rather than formal training and managing the tensions of visibility, stigma and relationships in close-knit communities. Work with people with mental health illness in rural emergency settings is perceived as relational, adaptive and context bound. Building sustainable rural mental health responses may benefit from embedding specialist support, accessible education and reflective spaces that honour both professional wellbeing and community interdependence.
In Brazil, approximately 6.9 million people live with severe, mild, or moderate mental disorders, requiring different levels of care. Psychosocial Care Centres play a fundamental role in providing specialized care to this population, promoting welcoming practices, continuous treatment, and social reintegration within the Psychosocial Care Network. Although effective in reducing crises and hospitalizations, challenges remain regarding the maintenance of users' physical health. This observational and analytical study aimed to identify the prevalence of obesity (defined as a body mass index ≥ 30 kg/m2) and its associated factors among 358 adults receiving care in three specialized mental health services in a medium-sized municipality. A structured, content-validated questionnaire collected sociodemographic, clinical, behavioural and service-related information. Weight, height and waist circumference were measured following international standards. The prevalence of obesity was 32.1%, and an additional 32.7% were overweight, totaling 64.8% with excess weight. Lower prevalence of obesity was observed among users of services focused on the treatment of substance use disorders. Higher prevalence was identified among women, individuals who self-identified as Black, people with hypertension, and those with poorer self-rated health. Smoking was associated with lower obesity prevalence. It is concluded that obesity is highly prevalent among users of community mental health services, highlighting the need for integrated strategies that incorporate physical health as an essential component of mental health care.
Artificial intelligence is increasingly used in mental health nursing, yet its alignment with person-centred care remains underexplored. This scoping review examines the extent to which artificial intelligence applications in mental health nursing align with person-centred principles, and where tensions and risk emerge. A systematic search of three electronic databases identified studies published since 2018. Data were charted for study characteristics, artificial intelligence modalities, person-centred care concepts addressed, and research gaps. Findings show growing interest in technology-enabled care delivery, monitoring, and decision support in mental health settings, with varying degrees of attention to person-centred values such as empathy, shared decision-making, dignity and therapeutic alliances. However, considerable gaps remain regarding ethical integration, digital therapeutic relationships, trust, surveillance and the measurement of person-centred care outcomes. This review maps the current evidence base and highlights critical gaps in understanding how artificial intelligence reshapes therapeutic relationships, professional roles and power dynamics in mental health nursing. Future research is needed to ensure that the adoption of artificial intelligence is not only safe and effective, but also ethically grounded and aligned with the humanistic foundations of person-centred mental health nursing.
This study explored the lived experiences of African Australian consumers and their perspectives on the role of spirituality, religion and culture in shaping mental health and engagement with mental health services. A qualitative phenomenological design informed by transcultural nursing perspectives was used. Semi-structured interviews were conducted with 15 African Australian participants aged 18-25 years from diverse African backgrounds, including Zimbabwe (n = 2), Ethiopia (n = 3), South Sudan (n = 5), Somalia (n = 4) and Ghana (n = 1). Interviews were audio-recorded and transcribed verbatim. The data were analysed using Colaizzi's phenomenological method of analysis, which involved identifying significant statements, formulating meanings, clustering themes and developing an exhaustive description of participants' experiences and interpretations of mental health within cultural and spiritual contexts. Three interconnected themes were identified: living between two worlds, seeking healing beyond medication and breaking the silence. Participants described migration-related stress, disrupted social networks and tensions between collectivist cultural expectations and individual identity as contributing to psychological distress. At the same time, spirituality, religious practices and culturally grounded community networks were identified as important coping resources that fostered resilience and social support. Participants reported mixed experiences with formal mental health services, noting that biomedical approaches often overlooked cultural and spiritual dimensions of wellbeing, while culturally responsive care enhanced trust and engagement. The findings highlight the importance of culturally and spiritually responsive mental health care to improve service engagement and support the wellbeing of African Australian communities.
Mental health nursing requires specialised training in therapeutic communication and related soft skills. Innovative, digitally enhanced strategies may support competency development, particularly amid clinical placement shortages. This article outlines insights from a scoping review of technology use in undergraduate mental health nursing education. The objectives were to (a) explore the impact of using these technologies in students' experience and (b) develop insights that can contribute to the development of a curriculum that embed innovative educational technology with strong theoretical foundations and pedagogical strategies. This review was guided by the modified Arksey and O'Malley methodological framework. The PCC (Population, Concept, Context) framework was used to formulate the eligibility criteria. A review protocol was registered with the Open Science Framework (OSF). The databases for searching included CINAHL, MEDLINE, Scopus, PsycINFO, Web of Science. The results were reported according to the PRISMA-ScR checklist. The review included 35 studies and the evidence showed that, virtual reality simulations (VRS) with varying immersive abilities were the most popular innovative educational technology used in undergraduate mental health nursing education. Interestingly, no articles were identified that used other innovative educational technologies as outlined in the search strategies. Both immersive and non-immersive VRS were equally effective in improving student learning experiences compared to traditional learning modalities. The main benefits included enhanced learning experiences and comprehension and the development of necessary skills and confidence before entering clinical settings. Advanced technologies offer future-focused benefits for mental health nursing education; however, core therapeutic skills remain essential. Virtual learning should therefore complement, not replace, realistic learning experiences.
Mental health issues such as anxiety and depression are reported at higher rates in undergraduate nursing students than in the general population, highlighting the potential value of enhanced wellbeing supports for recent graduates. Evidence suggests that supportive strategies, including clinical supervision and structured wellbeing programmes, can improve graduate wellbeing and retention within health services. This study aimed to explore mental health nursing educators' perceptions of early career nurses' work readiness, wellbeing and preparedness for practice. Using a qualitative descriptive design, semi-structured interviews were conducted with 10 registered nurse educators employed at a large tertiary metropolitan health service in Melbourne, Australia. Data were analysed thematically following Braun and Clarke's method. Four key themes emerged: (1) Registered but not ready, (2) Perceptions, practice and role identity, (3) The work of wellbeing and (4) At the boundaries of education and care. Findings indicate that graduates frequently lack readiness for independent practice and demonstrate a disconnect between expectations and the realities of mental health nursing. Emerging mental health concerns among graduates further highlight the emotional demands of the role and gaps in coping strategies. Educators face the added challenge of navigating a dual role: supporting graduates' wellbeing while maintaining educational responsibilities, without assuming a counselling function. These insights underscore the need for structured interventions to support both graduates and educators, including enhanced preceptorship, resilience training and clear delineation of educational versus therapeutic roles, to strengthen workforce readiness and sustainability in mental health nursing.
As community mental health services expand in scope and responsibility, mental health nurses are playing a central role in delivering integrated, recovery-oriented care. However, they face substantial challenges in adapting to community practice and sustaining professional development. Clinical supervision can mitigate these demands through its formative, normative, restorative functions. This study explored the supervision experiences of community mental health nurse specialists in South Korea to provide evidence for specifying the effective functions and operational systems of supervision using an exploratory qualitative design. Twelve community mental health nurse specialists participated in three focus group interviews conducted between June 2024 and July 2025. Data were analysed using reflexive thematic analysis. Four themes and 10 subthemes were generated: translating community mental health ideals into professional practice; serving as an anchor in unfamiliar terrain; supervision undermined by superficiality and disrespect; and competency development constrained by structural barriers. Supervision was perceived as a critical space for clarifying clinical direction, regulating emotional involvement and supporting professional adaptation. However, formalistic delivery and structural constraints limited its impact. These findings highlight the need for integrated and systematic supervision approaches aligned with the community mental health paradigm, supported by organisational and policy commitments to protected time, staffing, education and financial resources. Strengthening supervision under such conditions may enhance practitioner development and service user outcomes.
Adults who grow up with a parent with severe mental illness are exposed to prolonged developmental adversity, yet little is known about how this experience shapes multidimensional outcomes in adulthood. In particular, the roles of personal adaptive resources, childhood trauma, parental bonding, and morbidity in influencing quality of life, social functioning, and healthcare utilization remain insufficiently understood. This study aimed to examine the relationships between personal adaptive resources (resilience and general self-efficacy), childhood experiences (trauma and parental bonding), and adult outcomes, including quality of life, social functioning, morbidity, and healthcare utilization, as well as to examine the moderating role of resilience. A cross-sectional quantitative design was employed. A convenience sample of 300 adults who grew up with a parent with severe mental illness completed a self-report questionnaire which consisted of validated scales for study variables: Personal Wellbeing Index-Adult, Connor-Davidson Resilience Scale-10, New General Self-Efficacy Scale, Social Functioning Questionnaire, Parental Bonding Instrument, Childhood Trauma Questionnaire, and EUROHIS survey items for morbidity and healthcare utilization. Data were analyzed using Spearman correlations, hierarchical multiple linear regression, negative binomial regression, and moderation analysis using PROCESS. Resilience and self-efficacy independently predicted higher quality of life. Childhood trauma and parental overprotection independently predicted poorer social functioning, while parental care did not contribute unique variance in multivariate models. Childhood trauma significantly predicted morbidity, and morbidity was associated with increased healthcare utilization. Resilience did not moderate the relationship between childhood trauma and either morbidity or social functioning, indicating independent rather than interactive effects. Among adults who grew up with a parent with SMI, resilience and self-efficacy function as independent contributors to subjective wellbeing, while childhood adversity and morbidity shape long-term social and health outcomes. Resilience does not appear to buffer the long-term effects of trauma on health or functioning.
Violence in mental illness settings poses a serious problem, threatening nurses' physical and psychological safety and compromising quality of care. Front line responses tend to rely heavily on nurses' individual capabilities, making the establishment of organisational support systems and management policies an urgent necessity. This study aimed to clarify the essence and components of the concept 'violence management' in mental health nursing and to propose a definition that will contribute to future practice and education. We analysed 35 articles, following Rodgers' (2000) conceptual analysis methodology and reporting in accordance with PRISMA guidelines. Four antecedent conditions were identified: 'consumers' ineffective impulse control', 'nurses' affinity for exposure to violence', 'difficulty in establishing a shared understanding of safety', and 'lack of consistency in violence response'. In addition, five attributes were identified: 'relationship-centred non-invasive care', 'ensuring a safe healthcare environment', 'adherence to forensic frameworks', 'early risk detection', and 'professional capacity development'. Five consequences were also identified: 'strengthening support for nurses', 'strengthening human resource development', 'organisational conditions that strengthen safety', 'challenges in violence reporting', and 'challenges in assessment tools'. Mental health nursing defines the concept of violence management as an effort to provide flexible and comprehensive care across national and cultural differences in response to diverse and uncertain factors that make consumer impulse control difficult, maximising limited resources while establishing an organisational support system. This definition presents a new framework linking nursing management and clinical practice.
Evidence suggests respite care reduces carers' burden by providing temporary relief, reducing stress and ensuring safety. Most research focuses on carers of people with dementia or physical disabilities, leaving a gap in understanding carers of individuals with mental illness (MI). Few studies explore their specific needs, indicating a crucial area for further research. This study utilised phenomenology to examine the perception of respite for those who care for people with mental illness. An interpretative phenomenological approach guided and informed the philosophy of the study. A purposive sample of 14 caregivers who utilise respite care (n = 14) provided narrative data through individual semi-structured interviews. Verbatim transcripts were analysed using van Manen's approach revealing eight key elements, four primary themes and an overarching essence of meaning. The themes include (1) feeling overwhelmed, (2) the process of obtaining respite, (3) facility suitability and (4) the need to keep going. The overarching essence of meaning was identified as "Constant care is constant." This study presents an in-depth analysis of the findings, supplemented by a comprehensive exploration based on established theoretical frameworks. Carers benefit from respite services by improving their mental and physical health and quality of life, but service delivery needs enhancement. Service providers should improve communication, offer flexible scheduling, and tailor services to individual needs. Training and education for respite care workers, especially in managing challenging situations and providing emotional support, are vital. Raising awareness through collaborations with healthcare providers and community organisations can better inform carers about available options.
Out-of-home care experienced young people have elevated mental health needs, yet their mental health help-seeking remains insufficiently understood. Understanding help-seeking is critical for identifying barriers and facilitators that shape whether, how and from whom care-experienced young people seek and access mental health support. Existing syntheses are limited in scope and have under-represented quantitative evidence, residential care, care leavers and equity-relevant subgroups. This review will synthesise international evidence on sources, barriers and facilitators of mental health help-seeking among care-experienced young people. This mixed-methods systematic review and meta-analysis protocol is reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols and informed by Preferred Reporting Items for Systematic Review and Meta-Analyses-Equity. Electronic searches will be undertaken in PsycINFO, MEDLINE, EMBASE, Applied Social Sciences Index and Abstracts, Social Sciences Citation Index, Social Policy and Practice, Health Management Information Consortium, ProQuest Dissertations & Theses Global, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus and Child Development and Adolescent Studies, alongside grey literature and citation searching. Eligible studies will include qualitative, quantitative and mixed-methods research involving care-experienced young people aged 13-25 years, including care leavers, and studies reporting help-seeking initiated by young people or on their behalf by adults, carers or professionals. Quantitative and qualitative evidence will be synthesised separately before narrative integration. Meta-analysis will be considered where independent quantitative studies report sufficiently comparable populations, outcomes and effect measures; otherwise, findings will be synthesised narratively using Synthesis Without Meta-analysis (SWiM) guidance. Qualitative findings will be synthesised using thematic synthesis. Study quality will be appraised using the Newcastle-Ottawa Scale, Critical Appraisal Skills Programme and Mixed Methods Appraisal Tool. Equity-relevant characteristics will be extracted where reported, informed by the PROGRESS-Plus framework. Care-experienced young advisors have informed the wider programme and this review, and will contribute to interpretation and dissemination. Ethical approval is not required as the review involves secondary analysis of the existing evidence base. Findings will be disseminated through peer-reviewed publication, conferences, webinars and accessible outputs co-developed with care-experienced young people. CRD420251047424.
Intensive Home Treatment for acute mental health crises has expanded internationally as a community-based alternative to inpatient admission. Despite its growing use, little is known about how informal carers experience supporting a relative during acute psychiatric decompensation at home-an emotionally demanding context marked by intensified responsibility and disruption of daily life. The aim of this study is to explore the lived experiences of informal caregivers providing support to a family member admitted to mental health Intensive Home Treatment using a reflexive thematic analysis within a constructivist orientation. The study adhered to the COREQ guidelines for qualitative research reporting. Data were collected using individual semi-structured interviews (n = 30) and one focus group (n = 8). The Stress Process Model informed the interview guide and acted as a sensitising lens; however, coding and theme development remained inductive. Three overarching themes and seven sub-themes captured the caregiving experience. Carers reported substantial physical, emotional, occupational and social consequences, including exhaustion, anxiety and marked disruption of daily routines. Their experiences combined distress with positive meaning making: strengthened bonds, feelings of usefulness and increased closeness coexisted with uncertainty, fear of relapse and difficulty managing unpredictable behaviours. Coping strategies included personal practices and external supports. All these findings suggest that caring during acute Intensive Home Treatment is meaningful yet highly demanding. Mental health professionals should systematically assess caregiver burden, support needs and coping resources, offering targeted interventions to enhance emotional well-being and sustain effective home-based psychiatric care.
Stigmatising beliefs towards people with mental health disorders impede treatment-seeking and recovery. This study examined how the predictive contributions of knowledge, attitudes, and behaviours to stigmatising beliefs towards people with mental health disorders differed by clinical practicum experience among nursing students exposed to auditory hallucination simulation. A non-randomised comparative cross-sectional design was employed (Strengthening the Reporting of Observational Studies in Epidemiology guidelines). Nursing students (n = 363) from four Korean universities were allocated to groups with (n = 175) and without (n = 188) clinical practicum experience based on academic progression. All participants completed an auditory hallucination simulation programme followed by questionnaires measuring knowledge, attitudes, behaviours, and stigma. Stepwise multiple regression analyses revealed that among students without clinical experience, knowledge (β = -0.435, p < 0.001), attitudes (β = -0.259, p < 0.001), and behaviours (β = -0.144, p = 0.020) predicted stigma (Adjusted R2 = 0.419). Among students with clinical experience, only knowledge (β = -0.455, p < 0.001) and attitudes (β = -0.287, p < 0.001) predicted stigma (Adjusted R2 = 0.478); behaviours did not reach significance despite a stronger bivariate correlation in the experienced (r = -0.390) than inexperienced group (r = -0.332). This paradoxical pattern-a stronger zero-order association losing independent variance in the multivariate model-suggests clinical experience integrates the three stigma components such that behaviour's effect becomes fully mediated through knowledge and attitudes. These findings support a stage-sensitive model: direct behavioural strategies are most effective pre-practicum, while post-practicum intervention should prioritise cognitive-affective integration via structured debriefing.
Police and specialised police teams are frequently called to respond to mental health crises, often becoming de facto gatekeepers to care. Yet the perspectives of people in crisis and their carers remain underrepresented in the literature. The aim of this review is to explore the lived experiences of people, including carers, who encounter police or specialised police teams during a mental health crisis. A narrative review was conducted following Sukhera's five-step approach. Searches across CINAHL, MEDLINE, PsycInfo, and Sociological Abstracts identified 33 qualitative studies from eight countries. Data were analysed thematically. Results reveal nuanced experiences, ranging from trust in police and crisis services to refusals to ever call them again; from successful de-escalation to rapid escalation; and from encounters that preserved life to those that ended it. Five themes were identified: (1) Initiating and navigating the crisis response; (2) Interacting and communicating during the response; (3) Perceptions of safety, risk, and coercion during the response; (4) The harms of the response; and (5) Improving police and specialised police team response. The review clearly lists the types of coercion that can be experienced during these responses, whether they involve only police officers or a co-responder model. The findings highlight that positive crisis response experiences depend on whether interactions are perceived as fair, respectful, humane, and non-coercive. While some encounters are supportive and lifesaving, negative experiences often carry disproportionate weight, eroding trust and deterring future help-seeking. More approaches grounded in procedural justice theory are needed to reduce coercion and rebuild trust.
This study explored the quality of maternal and newborn care (QMNC) in Belgium, focusing on women's experience with care and their mental health (MH). We conducted a cross-sectional survey using the WHO-based IMAgiNE EURO questionnaire, updated with MH items. All women who gave birth in a health facility in Belgium were included. Data were collected from 621 women who gave birth between March 2022 and January 2025. Descriptive statistics summarised QMNC and MH outcomes, while logistic regression examined factors associated with negative emotional childbirth experiences. The median QMNC index was 260/300, suggesting high adherence to WHO quality standards. However, 33.5% of respondents reported ineffective communication, 34.0% a lack of involvement in decision-making, 8.7% no emotional support from healthcare providers and 8.2% reported abuse. Overall, 40.9% of women reported emotional difficulties related to childbirth, with 10% reporting a negative impact on well-being. MH screening and support were not structurally embedded in perinatal care. Emergency caesarean deliveries (adjusted odds ratio (aOR): 14.94), instrumental births (aOR: 2.36), fundal pressure (aOR: 4.11) and abuse (aOR: 3.74) were significantly associated with emotional difficulties around childbirth. The presence of an obstetric consultant (aOR: 0.44) and higher QMNC scores (aOR: 0.97) were associated with a lower likelihood of reporting emotional difficulties. Belgium shows a high level of QMNC, yet significant gaps remain in communication, MH screening and support and adherence to evidence-based practices. Our study highlights a strong association between certain childbirth interventions and a negative emotional birth experience, emphasising the need for further research into the underlying causal patterns and contextual factors shaping women's childbirth experiences.
Up to one-third of medical inpatients experience clinically relevant mental distress, yet many remain untreated. Stepped and collaborative care (SCC) models may improve access to mental health care, but predictors of service uptake are unclear. We examined patient- and ward-level predictors of psychosomatic-psychiatric consultation (PPC). We analyzed data from SomPsyNet, a stepped-wedge cluster randomized trial targeting SOMatic inpatients across three Swiss tertiary hospitals, to prevent PSYchosocial distress by a care NETwork. Analyses focused on inpatients screening positive for mental distress. Multiple-imputed logistic regressions assessed predictors of four sequential service-use stages: PPC considered, offered, accepted, and received. Among 589 distressed patients, 93.9% were offered PPC, 63.1% accepted, and 83.9% of acceptors received PPC, yielding a 50% overall receipt rate. Patients without Swiss citizenship showed higher odds of acceptance (odds ratio [OR] = 1.82 [1.10, 3.00]) and eventual receipt (OR = 1.62 [1.01, 2.62]). Being in a geriatric ward facilitated PCC uptake, while patients from gynecology showed reduced progression through the care pathway. Age, gender, income, education, marital status, and living arrangement showed no statistically robust associations. Almost two-thirds of mentally distressed medical hospital inpatients accepted an offered PPC, indicating high acceptability. About half ultimately received a consultation, highlighting substantial attrition along the SCC pathway. Ward specialty and nationality were key determinants of PPC uptake. These findings suggest that proactive, ward-oriented consultation-liaison models embedded in routine inpatient care may improve timely and equitable access to mental healthcare, including for migrant and minority patients who are otherwise less likely to access such care.