Quality mental health services are pivotal in addressing mental health issues worldwide. Despite this importance, many countries face challenges in providing accessible, high-quality mental health care. This study examines the nexus between mental health services and worry about mental health issues across different countries. This study used data from the Lloyd's Register Foundation 2021 World Risk Poll, the OECD, the World Health Organization, and Our World in Data. The variables include worry about the personal harm that mental health issues could cause, mental health services (i.e. service facilities, service availability, and service utilisation), and estimated prevalences of major mental disorders. The results revealed that structural components - specifically the availability of mental health outpatient facilities - were associated with less worry about mental health issues across countries. However, no significant association was observed between process components - such as service utilisation - and worry about mental health issues. Additionally, the association between the prevalence of various mental disorders and worry about mental health issues showed mixed results. The findings emphasise the importance of increasing the availability of these facilities to ensure universal access to essential mental health care, thereby improving mental well-being across both low-income and high-income countries.
Although research has shown that stigma toward people with mental illness (PMI) differs among different types of healthcare providers, the direction and underlying mechanisms of the relationship between familiarity with PMI and stigma toward PMI remain unclear. The aims were to examine the associations between familiarity with and stigma toward PMI among healthcare providers, explore the mediating role of mental health knowledge (MHK) and test whether the relationship varies among mental health care providers and general health care providers. A total of 2874 healthcare providers from seven cities completed an online survey assessing familiarity, MHK, stigma. Moderated mediation analyses were conducted using PROCESS macro. Health providers who were more familiar with PMI knew more about mental illness, and those who knew more about mental illness had less stigma toward PMI. The effect of MHK on stigma was stronger in mental health care provider than general health care providers. This study lends support to intergroup contact theory. When designing anti-stigma interventions for healthcare providers, their work experience and organizational context should be considered. Healthcare providers need to realize the effects that their stigma might have on PMI and the public.
While the promotion and optimization of tele-mental health (TMH) is increasingly recognized as essential, empirical research on public perceptions of this emerging support modality remains limited. This study aims to investigate public attention, sentiment, and thematic concerns related to TMH in China across different phases of the COVID-19 pandemic, offering demand-side insights to support the development of digital mental health systems. Drawing on 41,820 Weibo posts spanning the periods before, during, and after COVID-19 in China, this study employed sentiment analysis and topic modeling to capture dynamic public attitudes toward TMH. (1) Sentiment patterns revealed a mixture of emotions across all periods, with a slight predominance of positive sentiment; (2) Seven core discussion topics emerged, including TMH during COVID-19, campus-based applications, industrial development, emotional support, interpersonal relationships, mental disorders, and mental health promotion; (3) Public focus and emotional tone regarding these topics shifted significantly across pandemic phases. The findings offer critical demand-side insights for advancing TMH initiatives in China and provide evidence to inform the global development of digital mental health systems.
There is growing interest in measuring patient experience within mental health care and central to doing so is the development of appropriate measurement methods. Whilst numerous patient-reported experience measures (PREMs) are available, systematic reviews examining their psychometric properties have excluded measures designed specifically for older people. This review aimed to identify and critically analyse all available patient and carer-reported patient experience measures designed to, or applicable in, measuring the mental health care experience of older people. Four databases were systematically searched and identified 21 reports dealing with the process of development and/or validation of relevant instruments. The methodological quality and psychometric properties of the instruments were assessed according to Pesudovs et al. (2007) quality criteria, and results were heterogeneous. An inductive qualitative analysis of instrument content identified 10 key domains of patient experience applicable to OPMH: interpersonal/relational aspects, information, patient involvement, service aspects, discharge, goal setting, safety, social support, access and medication. The heterogeneity of study designs highlights the need for greater standardization and rigour of methodological processes for the development and validation of PREMs. Further well-designed studies to appropriately validate existing and new PREMs applicable for use within older people's mental health services are required.
Mental health professionals have stressed the importance of terminology used to describe people with mental health conditions (MHCs) and its stigmatizing outcomes. Little research, however, has investigated the underlying processes by which terminology affects prejudice. To investigate theoretical mechanisms by which the terms "mental illness," "psychological problem," and "mental disorder" influence prejudice via causal attributions. An online experiment randomly assigned 765 U.S. participants from the general population to one of three conditions. Participants completed measures of hereditary/biological and social/stress attributions of MHCs and one of three 28-item measures of prejudice, which differed only in the terminology used to describe MHCs. Confirmatory factor analysis supported the four-factor structure of prejudice (Fear/Avoidance, Unpredictability, Authoritarianism, and Malevolence) for each measure. Although terminology did not directly affect prejudice, both hereditary/biological and social/stress attributions significantly decreased it. Mediation analyses demonstrated indirect effects of terminology on prejudice via causal attributions, with the term "mental illness" increasing it via reduced social/stress attributions but decreasing it via increased hereditary/biological attributions. The results illustrate complex relationships between terminology, causal attributions, and prejudice, and are largely consistent with the mixed-blessings model. The study contributes to discussions about terminology suited for public discourse and prejudice-reduction campaigns.
Reducing barriers to engagement in mental health services by meeting people in the communities "where they are" has potential to reach those who would be otherwise disengaged. This study explores the potential of laundromats as a space to reach individuals with elevated social, mental health, and suicide risk. Participants (N = 197) were recruited from over 50 laundromats across San Antonio, Texas. Rates of mental health conditions and suicide risk were compared to national estimates, and analyses were supplemented with bootstrapped samples. The majority (60%) of participants indicated one or more financial need. Participants were significantly more likely to report poor/fair mental health and screen positive for suicidal ideation relative to the national average. In a multivariable logistic regression, suicidal ideation was related age, education and housing insecurity prior to the addition of mental health. Over 1/3 of participants indicated an interest in receiving behavioral health services at a laundromat. Laundromat customers in San Antonio, Texas reported poorer mental health and elevated suicidal ideation relative to the national average. Current utilization of mental health services was low with many participants indicating an interest in receiving services at the laundromat, suggesting an opportunity for community intervention.
In Canada, more than 4,500 people die by suicide annually, with individuals diagnosed with psychotic disorders being at significantly higher risk. Although the risk factors for suicide in this population are well-established, the assessment of suicide risk remains underexplored. This study examines the practices of mental health professionals working with clients with a psychotic disorder in relation to suicide risk assessment, using the Theory of Planned Behavior (TPB) as a theoretical framework. A survey of 148 professionals across Canada was conducted to assess factors influencing the frequency and thoroughness of suicide risk assessments. Despite our perceived behavioral control scale having psychometrical flaws, results revealed that social norms were a significant predictor of systematic suicide risk assessments. Professionals identified a lack of time, training, and inadequate clinical tools as major obstacles to thorough assessments. Despite the widespread availability of suicide risk assessment training, many professionals did not feel adequately prepared or confident in conducting such assessments, particularly with clients with a psychotic disorder. The findings highlight the need for enhanced support, training, and organizational changes to improve the systematic assessment of suicide risk in this vulnerable population.
Mental health nurse practitioners represent a workforce with capacity to significantly contribute to meeting public need for psychotherapy. The purpose of this scoping review study is to synthesize evidence regarding mental health nurse practitioner use of psychotherapy. Arksey and O' Malley's framework was used to guide the review which sought and synthesized papers written in English published between January 2000- April 2025 describing mental health nurse practitioners use of psychotherapy. Sixteen papers were included, nine written in the United States, four from Australia, and one each from South Africa, the Netherlands and Korea. Studies revealed that mental health nurse practitioners utilize a wide range of psychotherapy to assist people throughout the lifespan and across diverse settings. However, despite such wide-ranging and valuable service provision regulatory barriers often restrict mental health nurse practitioners' delivery of psychotherapy. Evidence outlined in this scoping review challenges governments, policy advisors and service managers to better support mental health nurse practitioners as they seek to serve their communities by providing psychotherapy alongside other forms of mental healthcare.
Children of parents with mental illness (COPMI) have not received sufficient support in China despite their genetic and environmental risk of adverse mental health outcomes. This study was conducted for the first time in China to assess mental distress in adolescent COPMI compared with the population-based control (PBC) group of parents without mental disorders. A total of 1,114 participants including 558 COPMI and 556 PBC, aged 12-17, were recruited from the communities and assessed by self-report scales about anxiety, depression, and suicidality. Regression and mediation analyses were used to identify risk factors for mental distress. The estimated prevalence of anxiety and depression in the COPMI group was significantly higher than in the PBC group (anxiety: 3.9% vs. 1.6%, depression: 5.9% vs. 3.4%). A history of parental mental illness was associated with the lack of family communication, which in turn had a significant (BootCI = (0.020 - 0.062)) indirect effect on the increased anxiety and depression levels of the adolescent offspring. Our findings emphasized the necessity to early identify mental distress in COPMI and provide timely and targeted intervention to improve family communication and mental health well-being for these high-risk adolescents.
Community care for persons with severe mental health challenges [SMHC] is typically provided by family members or relatives who are referred to as carers or caregivers. Identifying carer needs and suggestions for support is therefore critical to the enhancement of community care for such individuals. This study aimed to explore the responsibilities and unmet needs of carers of persons with SMHC. Semi-structured interviews were conducted with carers of persons with severe mental health challenges. Data were analysed thematically. Fourteen carers were interviewed for the study. Twelve of them (86%) cared for their own adult children and 8 (57%) had been in the caring role for over 10 years. Five categories emerged from the data. They were: (1) The responsibility for caring falls on the carer, (2) Caring is exhausting work, (3) Carers are secondary consumers, (4) Carers have specific needs and (5) What carers want. Family carers have no reasonable alternative but to take over the responsibility of caring. Caring is exhausting work and carers struggle to cope with the challenges of caring to the point where they become mentally unwell themselves. Therefore, carers need to be treated as secondary consumers.
Early labor market exit is common in Taiwan, yet its long-term mental health consequences are not well understood. This study examined the association between early labor market exit and the incidence of mental disorders, and explored the moderating effects of sociodemographic and physical health factors. Using Taiwan's National Health Insurance Research Database (2011-2021), we identified 1,195,611 individuals aged 45-64 who exited the labor market early and 1,227,084 continuously employed counterparts. Incidence rates of dementia, depressive disorders, anxiety disorders, sleep disorders, and alcohol use disorders were assessed. Lag-time exclusions of one, three, and five years were applied to minimize reverse causation. Early labor market exit was associated with higher risks of dementia (adjusted hazard ratio [aHR] = 1.04, 95% CI = 1.01-1.07) and alcohol use disorders (aHR = 1.16, 95% CI = 1.11-1.22). Associations with depressive, anxiety, and sleep disorders were weak or nonsignificant. The strength of associations varied by sex, occupation, and physical health status. Early labor market exit increases the risk of dementia and alcohol use disorder. Preventive strategies promoting cognitive engagement, social participation, and healthy lifestyles may help reduce mental health risks among individuals leaving the workforce prematurely.
Caregivers often report high stress levels, which may be associated with adverse mental health. Less is known about adult sexual and gender minority (SGM) caregivers' experienced stress and/or mental health considering they are likely at increased vulnerability to these outcomes due to social stigma, familial estrangement, and discrimination. We tested relationships between caregiving and adverse mental health and if these associations were modified by SGM identity. Using 2023 national BRFSS data (n = 32,151) we examined relationships between caregiving and two outcomes: depression and 14+ days with poor mental health, testing effect modification by SGM identity. Regression analyses, using both SGM and caregiving cross-categories and interaction term models were also conducted. Compared to heterosexual non-caregivers, both caregiving and SGM status were associated with greater depression and having 14+ days of poor mental health, with the highest prevalence of depression among transgender caregivers (aPR = 4.05, CI 3.03-5.00), transgender non-caregivers (aPR = 2.80, CI 2.24-3.25), and cisgender gay caregivers (aPR = 2.52, CI 2.01-2.93). Transgender and cisgender gay and bisexual caregivers also had the highest days with poor mental health. Additionally, interaction term models identified effect modification. Disproportionate adverse mental health outcomes exist among caregivers, modified by SGM status. Longitudinal research is needed to understand these mechanisms and related outcomes including substance use and suicidality.
Criminalization of people experiencing mental illness is systemic, but the conditions surrounding police use-of-force in such encounters are under-examined. To describe mental or behavioral health (MBH) involvement in injurious shootings by U.S. police compared with MBH-uninvolved shootings. Using a 2015-2020 dataset developed from manual review of injurious shootings by police compiled from the Gun Violence Archive (GVA) (n = 10,615), we identified 2454 people shot in MBH-involved encounters. Through further review, we classified the MBH conditions and behaviors involved. Using descriptive statistics and logistic regression models, we compared characteristics of injured people, presenting conditions, and responses. Twenty-three percent of injurious shootings by police involved MBH symptoms (n = 2336) or substance use (n = 921). Eighty-one percent of injured people threatened violence against others; 10% presented only self-harming symptoms, and 5% presented no symptoms. MBH involvement was associated with 1.5-times higher odds of fatality than MBH-uninvolved shootings and 31% higher odds of injuring an unarmed person vs. person with a gun. Clinician presence was identified in 1% of MBH-involved shootings. Police are de facto mental health system responders. Associated harms may be reduced through triage systems to facilitate clinician involvement, extreme risk protection order statutes, and better police training and protocols.
Emerging adulthood is a peak period for mental health problems, and transition to university heightens both risks and opportunities. Targeted interventions may support students with pre-existing conditions, but the evidence base has not been systematically updated since 2021. Following PRISMA guidelines, we searched MEDLINE, PsycINFO, Embase, and ERIC (2015-2025) for peer-reviewed studies evaluating interventions supporting students with diagnosed or self-reported mental health conditions during transition to higher education. Eligible designs included quantitative pre-post and controlled studies. Data extraction followed the TIDieR checklist, and risk of bias was assessed using a modified NIH tool. Eight studies (five interventions) were identified. Four interventions used controlled designs, three were randomised controlled trials. Common components included peer mentorship, goal setting, psychoeducation, and skills for independence. Several targeted help-seeking barriers, empowerment, and loneliness. Interventions were generally acceptable, with evidence of improvements in educational outcomes, adjustment, and depressive symptoms, but not anxiety. Most were opt-in, reliant on disclosure, and none were university-led. Targeted interventions show promise in supporting students with mental health conditions during university transition. However, evidence remains limited, heterogeneous, and predominantly North American. Larger, equity-focused, and university-led trials are urgently required.
The Emergency Department (ED) is a key setting for suicide risk assessments. In the UK, mental health professionals (MHPs) in psychiatry liaison teams assess suicide risk. This study aimed to explore how MHPs in EDs experience and approach the assessment of suicide risk for people presenting for suicidal ideation and/or self-harm. We interviewed 22 MHPs from one hospital (England) on their views of conducting psychosocial assessments. Interviews were recorded, transcribed and analysed using inductive thematic analysis. MHPs described various challenges, summarised in four main areas: the complexity of assessing suicide risk and lack of confidence in some patients/ accounts, the dynamic nature of risk, the impact/barrier of a structured assessment form, and institutional pressures and lack of resources. We identified views and attitudes that delegitimise patients. While such practices at an individual level need to be addressed, we posit this reflects organisational pressures that stifle practitioners' ability to prioritise therapeutic alliance. It is unsurprising that MHP experience moral injury that can be manifested as amplify biases and compassion fatigue. This calls for changes to support staff striving to make assessments therapeutic and we recommend both top-down and bottom-up initiatives to improve the experiences of MHPs and their patients.
Complex PTSD (CPTSD) is often associated with prolonged or repeated trauma exposure and the experience of intimate partner and childhood abuse. CPTSD includes the criteria for PTSD (re-experiencing, avoidance, and sense of threat) in addition to three criteria for self-organization disturbances (affective dysregulation, negative self-concept, and relational disturbance). This study aimed to assess profiles of CPTSD symptoms and their association with psychiatric distress among people with co-occurring Serious Mental Illness (SMI; schizophrenia/schizoaffective, bipolar, and treatment-refractory major depression). Treatment-seeking participants (N = 307) with SMI and PTSD diagnoses were drawn from two randomized controlled trials. Distinct symptom profiles were assessed using Latent Profile Analysis (LPA). A model with three classes best fit the data with the most parsimonious interpretation: 26.7% (n = 82) in the PTSD class, 43.7% (n = 134) in the CPTSD class, and 29.6% (n = 91) in the CPTSD+ Borderline Personality Disorder (BPD) class. The CPTSD+BPD class showed the highest levels of psychiatric symptoms, followed by the CPTSD and PTSD groups, respectively. The results demonstrate the heterogeneity in symptom presentation across the PTSD classes and that, despite similar diagnoses, individuals may present with varying symptom patterns. This emphasizes the importance of studying CPTSD in subpopulations of persons with SMI.
Given the importance of intimacy to well-being and recovery, this systematic review aimed to synthesise the available qualitative literature on mental health practitioners' views and experiences of supporting people's needs for romantic/intimate relationships. We conducted searches on four research publication databases. Quality of studies was assessed using the Joanna Briggs Institute Checklist for Qualitative Research. Results were summarised using meta-aggregation. Confidence in the findings was measured using the ConQual assessment tool. We identified 24 papers which met our inclusion criteria. Four synthesised findings were developed, namely (1) ideas and perceptions surrounding the intimacy needs of service users, (2) service provision at a personal level, (3) fitting intimacy needs into the therapeutic context and (4) service provision at an organisational level. Staff understood the importance of addressing intimacy needs, but voiced a need for improved knowledge, skills and support on how to have such conversations. Our findings can inform mental health policy change and support the development of interventions and guidelines that will enable staff to discuss with service users their needs regarding romantic/intimate relationships.
Intimacy, romance, and sexuality are associated with well-being in early psychosis, yet these topics are understudied relative to their subjective importance for people with psychosis. This study explored how individuals with early psychosis view and navigate intimacy, romance, and sexuality, and how these topics are conceptualized as part of recovery and addressed in mental health settings. In-depth qualitative interviews were conducted with 20 participants from early psychosis intervention programs in Ontario, Canada, and analyzed using reflexive thematic analysis. Our analyses generated three main themes and associated sub-themes, which included how intimacy, romance, and sexuality are addressed in mental healthcare (e.g., barriers, stipulations, strategies for approaching these topics), navigating relationships and sexuality in the context of mental health symptoms (e.g., experiences of stigma, symptom interference, a loss of relationships and opportunities), and recovery (e.g., future goals, the value of relationships). Many people experiencing early psychosis see romance, intimacy, and sexuality as facilitators and indicators of recovery, which is discrepant with the lack of attention these topics receive in healthcare settings. Addressing illness-related barriers to intimacy, romance, and sexuality in clinical settings is necessary to support the diverse recovery goals of people accessing these services.
Trends in news being increasingly accessed via social media warrants more attention to how mental illness and suicide news is being communicated on social platforms, which have the potential to amplify or mitigate stigma in wider audiences. This study aimed to determine how mental illness and suicide are portrayed in Facebook posts by Australian news organisations, and examine engagement trends with these posts. A systematic search of 22 Australian news Facebook pages was conducted on Meta's CrowdTangle database for posts about mental illness or suicide over a 1-year period. Of the 1343 Facebook news posts identified, over half (55%) comprised "helpful" content. News posts featuring people with lived experience were the most common topics with helpful content, however harmful content was still prominent. Problematic content in news posts often included sensationalist, trivialising, or "suffering" language, and stigmatising or sensationalist quotes. Public engagement with news posts did not differ based on alignment with media guidelines. There is substantial room for improvement in how mental illness and suicide-related news is communicated on social media. Ensuring this aligns with responsible media guidelines will reduce public exposure to content that can perpetuate stigma and increase harms.
Burnout among healthcare workers is a growing concern worldwide, adversely affecting job satisfaction, performance, and well-being. Understanding the prevalence and psychosocial work-related factors that contribute to burnout is essential for designing effective interventions. We assessed the prevalence of burnout and examined psychosocial work environment factors as predictors among healthcare workers in Ghana. A cross-sectional design was used with 462 health workers from 14 healthcare facilities in three regions of Ghana (mean age = 34.05, SD = 5.62; 51.1% female). Descriptive statistics and regression modelling were used to analyse the data. Results shows that 33.3% reported moderate to high occupational exhaustion, 55.9% moderate to high depersonalization, and 95.2% low personal accomplishment. Job autonomy and control was associated with lower exhaustion and depersonalization and higher personal accomplishment. Workload and emotional demands, and performance feedback, were positively associated with exhaustion and depersonalization, while meaningful and skilful work, autonomy, and feedback positively predicted personal accomplishment. Burnout among Ghanaian health workers is high and closely linked to psychosocial work conditions. Interventions enhancing autonomy, managing workload, providing supportive feedback, and promoting emotional resilience are needed to reduce burnout and improve occupational well-being.