While some digital supports aid in improving young people's mental health, there is a dearth of information regarding the most effective ways to involve young people in the co-production of digital technologies. User input is essential, particularly for marginalised young people who are often excluded. The aim of this scoping review was to examine recent literature on the most common co-production processes of digital mental health supports with marginalised young people. A scoping review was conducted to identify literature published since 2021, written in English, focusing on co-production processes of digital mental health supports with marginalised young people aged 16-25. Basic information, data relating to the research question and key findings were extracted. A combination of Excel and Covidence management software was used to collate the charted data and manage the screening process. Studies were included if they used innovative youth-led approaches in the design, development, implementation or evaluation of digital mental health supports ranging from mental health promotion to targeted interventions. Out of 2341 studies initially screened, 21 studies published between 2021 and 2023 with a range of study designs and evidence were included. The studies reported on engagement with marginalised young people in the design, implementation, and/or evaluation of digital mental health technologies. The review examined qualitative and mixed methods studies from eleven countries, with most co-produced digital supports relating to mental health promotion and prevention. Most common were supports targeting general mental health and mental wellbeing. More than half of the studies included representation from LGBTQ+ young people, followed by ethnic minorities and migrants, but few included other marginalised groups. Only 6 of 21 studies used innovative approaches and many typically involved young people in only one of the co-production processes with design identified as most common. Finally, passive rather than active participation of young people was found to be pronounced. This limits young people's opportunities to shape the outcome to the data collection process only. Given the extent to which marginalised groups are actually involved in co-production, the review suggests the need for young people to be more actively involved in all co-production processes of digital mental health technologies. Offering a diverse range of methods through innovative, participatory approaches can facilitate more effective engagement from young people and provide an environment that is inclusive to a range of voices and perspectives. Lastly, the lack of inclusion of marginalised groups such as young people with a disability, or youth living in rural areas is an important issue to consider for future research.
People with disabilities (PWD) are more likely to report experiencing more mental distress than those without disabilities. Previous research suggests a general lack of knowledge and experience limits a mental health professional's ability to provide quality mental health services to PWD. To examine self-reported preparedness and comfort of licensed mental health professionals in providing services to PWD with co-occurring mental health issues in Connecticut. Mental health professionals were identified by the Connecticut Department of Public Health (DPH) and 640 professionals completed the 23-item online survey related to their experiences providing mental health services to PWD. Most participants felt prepared (79%) and comfortable (80%) in providing mental health services to PWD, however, only 59% reported receiving formal training in providing mental health services to PWD. Increased years of experience and receiving professional training were significantly related to feeling more prepared and comfortable in treating PWD for mental health issues (all p-values <.001). Results support the need for professional training programs to include disability content and develop disability competence among current and future providers. Additional work is needed to address other systemic barriers to quality, effective mental health care for PWD.
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.
Systematic reviews have identified variation and inequity in care provision for people with pre-existing severe mental illnesses who have palliative or end-of-life care needs. To analyse service use and variation for people with severe mental illness in the last year of life in Wales. This is an observational retrospective cohort study between 2018 - 2023 using anonymised linked routinely collected health datasets within a data dashboard. We identified n = 4722 (2.3%) deaths with ICD-10 codes for severe mental illness for the period 2018-2023. As a group, people with severe mental illness die younger, are in receipt of specialist palliative care at lower rates, die more often in institutional settings rather than their own homes and comorbidity indicates more unscheduled care use in the last year of life. Unscheduled care use in the last year of life is associated with comorbidity, indicating opportunities for upstream intervention to improve treatment, experience, and quality of life for people with severe mental illness. Further investigation, such as mixed methods approaches to examine experiences of those with severe mental illness in the last year of life, and the human and systems factors influencing the nature and effectiveness of unscheduled delivery, is needed.
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.
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.
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.
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.
Actively engaging clients in managing their health and care is crucial for person-centered mental healthcare. Self-monitoring tools such as the Experience Sampling Method (ESM) can help individuals collect information about their mental health and daily activities on their smartphones and share this with their clinicians. This qualitative paper examines how ESM self-monitoring might enhance self-insight, self-management, self-efficacy, therapeutic alliance, and shared decision-making and this way facilitate the activation of clients in mental healthcare. Twelve clinicians and 24 clients participated in the IMPROVE study. After using the IMPROVE ESM self-monitoring tool, seven clinicians and 11 clients were interviewed, and a thematic analysis examined participants' experiences of changes in processes related to client activation. Clients reported improvements in self-awareness, self-insight, and self-management. Only a few participants experienced enhanced self-efficacy, improved therapeutic alliances, and more client involvement. Self-awareness was mainly boosted via smartphone self-monitoring, while collaborative data interpretation between clients and clinicians was crucial for unlocking insights about clients' mental health and creating actionable therapy goals. Our findings suggest that using ESM self-monitoring tools can help facilitate the activation of clients in mental healthcare. Future research should develop best practice guidelines for integrating these tools into clinical care.
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.
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.
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.
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.
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.