Due to the high rates of mental disorder in prison there have been a number of initiatives to divert mentally disordered offenders out of custody. One of these is the Mental Health Treatment Requirement (MHTR): a criminal sentence available as part of a Community Order, offered as an alternative to short-term custodial sentences in an attempt to address recidivism and encourage concordance with community psychiatric treatment. In spite of the prevalence of mental disorder amongst offenders, MHTRs represent less than 1% of all community sentences. Here we aim to identify obstacles to the use of the MHTR at sentencing and to suggest ways of overcoming them.

A literature review and brief case series will be used to identify and illustrate what may be obstructing or limiting the use of the MHTR. The terms ‘MHTR’ and ‘Mental Health Treatment Requirement’ were searched on Google, Google Scholar, Athens, and PubMed, and results analysed for recurrent themes. The issues encountered clinically by one of the authors who referred three defendants for MHTRs in psychiatric sentencing reports in 2021 were reviewed with the same purpose.

The main barriers to the use of the MHTR which were identified were issues related to a lack of clinician awareness and experience, homelessness and housing, and service structure and provision. There may be a reluctance for Community Mental Health Teams (CMHTs) to accept offenders onto their caseloads, and there are challenges in obtaining assessments and recommendations for MHTRs. There are difficulties in securing an MHTR for homeless defendants on remand for whom identifying housing prior to sentencing, and thus a CMHT to supervise the MHTR, can be challenging. The MHTR assessment and referral process is more lengthy and cumbersome than that for most other disposals, leaving the defendant awaiting sentencing (potentially in custody) while the referral is processed.

Suggested solutions to improve access to the MHTR include increasing clinician awareness and confidence by providing teaching and training, and multi-agency meetings to enhance communication and create an understanding amongst professionals of duties, roles, and responsibilities. Initiatives to identify housing for homeless remand prisoners before their release, as well as ensuring the availability of community services to supervise treatment, would overcome some of the obstacles identified and increase availability of the MHTR. Funding for additional staff to conduct the assessment and referrals process would also be likely to improve uptake.

Firefighters are frequently exposed to stressful situations and are at high risk of developing post-traumatic stress disorder (PTSD). Hyperresponsiveness to threatening and emotional stimuli and diminishment of executive control have been suggested as manifestations of PTSD.

To examine brain activation in firefighters with PTSD by conducting an executive control-related behavioural task with trauma-related interferences.

Twelve firefighters with PTSD and 14 healthy firefighters underwent functional magnetic resonance imaging (fMRI) while performing a Stroop match-to-sample task using trauma-related photographic stimuli. Seed-based functional connectivity analysis was conducted using regions identified in fMRI contrast analysis.

Compared with the controls, the participants with PTSD had longer reaction times when the trauma-related interferences were presented. They showed significantly stronger brain activation to interfering trauma-related stimuli in the left insula, and had weaker insular functional connectivity in the supplementary motor area and the anterior cingulate cortex than the controls. They also showed a significant correlation between left insula–supplementary motor area connectivity strength and the hyperarousal subscale of the Clinician-Administered PTSD Scale.

Our findings indicate that trauma-related stimuli elicit excessive brain activation in the left insula among firefighters with PTSD. Firefighters with PTSD also appear to have weak left insular functional connectivity with executive control-related brain regions. This aberrant insular activation and functional connectivity could be related to the development and maintenance of PTSD symptoms in firefighters.

Hackney is home to the largest Charedi Orthodox Jewish community in Europe. According to the Census 2011, 7% of the population of Hackney are Charedi. Hatzola is a non-profit, volunteer organisation established in 1979 to provide pre-hospital emergency medical response and transportation to acute hospitals at no cost, to those living in and around the North London Charedi community. Given the large Charedi population served by Homerton University Hospital it is a common occurrence for psychiatry liaison staff to work side by side with Hatzola in delivering care to those in mental health crisis. Our aim was to create and nurture a professional relationship between Homerton University Hospital Psychiatry Liaison Service and Hatzola ambulance. We wanted to gain an understanding of the perception of mental illness within the Charedi community, and identify issues faced by members of Hatzola when working with those with mental illness. We wanted to identify the learning needs of Hatzola around psychiatric illness as well as increasing confidence within team members when called to manage mental health crises.

We scheduled an initial meeting with Hatzola to gain an understanding of their service. We used questionnaires to ascertain their level of knowledge on managing mental health patients. We set out to provide teaching sessions to address Hatzola's learning needs.

We designed interactive teaching sessions based on providing mental health first aid, discussing case studies, considering the legal framework around emergency mental health. We ensured coverage of working with both adults and children with mental health difficulties. We delivered these teaching sessions in person over four consecutive weekly meetings, with the sessions being recorded to serve as an educational resource.

We gathered qualitative evidence reflecting the impact of our intervention. We were able to compare levels of confidence among Hatzola members before and after our teaching programme.

Our training programme was well received by Hatzola, and it was an excellent opportunity to develop links with members of the community.

We have learned that mental health is a taboo subject for members of the Charedi community, and have identified a need for more support to Hatzola in coping with the emotional toll working with mental health patients can take. There may be scope for providing further training on developing reflective practice and more emotional support for Hatzola members in future.

Early-life interpersonal stress, particularly childhood maltreatment, is associated with neurobiological abnormalities. However, few studies have investigated the neural effects of peer victimisation.

This study examines common and specific associations between childhood maltreatment, peer victimisation and brain structural alterations in youths.

Grey matter volume (GMV) and cortical thickness data were collected from 105 age- and gender-matched youths (age range: 17–21 years). Region-of-interest and whole-brain analyses were conducted.

For the region-of-interest analyses, the childhood maltreatment group had smaller GMV than controls in left inferior frontal gyrus, bilateral anterior insula, postcentral and lingual regions, which were associated with greater emotional abuse, along with smaller insular GMV than the peer victimisation group, who had smaller left lingual and postcentral GMV than controls. At the whole-brain level, both childhood maltreatment and peer victimisation groups had smaller GMV than controls in a cluster comprising left post/precentral, inferior frontal gyrus, insula, superior parietal and supramarginal gyri. The peer victimisation group alone had increased cortical thickness in a cluster comprising left superior frontal, anterior cingulate and medial orbitofrontal gyri, which was related to greater cyberbullying.

Early-life interpersonal stress is associated with common structural alterations of the inferior frontal-limbic, sensory and lingual regions involved in cognitive control, emotion and sensory processing. The findings of childhood-maltreatment-related reduced anterior insular GMV and peer-victimisation-related increased cortical thickness in the left medial prefrontal-anterior cingulate cluster underscore the distinctive negative effects of childhood maltreatment and peer victimisation, and suggest that peer victimisation, particularly cyberbullying, could be as detrimental as childhood maltreatment.

Poverty in adolescence is associated with later drug use. Few studies have evaluated the role of adolescent psychiatric disorders in this association.

This study aimed to investigate mediation and interaction simultaneously, enabling the disentanglement of the role of adolescent psychiatric disorders in the association between poverty in adolescent and later drug use disorders.

A national cohort study of 634 223 individuals born in 1985–1990, residing in Sweden between the ages of 13 and 18 years, was followed from age 19 years until the first in-patient or out-patient care visit with a diagnosis of drug use disorder. A four-way decomposition method was used to determine the total effect of the association with poverty and possible mediation by and/or interaction with diagnosis of adolescent psychiatric disorders.

The hazard ratios for drug use disorders among those experiencing poverty compared with those ‘never in poverty’ were 1.40 (95% CI, 1.32–1.63) in females and 1.43 (95% CI, 1.37–1.49) in males, after adjusting for domicile, origin and parental psychiatric disorders. Twenty-four per cent of this association in females, and 13% in males, was explained by interaction with and/or mediation by adolescent psychiatric disorders.

Part of the association between poverty in adolescence and later drug use disorders was due to mediation by and/or interaction with psychiatric disorders. Narrowing socioeconomic inequalities in adolescence might help to reduce the risks of later drug use disorders. Interventions aimed at adolescents with psychiatric disorders might be especially important.

Bipolar disorder is a chronic and severe mental health disorder. Early stratification of individuals into subgroups based on age at onset (AAO) has the potential to inform diagnosis and early intervention. Yet, the psychosocial predictors associated with AAO are unknown.

We aim to identify psychosocial factors associated with bipolar disorder AAO.

Using data from the Bipolar Disorder Research Network UK, we employed least absolute shrinkage and selection operator regression to identify psychosocial factors associated with bipolar disorder AAO. Twenty-eight factors were entered into our model, with AAO as our outcome measure.

We included 1022 participants with bipolar disorder (μ = 23.0, s.d. ± 9.86) in our model. Six variables predicted an earlier AAO: childhood abuse (β = −0.2855), regular cannabis use in the year before onset (β = −0.2765), death of a close family friend or relative in the 6 months before onset (β = −0.2435), family history of suicide (β = −0.1385), schizotypal personality traits (β = −0.1055) and irritable temperament (β = −0.0685). Five predicted a later AAO: the average number of alcohol units consumed per week in the year before onset (β = 0.1385); birth of a child in the 6 months before onset (β = 0.2755); death of parent, partner, child or sibling in the 6 months before onset (β = 0.3125); seeking work without success for 1 month or more in the 6 months before onset (β = 0.3505) and a major financial crisis in the 6 months before onset (β = 0.4575).

The identified predictor variables have the potential to help stratify high-risk individuals into likely AAO groups, to inform treatment provision and early intervention.

The aim of this research was to highlight the aspects of Buddhist philosophy which may help to improve mental health. COVID-19 has had a considerable psychological impact on healthcare staff and the general population, emphasizing the importance of treatments and techniques to aid their mental health.

Mindfulness, Impermanence and Non-self were discussed as core aspects of Buddhist philosophy and how these relate to mental well-being. Reference was made to peer-reviewed studies that show the positive effects of these concepts.

This research highlighted the wealth of evidence that Mindfulness, Impermanence and Non-self has in improving mental well-being. However, there were also risks, including depersonalisation and increased anxiety in certain mindfulness practitioners.

The findings of this research has generated new ways in which we discuss mental well-being and challenges our current understanding of suffering, providing individuals with further tools to assist with their mental health. This study challenges the idea that philosophy and medicine must be discussed separately and seeks to find further common ground between these two disciplines.

Looked-after children are at risk of suboptimal attachment patterns and reactive attachment disorder (RAD). However, access to interventions varies widely, and there are no evidence-based interventions for RAD.

To modify an existing parenting intervention for children with RAD in the UK foster care setting, and test the feasibility of conducting a randomised controlled trial (RCT) of the modified intervention.

The intervention was modified with expert input and tested on a case series. A feasibility and pilot RCT compared the new intervention with usual care. Foster carers and children in their care aged ≤6 years were recruited across nine local authorities, with 1:1 allocation and blind post-treatment assessments. The modified intervention was delivered in-home by trained mental health professionals over 4–6 months. Children were assessed for RAD symptoms, attachment quality and emotional/behavioural difficulties, and foster carers were assessed for sensitivity and stress.

Minimal changes to the intervention programme were necessary, and focused on improving its suitability for the UK foster care context. Recruitment was challenging, and remained below target despite modifications to the protocol and the inclusion of additional sites. Thirty families were recruited to the RCT; 15 were allocated to each group. Most other feasibility outcomes were favourable, particularly high numbers of data and treatment completeness. The revised intervention was positively received by practitioners and foster carers.

A large-scale trial may be feasible, but only if recruitment barriers can be overcome. Dedicated resources to support recruitment within local authorities and wider inclusion criteria are recommended.

Around one in ten people who contract COVID-19 report persistent symptoms or ‘long COVID’. Impaired mental health and well-being is commonly reported, including anxiety, depression and reduced quality of life. However, there is limited in-depth research exploring why mental health and well-being are affected in people experiencing long COVID.

To explore factors affecting mental health and well-being from the perspective of people with long COVID.

Semi-structured qualitative interviews were audio-recorded and transcribed. Data were analysed using reflexive thematic analysis. Twenty-one people with long COVID participated in the study. Participants were eligible if they self-reported a positive swab test/antibody test or one or more commonly reported COVID-19 symptoms at illness onset. and experiences of one or more long COVID symptoms ≥3 weeks following illness onset.

Five themes were identified across participant accounts regarding factors affecting mental health and well-being, including symptoms causing severe disruption to daily life, lack of service and treatment options, uncertainty of illness trajectories, experiences of care and understanding from others and changes to identity.

People with long COVID experience a range of factors that negatively affect their mental health and well-being. Providing patient-centred health services that integrate rapidly evolving research in this area is important, as are peer support groups and supported approaches to self-management.

This teaching project aims to improve attitudes and perspectives towards psychiatry by using Patient as Educators (PaE) in a psychiatry teaching program early in medical training.

Following the success of a small pilot study in 2020, the project was rolled out to the entire second year medical student body in 2021. Two-hour interactive sessions were delivered online to groups of approximately twelve students. Each session was introduced by a psychiatrist, followed by PaE discussion with questions and answers. The students completed a bespoke online survey at the beginning and the end of the session, looking at attitudes towards psychiatry. Comparative analysis of attitudes pre- and post-intervention was then undertaken. Qualitative data were examined through content analysis and quantitative methods were used to compare pre- and post- attitudes on the Likert scale.

The pre- and post-intervention questionnaires were completed by 373 and 305 students respectively. Both pre- and post-intervention attitudes were overwhelmingly positive. Post-intervention qualitative results demonstrate the session, especially the PaE, helped students to better understand the complexities of mental illness, the stigma faced and the potential efficacy of good treatment. There was a 25.7% increase in students’ perception of preparedness to see mentally unwell patients. The most significant findings were that the majority of students found having the PaE valuable in improving attitudes regarding the value of psychiatry (72.8% agreed/strongly agreed) and increasing interest in the speciality (84% agreed/strongly agreed).

Early experience to clinical placements is an essential component in medical education. In Psychiatry, apart from gentle introduction into the specialty, it is essential that students are orientated into the world of mental health and its various challenges. This project has clearly demonstrated the effectiveness of early exposure of medical students to psychiatry as a specialty. It also demonstrates the effectiveness of using PaE in medical education. Further research would aim to examine whether effect on attitudes persist and correlate the effect on early exposure on recruitment to the speciality.

The severity of COVID-19 remains high worldwide. Therefore, millions of individuals are likely to suffer from fear of COVID-19 and related mental health factors.

The present systematic review and meta-analysis aimed to synthesize empirical evidence to understand fear of COVID-19 and its associations with mental health-related problems during this pandemic period.

Relevant studies were searched for on five databases (Scopus, ProQuest, EMBASE, PubMed Central, and ISI Web of Knowledge), using relevant terms (COVID-19-related fear, anxiety, depression, mental health-related factors, mental well-being and sleep problems). All studies were included for analyses irrespective of their methodological quality, and the impact of quality on pooled effect size was examined by subgroup analysis.

The meta-analysis pooled data from 91 studies comprising 88 320 participants (mean age 38.88 years; 60.66% females) from 36 countries. The pooled estimated mean of fear of COVID-19 was 13.11 (out of 35), using the Fear of COVID-19 Scale. The associations between fear of COVID-19 and mental health-related factors were mostly moderate (Fisher's z = 0.56 for mental health-related factors; 0.54 for anxiety; 0.42 for stress; 0.40 for depression; 0.29 for sleep problems and –0.24 for mental well-being). Methodological quality did not affect these associations.

Fear of COVID-19 has associations with various mental health-related factors. Therefore, programmes for reducing fear of COVID-19 and improving mental health are needed.

Patients with alcohol use disorder (AUD) are at high risk for suicide attempts. Mental health problems along with AUD-related factors may contribute to this increased risk. Studies have shown sex differences in rates and correlates of suicide attempts.

The purpose of the study was to examine mental-health-related and AUD-related factors associated with suicide attempt separately in female and male AUD patients.

We collected information about lifetime suicide attempt and mental-health- and AUD-related factors for AUD in-patients (n = 114; 32 females) receiving rehabilitative treatment.

The prevalence of lifetime suicide attempt was 27%, and the rate was similar in both sexes. Among females, current depressive symptoms and current post-traumatic stress disorder diagnosis were associated with suicide attempt. In male AUD patients, among the mental-health-related factors, lifetime major depression, panic disorder, social phobia, childhood sexual abuse and antisocial personality disorder were associated with suicide attempt. In addition, AUD-related factors including longer duration of drinking, history of delirium tremens, greater severity of AUD and lower levels of prolactin were associated with suicide attempt in males.

Our results indicate that suicide attempts in female AUD patients were more mental-health-related, whereas those in males were also related to the severity of AUD. This suggests that a suicide prevention programme for AUD patients would benefit from a sex-based understanding of the risk factors.

Mental health disorders can be a burden on both patients and the National Health Service. With the majority of lifetime mental health problems emerging in childhood and the prevalence of childhood mental illness increasing, the need for effective, standardised mental health education and fostering healthy socio-emotional development is more important than ever before. The aim was to explore if Inside Out provides an accurate representation of depression, and thus, can it be a useful resource for teaching mental health and developing emotional awareness in the classroom?

I explored a novel educational concept: ‘edutainment’, to see if it has use in state mental health education. This project provides a quantitative coding analysis and a qualitative artistic analysis of a contemporary Disney film, Inside Out (2015), for The International Classification of Diseases 10th Edition (ICD-10) depression symptoms. Depression has been chosen as an example of a mental health disorder as it is one of the commonest mental health problems and the leading cause of disability worldwide.

Inside Out provides an accurate representation of many of the ICD-10 ‘core’ and ‘cognitive’ symptoms of depression through both coding words and artistic means.

Inside Out, alongside teacher-led discussion, could be useful in teaching children about depression in a relaxed but educational way. Inside Out features themes that can help children develop their emotional intelligence and reduce mental health stigma. I highlight a need for standardised mental health education and suggest that film may be an effective tool for learning about common mental health conditions, such as depression.

People who experience homelessness are thought to be at high risk of suicide, but little is known about self-harm in this population.

To examine characteristics and outcomes in people experiencing homelessness who presented to hospital following self-harm.

Data were collected via specialist assessments and/or hospital patient records from emergency departments in Manchester, Oxford and Derby, UK. Data were collected from 1 January 2000 to 31 December 2016, with mortality follow-up via data linkage with NHS Digital to 31 December 2019. Trend tests estimated change in self-harm over time; descriptive statistics described characteristics associated with self-harm. Twelve-month repetition and long-term mortality were analysed using Cox proportional hazards models and controlled for age and gender.

There were 4841 self-harm presentations by 3270 people identified as homeless during the study period. Presentations increased after 2010 (IRR = 1.09, 95% CI 1.04–1.14, P < 0.001). People who experienced homelessness were more often men, White, aged under 54 years, with a history of previous self-harm and contact with psychiatric services. Risk of repetition was higher than in domiciled people (HR = 2.05, 95% CI 1.94–2.17, P < 0.001), as were all-cause mortality (HR = 1.45, 95% CI 1.32–1.59. P < 0.001) and mortality due to accidental causes (HR = 2.93, 95% CI 2.41–3.57, P < 0.001).

People who self-harm and experience homelessness have more complex needs and worse outcomes than those who are domiciled. Emergency department contact presents an opportunity to engage people experiencing homelessness with mental health, drug and alcohol, medical and housing services, as well as other sources of support.

This study aims to explore the relationship between mental well-being (The Warwick-Edinburgh Mental Well-being Scale), stress (Appraisal of Life Events Scale) and mindfulness (5 Facet Mindfulness Questionnaire) by means of a questionnaire.

The questionnaire was part of a mixed-method study looking into Mindfulness Resilience and Effectiveness Training in foundation doctors. In total 144 foundation doctors across the North West of England completed the questionnaire over a period of 5 months.

A Pearson's correlation coefficient was used to assess the relationships between mental well-being, appraisal of stress and mindfulness. Results show that there was a significant, negative, and somewhat weak association between mental well-being and the appraisal of stressful life events (r = (142) –.23, p = .006). A significant, positive, and strong relationship was also found between the two variables mindfulness and mental well-being (r (142) = .60, p < 0.001), in addition to a significant, weak positive relationship between mindfulness and appraisal of stressful life events (r (142) = –.18, p = .033).

The results indicate that those with greater mental well-being were better able to tolerate stressful life events and appraise them as a challenge. Likewise, those with greater mindfulness scores showed greater well-being suggesting that improving one may improve the other. This has implications for intervention development (e.g., training in mindfulness) which can help to further improve well-being and appraisal of stressful life events in trainee doctors.

Mental illness has a significant impact not only on patients, but also on their carers’ capacity to work.

To estimate the costs associated with lost labour force participation due to the provision of informal care for people with mental illness in Australia, such as income loss for carers and lost tax revenue and increased welfare payments for government, from 2015 to 2030.

The output data of a microsimulation model Care&WorkMOD were analysed to project the financial costs of informal care for people with mental illness, from 2015 to 2030. Care&WorkMOD is a population-representative microsimulation model of the Australian population aged between 15 and 64 years, built using the Australian Bureau of Statistics Surveys of Disability, Ageing and Carers data and the data from other population-representative microsimulation models.

The total annual national loss of income for all carers due to caring for someone with mental illness was projected to rise from AU$451 million (£219.6 million) in 2015 to AU$645 million (£314 million) in 2030 in real terms. For the government, the total annual lost tax revenue was projected to rise from AU$121 million (£58.9 million) in 2015 to AU$170 million (£82.8 million) in 2030 and welfare payments to increase from AU$170 million (£82.8 million) to AU$220 million (£107 million) in 2030.

The costs associated with lost labour force participation due to the provision of informal care for people with mental illness are projected to increase for both carers and government, with a widening income gap between informal carers and employed non-carers, putting carers at risk of increased inequality.

Lockdown during the pandemic has had significant impacts on public mental health. Previous studies suggest an increase in self-harm and suicide in children and adolescents. There has been little research on the roles of stringent lockdown.

To investigate the mediating and predictive roles of lockdown policy stringency measures in self-harm and emergency psychiatric presentations.

This was a retrospective cohort study. We analysed data of 2073 psychiatric emergency presentations of children and adolescents from 23 hospital catchment areas in ten countries, in March to April 2019 and 2020.

Lockdown measure stringency mediated the reduction in psychiatric emergency presentations (incidence rate ratio of the natural indirect effect [IRRNIE] = 0.41, 95% CI [0.35, 0.48]) and self-harm presentations (IRRNIE = 0.49, 95% CI [0.39, 0.60]) in 2020 compared with 2019. Self-harm presentations among male and looked after children were likely to increase in parallel with lockdown stringency. Self-harm presentations precipitated by social isolation increased with stringency, whereas school pressure and rows with a friend became less likely precipitants. Children from more deprived neighbourhoods were less likely to present to emergency departments when lockdown became more stringent,

Lockdown may produce differential effects among children and adolescents who self-harm. Development in community or remote mental health services is crucial to offset potential barriers to access to emergency psychiatric care, especially for the most deprived youths. Governments should aim to reduce unnecessary fear of help-seeking and keep lockdown as short as possible. Underlying mediation mechanisms of stringent measures and potential psychosocial inequalities warrant further research.