It is likely that those planning, managing or commissioning mental health services will be able to create changes that make them more effective for people seeking asylum. There are some recurrent themes in publications about what changes are needed. However, priorities are different in different situations and from different perspectives. One approach to choosing how to use limited resources is to consider what guiding principles are most important. We consider the implications of adopting each of six principles: anti-racist and anti-discriminatory practice; ‘first do no harm’; a human rights approach; evidence-based care; using public health principles; working with organisational values. An alternative approach to deciding on what actions to prioritise is to identify specific goals. We discuss what might be done towards the following nine goals: involving people seeking asylum; improving interpreting; removing barriers to access; using training, supervision and support to enable staff to provide good care; working with community groups and other agencies; working to guidelines, standards or checklists; creating alternative services; prevention; making a difference quickly.

Clinical psychologists, even those who work in solo practices, are part of a larger health care delivery system. The chapter frames the evidence-based practice of a clinical psychologist in the broader context by outlining the evolving parameters of service delivery and how the field is aiming to provide integrated, patient-centred care that is committed to accountability. It is apparent that clinical psychology’s commitment to accountable practice adds value to integrated care and psychologists bring specific skills to the health care system. The chapter outlines the specific skills that clinical psychologists need to provide effective interventions expeditiously, be good team players, understand their medical colleagues, articulate their distinctiveness, be accountable for outcomes and to attend to ethical issues.

Access to effective psychosocial treatment for psychosis continues to be elusive in the United States. For years, the literal and figurative costs associated with the diagnosis of schizophrenia have been known, policies to promote improved national mental healthcare have been in place and recommendations for evidence-based treatments have existed. And yet, the implementation and uptake of such policies and recommendations within psychosis treatment have only been moderately successful because clinicians have been overlooked as agents of change. Continuous development and transmission of the latest evidence and practices for psychosocial treatments for psychosis are essential, but so is the support of the individual clinicians who will implement them. The path forward must attack this problem from a number of directions and can follow the recommendations put forth by the President’s New Freedom Commission. We conclude with concrete action steps individual providers can take to facilitate change.

It can be difficult to determine when a child can be defined as having complex medical needs (Cohen et al., 2011). What one family finds complex, another family may adapt to more easily. One child with a particular condition may have less severity and more function than another child with the same or a similar condition. Furthermore, the discussion around the care of children with complex medical needs has often used different terms for similar things – care that is ‘medically complex’, or children who are ‘technology dependent’ or ‘medically frail’.

This chapter explores some of the causes of complex medical needs in children and young people, and discusses related nursing care and interventions. The important and central role of parents, caregivers and families in the care of children with complex needs is also considered. The chapter concludes by discussing the challenges facing young people with complex conditions and their families as they transition from paediatric to adult healthcare services.