Research suggests that a significant minority of hospital in-patients could be more appropriately supported in the community if enhanced services were available. However, little is known about these individuals or the services they require.

To identify which individuals require what services, at what cost.

A ‘balance of care’ (BoC) study was undertaken in northern England. Drawing on routine electronic data about 315 admissions categorised into patient groups, frontline practitioners identified patients whose needs could be met in alternative settings and specified the services they required, using a modified nominal group approach. Costing employed a public-sector approach.

Community care was deemed appropriate for approximately a quarter of admissions including people with mild-moderate depression, an eating disorder or personality disorder, and some people with schizophrenia. Proposed community alternatives drew heavily on carer support services, community mental health teams and consultants, and there was widespread consensus on the need to increase out-of-hours community services. The costs of the proposed community care were relatively modest compared with hospital admission. On average social care costs increased by approximately £60 per week, but total costs fell by £1626 per week.

The findings raise strategic issues for both national policymakers and local service planners. Patients who could be managed at home can be characterised by diagnosis. Although potential financial savings were identified, the reported cost differences do not directly equate to cost savings. It is not clear whether in-patient beds could be reduced. However, existing beds could be more efficiently used.

None.

Expert-consensus guidelines have been developed for how members of the public should assist a person with a mental health problem or in a mental health crisis.

This review aimed to examine the range of guidelines that have been developed and how these have been implemented in practice.

A narrative review was carried out based on a systematic search for literature on the development or implementation of the guidelines.

The Delphi method has been used to develop a wide range of guidelines for English-speaking countries, Asian countries and a number of other cultural groups. The primary implementation has been through informing the content of training courses.

Further work is needed on guidelines for low- and middle-income countries.

A.F.J. is an unpaid member of the Board of Mental Health First Aid International (trading as Mental Health First Aid Australia), which is a not-for-profit organisation.

The mental health of university students, especially medical students, is of growing concern in the UK.

To estimate the prevalence of mental disorder in health sciences students and investigate help-seeking behaviour.

An online survey from one English university (n = 1139; 53% response rate) collected data on depression (using the nine-item Patient Health Questionnaire), anxiety (seven-item Generalised Anxiety Disorder Assessment), alcohol use (Alcohol Use Disorders Identification Test), self-harm and well-being, as well as help seeking.

A quarter of the students reported symptoms of moderate/severe depression and 27% reported symptoms of moderate/severe anxiety. Only 21% of students with symptoms of severe depression had sought professional help; the main reason for not seeking help was fear of documentation on academic records.

The study highlights the extent of mental health problems faced by health science students. Barriers to help seeking due to concerns about fitness-to-practise procedures urgently need to be addressed to ensure that this population of students can access help in a timely fashion.

None.

The family physician is key to facilitating access to psychiatric treatment for young people with first-episode psychosis, and this involvement can reduce aversive events in pathways to care. Those who seek help from primary care tend to have longer intervals to psychiatric care, and some people receive ongoing psychiatric treatment from the family physician.

Our objective is to understand the role of the family physician in help-seeking, recognition and ongoing management of first-episode psychosis.

We will use a mixed-methods approach, incorporating health administrative data, electronic medical records (EMRs) and qualitative methodologies to study the role of the family physician at three points on the pathway to care. First, help-seeking: we will use health administrative data to examine access to a family physician and patterns of primary care use preceding the first diagnosis of psychosis; second, recognition: we will identify first-onset cases of psychosis in health administrative data, and look back at linked EMRs from primary care to define a risk profile for undetected cases; and third, management: we will examine service provision to identified patients through EMR data, including patterns of contacts, prescriptions and referrals to specialised care. We will then conduct qualitative interviews and focus groups with key stakeholders to better understand the trends observed in the quantitative data.

These findings will provide an in-depth description of first-episode psychosis in primary care, informing strategies to build linkages between family physicians and psychiatric services to improve transitions of care during the crucial early stages of psychosis.

None.

Patients with schizophrenia or bipolar disorder have a high risk of developing type 2 diabetes.

To identify predictive factors for hyperglycaemic progression in individuals with schizophrenia or bipolar disorder and to determine whether hyperglycaemic progression rates differ among antipsychotics in regular clinical practice.

We recruited 1166 patients who initially had normal or prediabetic glucose levels for a nationwide, multisite, l-year prospective cohort study to determine predictive factors for hyperglycaemic progression. We also examined whether hyperglycaemic progression varied among patients receiving monotherapy with the six most frequently used antipsychotics.

High baseline serum triglycerides and coexisting hypertension significantly predicted hyperglycaemic progression. The six most frequently used antipsychotics did not significantly differ in their associated hyperglycaemic progression rates over the 1-year observation period.

Clinicians should carefully evaluate baseline serum triglycerides and coexisting hypertension and perform strict longitudinal monitoring irrespective of the antipsychotic used.

The authors report no financial or other relationship that is relevant to the subject of this article. Relevant financial activities outside the submitted work are as follows. I.K. has received honoraria from Astellas, Chugai Pharmaceutical, Daiichi Sankyo, Dainippon Sumitomo Pharma, Eisai, Eli Lilly, Janssen Pharmaceutical, Kyowa Hakko Kirin, Meiji Seika Pharma, MSD, Nippon Chemiphar, Novartis Pharma, Ono Pharmaceutical, Otsuka Pharmaceutical, Pfizer, Tanabe Mitsubishi Pharma, Shionogi and Yoshitomiyakuhin; has received research/grant support from AbbVie GK, Asahi Kasei Pharma, Astellas, Boehringer Ingelheim, Chugai Pharmaceutical, Daiichi Sankyo, Dainippon Sumitomo Pharma, Eisai, Eli Lilly, GlaxoSmithKline, Kyowa Hakko Kirin, Meiji Seika Pharma, MSD, Novartis Pharma, Ono Pharmaceutical, Otsuka Pharmaceutical, Pfizer, Takeda Pharmaceutical, Tanabe Mitsubishi Pharma, Shionogi and Yoshitomiyakuhin; and is a member of the advisory boards of Dainippon Sumitomo Pharma and Tanabe Mitsubishi Pharma. Y.T. has received speaker's honoraria from Dainippon-Sumitomo Pharma, Otsuka, Meiji-Seika Pharma, Janssen Pharmaceutical, Daiichi-Sankyo Company, UCB Japan and Ono Pharmaceutical. K.U. has received honoraria from Dainippon Sumitomo Pharma, Eisai, Eli Lilly, Janssen Pharmaceutical, Kyowa Hakko Kirin, Meiji Seika Pharma, MSD, Takeda Pharmaceutical, Hisamitsu Pharmaceutical, Otsuka Pharmaceutical, Pfizer, Tanabe Mitsubishi Pharma, Shionogi and Yoshitomiyakuhin. B.Y. has received speaker's honoraria from Otsuka Pharmaceutical and Janssen Pharmaceutical. J. I. has received honoraria from Dainippon Sumitomo Pharma, Eli Lilly, Janssen Pharmaceutical, Meiji Seika Pharma, MSD, Novartis Pharma, Otsuka Pharmaceutical and Mochida Pharma.

Children and adolescents with autism spectrum disorder (ASD) are a highly medicated group. Few studies have examined the neuropsychiatric profile and patterns of psychotropic medication use among adults with ASD.

To describe and compare the neuropsychiatric profile and psychotropic medication use in a cohort of adults with ASD and non-autistic controls.

Baseline data from a survey-based, longitudinal study of adults with ASD in Australia. Participants were 188 adults with ASD and 115 controls aged 25–80 years.

ASD was associated with increased odds of psychotropic medication use even when controlling for the presence of any neurological or psychiatric disorder. There were no corresponding indications for 14.4% of psychotropic medications prescribed to adults with ASD.

This study found substantial psychotropic prescribing for adults with ASD. Patterns of psychotropic medication use may reflect prescribing for behavioural indications despite limited evidence to support this practice.

None.

None.

Despite expansive knowledge on the detrimental effects of growing up with parents with alcohol use disorders (AUDs), little is known about the prognosis of alcohol treatment among parents with childcare responsibility.

This observational cohort study aimed to examine the prognosis of patients with and without childcare responsibility, in a conventional out-patient alcohol treatment clinic.

A consecutive AUD sample (N = 2201), based on ICD-10 Diagnostic Criteria for Research, was assessed with the European Addiction Severity Index during the clinical routine, at treatment entry and conclusion. Data on addiction severity, treatment course and drinking outcomes were derived, and adjusted odds ratios (AORs) were calculated with logistic-regression models. Drinking outcomes were compared in an intention-to-treat analysis, including all patients in a logistic regression with inverse probability weighting.

Patients with childcare responsibility (aged <18 years) had a less severe addiction profile and lower drop-out rate compared with patients without children or with children living out-of-home. They were also more likely to improve on all drinking-related outcomes, including abstinence (AOR 2.68, 95% CI 1.82–3.95), number of drinking days (AOR 2.45, 95% CI 1.50–4.03) and excessive drinking days (AOR 4.66, 95% CI 2.36–9.17); and those with children living out-of-home had better outcomes on abstinence (AOR 1.59, 95% CI 1.08–2.34) than patients without children.

Childcare responsibility among out-patients was associated with better treatment course and outcomes than those without or not living with their children. This knowledge can help guide clinical practice, effectuate interventions and inform social authorities.

Provider working conditions are important in mental health service delivery.

To identify variables associated with perceived recovery-oriented care among mental health professionals.

A total of 315 mental health professionals and 41 managers across four Quebec service networks completed questionnaires. Univariate and multilevel mixed-effects linear regressions for bivariate and multivariate analyses were performed using independent variables from the input–mediator–output–input model and recovery-oriented care.

Recovery-oriented care related to: working in primary care or out-patient mental health services, team support, team interdependence, prevalence of individuals with suicide ideation, knowledge-sharing, team reflexivity, trust, vision (a subset of team climate), belief in multidisciplinary collaboration and frequency of interaction with other organisations.

Optimising team processes (for example knowledge-sharing) and emergent states (for example trust) may enhance recovery-oriented care. Adequate financial and other resources, stable team composition, training on recovery best practices and use of standardised assessment tools should be promoted, while strengthening primary care and interactions with other organisations.

None.

Routine screening to identify mental health problems in English looked-after children has been conducted since 2009 using the Strengths and Difficulties Questionnaire (SDQ).

To investigate the degree to which data collection achieves screening aims (identifying scale of problem, having an impact on mental health) and the potential analytic value of the data set.

Department for Education data (2009–2017) were used to examine: aggregate, population-level trends in SDQ scores in 4/5- to 16/17-year-olds; representativeness of the SDQ sample; attrition in this sample.

Mean SDQ scores (around 50% ‘abnormal’ or ‘borderline’) were stable over 9 years. Levels of missing data were high (25–30%), as was attrition (28% retained for 4 years). Cross-sectional SDQ samples were not representative and longitudinal samples were biased.

Mental health screening appears justified and the data set has research potential, but the English screening programme falls short because of missing data and inadequate referral routes for those with difficulties.

None.

Involuntary admission can be traumatic and is associated with negative attitudes that persist after the episode of illness has abated.

We aimed to prospectively assess satisfaction with care at the points of involuntary admission and symptomatic recovery, and identify their sociodemographic, clinical and service experience predictors.

Levels of satisfaction with care, and clinical and sociodemographic variables were obtained from a representative cohort of 263 patients at the point of involuntary admission and from 155 of these patients 3 months after termination of the involuntary admission. Data were analysed with multiple linear regression modelling.

Higher baseline awareness of illness (B = 0.19, P < 0.001) and older age (B = 0.05, P = 0.001) were associated with more satisfaction with care at baseline and follow-up. Transition to greater satisfaction with care was associated with improvements in awareness of illness (B = 0.13, P < 0.001) and in symptoms (B = 0.05, P = 0.02), as well as older age (B = 0.04, P = 0.01). Objective coercive experiences were not associated with variation in satisfaction with care.

There is wide variation in satisfaction with coercive care. Greater satisfaction with care is positively associated with clinical variables such as increased awareness of illness.

None.

A theoretical model of individuals' experiences before, during and after involuntary admission has not yet been established.

To develop an understanding of individuals' experiences over the course of the involuntary admission process.

Fifty individuals were recruited through purposive and theoretical sampling and interviewed 3 months after their involuntary admission. Analyses were conducted using a Straussian grounded theory approach.

The ‘theory of preserving control’ (ToPC) emerged from individuals' accounts of how they adapted to the experience of involuntary admission. The ToPC explains how individuals manage to reclaim control over their emotional, personal and social lives and consists of three categories: ‘losing control’, ‘regaining control’ and ‘maintaining control’, and a number of related subcategories.

Involuntary admission triggers a multifaceted process of control preservation. Clinicians need to develop therapeutic approaches that enable individuals to regain and maintain control over the course of their involuntary admission.

None.

It is well established that migration and ethnic minority status are risk factors for psychotic disorders. Recent studies have aimed to determine if they are also associated with subclinical psychosis (psychotic-like experiences and schizotypal traits).

We aimed to determine to what extent migrant and ethnic minority groups are associated with higher risk of subclinical psychosis.

We conducted a systematic review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, and examined findings by ethnicity, migrant status, outcomes of subclinical psychosis and host country. A meta-analysis was carried out with robust variance estimation where possible, to handle statistically dependent effect size estimates.

We included 28 studies (19 studies on psychotic-like experiences and 9 studies on schizotypal traits) and found that ethnicity, but not migrant status, was associated with current and lifetime psychotic-like experiences. In the narrative analysis, we observed the effect of psychosocial risk factors on this association: Black ethnicity groups showed consistent increased prevalence of current and lifetime psychotic-like experiences compared with the reference population across countries.

More generalisable and standardised cohort studies of psychotic-like experiences and schizotypal traits in relation to migration/ethnicity are necessary to examine the effects of exposures and outcomes in different contexts, and to understand the underlying mechanisms of the association between subclinical psychosis and migrant and ethnic minority status.

None.