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The complex challenges facing the healthcare sector call for a revision of the ways it can provide high-quality services with economic sustainability. Revision can proceed along different pathways. Among the new paradigms of healthcare is the shift from a silo approach by hospitals towards an integrated, multidisciplinary approach. This entails restructuring hospitals in disease centres and exploring how AI can aid in the integration of hospital services and community care. Reorganization is vital to the development of patient-centred healthcare and the holistic approach. To achieve these goals, healthcare and policy decision-makers need to consider both the administrative and the clinical aspects of everyday issues. AI can play a key role in helping balance this duality. The overarching objective is to create interdisciplinary therapeutic and diagnostic pathways within care networks shared between the hospital and the community. This involves the analysis of huge amounts of data and interdisciplinary knowledge beyond the grasp of an individual. Therefore, knowing how AI can help in the development and reorganization of community healthcare is essential for clinical leaders to take advantage of this enormous opportunity in larger settings.

This chapter reviews the evidence on the role of physicians in shaping inequalities in access to and utilisation of healthcare. The authors examine three types of physician decisions that can influence inequalities in access and utilisation: location decisions, decisions to work in the public and/or private sector, and decisions or behaviours in the doctor–patient encounter. For each, the authors summarise the issues and empirical evidence on possible policies to help reduce inequalities in access. Future research to reduce inequalities should focus on changes to health systems that influence physician decisions, such as health insurance expansions, the public–private mix and financial incentives, as well as physician training and policies for a more diverse physician workforce.

In educational settings, intersectional factors such as neurodiversity, structural inequalities and social isolation have resulted in additional complexity in meeting young people’s mental health needs. The specific phenomenon of voice-hearing can be linked to these complexities and stigma has been shown to further marginalise young people following disclosure. Educational staff report a lack of confidence and specialist training in this area. This chapter outlines the current understanding around the experience of voice-hearing and identifies examples of good practice by considering the lived experiences of individuals that have made a disclosure of this nature in school. Barriers to disclosure and what was helpful about the experience are discussed. Developing a trauma-informed ethos and compassion-focussed principles are highlighted as whole-setting approaches to support and benefit both young people with these presentations and education staff. Recommendations of relevant organisations and training initiatives in schools are provided with guidance on developing and implementing best practices.

The second chapter of this text provides an introduction to policy relating to mental health, addiction and dual diagnosis from three jurisdictions [Ireland, UK and Australia], chosen because of their close links to Irish people and mental health service provision. The chapter begins with an introduction, reflecting on key points raised in Chapter 1 and how they are relevant to this present chapter. A critical exploration of the policies within these three jurisdictional areas is then presented to highlight the strategic direction of mental health and addiction service provision within the three jurisdictions. This includes the acknowledgement that mental health and addiction services need to be integrated as the presence of dual diagnosis in modern society increases at an alarming rate. Finally, this chapter concludes with a link to each of the policies mentioned herein for those who wish to explore these issues further.

Tabletop ‘pen and paper’ role-play games (TTRPGs) can function as spaces of creative experimentation with gender identity through shared storytelling. The last decade has seen an explosion of Actual Play (AP) shows that broadcast recorded gameplay of TTRPGs to online audiences. Neverafter is the 15th season of well-known AP show Dimension 20 and is a horror-themed re-imagining of classic fairy tales through the rules of Dungeons and Dragons. Four of the six player characters are male, based individually on the fairy tales of Pinocchio, Puss in Boots, the Frog Prince, and a (gender-swapped) Mother Goose, adventuring together in a story-world called ‘The Neverafter’. Not only are these versions of the fairy tale characters shaped by the players' own explorations of identity, but as an AP show, this is also layered with the expectations produced by the show's wide fan base. Their diverse gender explorations and their subversion of fairy tale conventions are enabled by the fluency of the players and audience in freely flowing between the framing perspectives of player and character. This chapter will focus on non-binary player Ally Beardsley's creation and performance of Mother Timothy Goose as a gay, elderly, human man as a particularly meaningful case study. This analysis considers how heroic masculinity is reconceptualised in Neverafter through the horror-themed embodiment of fairy tale men in the context of contemporary gender issues.

Ensuring adequate access to healthcare services is a priority across European countries. The EU has developed performance indicators to compare access using self-reported unmet need. Cross-country comparisons require adjustment for factors outside the health systems' control. We address two research questions to improve the comparability of unmet need for medical and dental care across the EU and the comparability of socio-economic inequalities in unmet need across the EU. First, we explore the role of risk adjustment for demographic and socio-economic factors, which are outside health systems' control, for both overall unmet need and unmet need due to affordability, waiting lists and distance. Second, we compare differences in unmet need by socio-economic status, and investigate whether different forms of risk adjustment affect such comparison. We show that adjusting for age, gender and chronic conditions reduces dispersion of unmet need for medical care across the EU. Controlling for income further reduces the dispersion, mostly due to affordability. When comparing socio-economic inequalities across countries, risk adjustment for age, gender and chronic conditions play a limited role. Socio-economic inequalities by income and education vary by reason of unmet need: the income gradient, even controlling for education, is mostly due to affordability rather than waiting list or distance. For dental care, the main reason for unmet need is affordability. Risk adjustment for age, gender, chronic conditions and education plays a limited role. The income and education gradients are more pronounced for dental than medical care.

This chapter introduces the topic of mental health and wellbeing in schools and the overarching theoretical framework for the book. The evolving role of schools from nurturing environments to frontline support for pupils’ mental health and wellbeing is scrutinised in the context of demand, capacity and constraints in a post-pandemic world. Alongside this is a critical consideration of schools’ and education staff’s role, responsibilities and boundaries. The disparate mental health needs of pupils within the school population are discussed, as well as key risk and protective factors to help facilitate timely identification and appropriate support pathways for vulnerable pupils. Key topics and case studies which comprise the remainder of the book are introduced to navigate the reader, and this concludes the chapter.

Leadership as hosting is a leadership practice that shows promise of positively impacting the wellbeing of stakeholders in higher education organizations. This chapter examines this leadership practice and its effect on the wellbeing of stakeholders of higher education. Using the methodological design of grounded theory and an appreciative inquiry (AI) lens, this study involved 54 educators, who occupied a wide array of roles in post-secondary educational organizations, participating in two iterations of an electronic Delphi, a set of semi-structured interviews, and expert interviews. Findings revealed that those educators who hosted well-created, inviting educational environments that improve stakeholders’ wellbeing were competent at building positive relationships, managing vulnerabilities, creating a culture of support and care for constituents, and displaying high levels of emotional, social, and cultural intelligence (CQ) which enhanced the wellbeing of stakeholders.

This final chapter draws together the key findings presented in the preceding pages and considers emergent conclusions and implications for mental health and wellbeing in schools. The author draws upon the evidence presented by the book’s eclectic range of contributors and the health promoting schools’ (HPSs) framework to provide a road map of what an effective whole school approach (WSA) might look like moving forward. Crucially, lessons from recent crises in education, including COVID-19-driven changes in pathways to support, are highlighted as pivotal factors in a future vision which sees schools as an effective and sustainable frontline force to help tackle the global burden of child and adolescent mental health through a proactive, preventive stance. With this future focus in mind, next steps are considered in terms of developing effective and sustainable mental health and wellbeing support for all within healthy school settings.