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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.

This, the first chapter of this text provides an introduction to a social world that is constructed through cultural attitudes, with a long history of the so-called ‘insane’ or deviants being excluded from society. In many cases, this was due to their behaviour resulting from an addiction issue, mental ill health or as is often the case, both. The chapter begins with an introduction to what led to the conceptualisation of this text. Once this occurs, the interplay between the ‘normal’ and the deviant, as discussed above, is played through an examination of the cultural perceptions of both mental health and addiction. In addition, to support this, a brief historical timeline of mental health, addiction and dual diagnosis is described and visually depicted. Finally, the chapter concludes with an introduction to both editors of this text who then describe what will be discussed in the chapters that follow.

User involvement and co-production are imperative to the design, delivery and evaluation of service provision. This chapter provides a brief introduction to these concepts as they relate to mental health, addiction and dual diagnosis. This occurs through an exploration of models of user involvement, particularly, Arnstein’s ladder of participation and MHERs engagement continuum. This is followed by exploring the benefits of user involvement at both a micro and macro level. Co-production – as the highest form of participation is also introduced followed by how these concepts are noted within policy. These concepts are imperative to the creation of a recovery-orientated service that meets the needs of the whole person and their supporters.

New psychoactive substance (NPS) use in mental health and addiction health-care services is a common co-morbidity. This paper aims to explore the survey responses with health-care professional’s (HCPs) engagements and experiences towards people who use NPS in five health-care services.

A theoretically adapted online survey design explored the engagements and experiences of participants towards people who use NPS across (n = 3) community and (n = 2) rehabilitation mental health and addiction health-care services consisting of (n = 1,027) service users.

A total of 92 participants (of 120 participants) completed the survey and 28 did not. Most (56.33%) reported neutral to poor experiences and engagements and a lack of NPS-related policies, procedures and educational training. Participants (99%) recognised the harmful effects of NPSs and (87%) requested clinical assessment procedures. The participants are unable to identify and manage acute intoxication by NPS, lack knowledge of NPS adverse effects and requested NPS-specific training on drug legislation.

The sample may not be representative with the broader UK population. The study’s methods are comparable to similar research surrounding NPS in health-care services. Similar studies may advance the findings.

The implications for practice include NPS awareness trainings, educational updates through seminars and conferences. Participants requested clearer NPS assessment, referral and management processes. Several policy-making and procedural opportunities exist to ensure a better health outcome for people who use NPS.

To the best of the authors’ knowledge, this is the first theoretically adapted survey to explore participant’s engagements and experiences with people who use NPS in addiction and mental health settings.

This discursive paper considers the use of restrictive practices in mental health inpatient settings and how these are often prioritised over relational approaches, especially where the diagnostic label of personality disorder intersects with risk.

Key concepts from Orwell’s 1984 are studied for their pertinence to mental health inpatient settings, supporting our argument that restrictive practices arise from dichotomous thinking and externalised fears.

Drawing upon Orwellian themes of power, social control and digital surveillance from 1984, the authors highlight the role of fear in perpetuating restrictive practices under a guise of benevolent care in mental health inpatient settings, especially for those who are diagnosed with a personality disorder. A lack of preparedness to work with complexity in such environments, coupled with a deficit in self-reflexivity and critical thinking, can exacerbate challenges.

To transcend damaging dichotomies and reduce restrictive practices in inpatient settings, the authors make the argument for the adequate preparation and education of the mental health nurse and authentic, collaborative, user-involved care.

The authors use Orwell’s novel to support a critical discourse around those damaging dichotomies and inherent contradictions that contribute to restrictive practice in contemporary mental health settings and to question whose interests’ these restrictive practices serve.

Chapter 6 explores the cultural impact of mental health, addiction, and dual diagnosis challenges with a specific focus on Irish society. The chapter takes a staggered approach whereby each type of challenge is separated and discussed individually, before being joined together through discussions on dual diagnosis as presented in Section 6.4. These discussions are designed to highlight the cultural deviance that is perceived by other people towards those with such diagnosis over the years that such diagnosis have been prevalent in history. In particular, the discussions around dual diagnosis here will strengthen the discussion in Chapter 4: ‘The Conundrum of Dual Diagnosis’ and will set the groundwork for the remainder of this text.

This qualitative case study aims to investigate how current services meet the emotional needs of young women growing up with perinatally acquired human immunodeficiency virus (HIV). Young women (15–19 years old), caregivers and service providers were recruited through three multidisciplinary HIV management centres in Malawi.

In-depth interviews were used to collect data for 14 “cases” (each “case” involved a young woman, a caregiver and a service provider, for a total of 42 participants). The interviews with adolescents were conducted using an innovative visual method known as the “my story” book.

Thematic analysis revealed that young women experienced traumatic experiences and emotional neglect after being diagnosed as HIV positive. Lack of adult support networks and social isolation were identified as intersecting factors contributing to their mental distress. According to the findings of this study, HIV care should more explicitly include comprehensive mental health-care services. This provision should include ongoing individualised counselling sessions, supplemented by communication skills training to help break the prevalent cultural silence on HIV issues. Young people living with HIV, in general, and young women, are more likely to experience mental health issues than their non-infected peers. Integrating comprehensive mental health evaluation and treatment into HIV care for young people can be beneficial.

Mental health issues are critical and underserved challenges among young people living with perinatally acquired HIV. Women experience a higher prevalence of mental challenges than men. Integrating comprehensive mental health evaluation and treatment into HIV care for young people can be beneficial. Therefore, interventions to assist young people with mental health issues are needed within the context of HIV management in Malawi.

Many studies on mental health and HIV/AIDS have been conducted. However, there is very little information as regards the emotional needs of young women growing up with perinatally acquired HIV. This study fills the void.

This chapter presents the results of a process of reflexive thematic analysis. It highlights the recovery journeys of those with mental health, addiction and dual diagnosis challenge. In doing so, a number of similarities occurred. These included beginning in a place of trauma, working to cope with the trauma, seeking help from services, peer support, relapse and finally fully embracing recovery in one’s own life. A number of differentials were also identified, including additional steps in the mental health recovery journey along with the title of various phases of recovery. The chapter ends with an acknowledgement of these similarities and differentials which the following chapter can then utilise as a basis for making recommendations to policy, practice and the users of services themselves.

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.

The Mental Health of Children and Young People in England survey (National Health Service Digital, 2020) found that 1 in 6 children aged 5–16 have a probable mental health disorder. This represents 16% of children in that age group and is an increase from 1 in 9 in 2017 (Public Health England, 2021). Evidence suggests that some children and young people, particularly those who are economically disadvantaged, females and those with pre-existing mental health needs appear to have experienced greater negative impacts on their mental health and wellbeing during the COVID-19 pandemic (Public Health England, 2021) and schools and colleges therefore play an important role in continuing to support children and young people’s mental health. Evidence from the national charity, Education Support (2022), also indicates that the mental health of staff working in education has deteriorated, leading to adverse effects on job satisfaction, burnout and retention. This chapter explores the latest evidence relating to Children and Young People’s (CYP) mental health and the whole school approach to mental health, including the mental health of staff who work in the education sector. It makes a case for implementing a mental health curriculum in schools. It addresses the concept of mental health literacy and approaches for working in partnership with children and young people. It makes an argument for universal screening and outlines approaches for working in partnership with parents, carers and other agencies. Theoretical perspectives are considered and applied to school contexts.