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The paper sets out to explore the leadership processes and dynamics of change management in a fragmented, and resource‐poor, health service in an impoverished rural region in South Africa.

The paper outlines an action research process aimed at assisting the stakeholders of two rural clinics to integrate psychiatric care into the Primary Health Care service that they offer their respective communities. This involved the transformation of existing practices through a form of praxis that involved learning from action and acting on learning.

The findings of the paper relate to the role of leadership in the facilitation of transformational learning in team‐based social action. Four areas of leadership responsibility are highlighted: the transformation of inappropriate mental models; the development of strategic resilience; the shifting of the locus of control of stakeholders to a more internal position; and the creation of a social environment in which intangible capital resources are generated and leveraged in the collective interest.

This paper is subject to the limitations of potential bias and distortion in action research. Although the “objective” evidence of the integration of psychiatric services at Pelsrus and Kwanomzamo clinics exists, the portrayal of the learning processes through which this was achieved could have been influenced unwittingly by the authors' own knowledge and other interests.

The paper endorses the educational importance of work‐based projects through which strong tacit leadership knowledge bases can be developed in health sector personnel.

This paper has attempted to share the effectiveness of work‐ and project‐based learning in district health teams in South Africa. In particular, it has outlined how the learning strategy of the module leverages the team structure of the district health management units in order to create and exploit the social and morale capital resources that are potentially available through such a structure and the covenantal culture that it spawns. Furthermore, an attempt has been made to show how these resources are leveraged in the generation of mission‐pertinent tacit knowledge that is then converted by project stakeholders into explicit knowledge forms that can be used more effectively in framing subsequent strategic action.

The purpose of this paper is to demonstrate how a psychiatric clinic in a general hospital can function in conflict-ridden Iraq through the easing of patient access to services.

The workload of psychiatrists was analyzed for one year (2010) at the psychiatry consultation clinic located in the campus of the Medical City Hospital in Central Baghdad which is also a training center.

A total of 2,997 consultations (both adults and children) occurred in 2010. In total, 96 percent were self or family referrals. Patient services were provided by five consulting psychiatrists for a variety of psychiatric disorders. The main therapeutic intervention was the prescription of psychotropics.

Despite the turbulent circumstances and limited mental health resources in Iraq, this clinic was established as a model to attract patients for consultation and triage management to reduce appointment defaults and delayed care.

The data can contribute to the planning and development of mental health services in Iraq, contributing to the current body of literature and serving as a model for other conflict areas.

To best of the understanding this study is the first in the country.

Depression and its symptoms negatively influence the health-related quality of life of patients. This paper aims to explore the occurrence of depressive symptoms and their relationship with health-related quality of life and sociodemographic characteristics.

It was a cross-sectional study conducted among patients attending the outpatient psychiatric clinics of two Nigerian hospitals. Data were collected using sociodemographic, PHQ-9 and 15 D questionnaires from a convenience sample of patients. Statistical Product and Services Solution Software (SPSS) version 21.0 was used to evaluate depressive symptoms, health-related quality of life, sociodemographic characteristics and the associations among them.

The mean depressive symptoms and health-related quality of life scores were found to be 12.118 ± 4.373 and 0.829 ± 0.141, respectively. The result showed a significant negative correlation (r = −0.318, p < 0.001) between respondents’ depressive symptoms and health-related quality of life. Patients with comorbid conditions reported a significantly higher level of depressive symptoms (p = 0.002) and lower health-related quality of life (p < 0.001). There was a significant difference in the mean health-related quality of life of the respondents across their level of education and marital status.

Depressive symptoms are a common occurrence in psychiatric conditions. This study provides an insight into the associations between depressive symptoms, socio-demographic factors and the health-related quality of life of psychiatric patients in a low-income country.

Recent guidelines suggest that cognitive behavioural therapy (CBT) has a pivotal role to play in the treatment of common mental health problems (CMHPs). There is a danger that we simply ask for ‘more of the same’ instead of looking at all the current limitations preventing individuals from accessing appropriate help. Doing this leads us to aim for a more radical and innovative approach to the CMHPs. This paper suggests that progress in primary care mental health has been much more limited than mental health workers and, in particular, researchers often acknowledge. It looks at the major obstacles barring the way to the development of services that could meet the needs of the very large number of people in our communities with CMHPs.

Psychiatric care for adult asylum seekers has been an area of conflict and turbulence in Sweden over the last 20 years. Sweden has been criticised for being one of the most restrictive EU countries in providing health care for asylum seekers. Mental health care for asylum seekers is characterised by short‐term emergency measures and inequality. The complex regulatory framework tends to be interpreted in a rather arbitrary fashion, which in many cases may lead to unnecessary restrictions. In this paper we present guidelines for care givers and decision makers aiming to improve psychiatric care for adult asylum seekers in Stockholm, Sweden. In this context it is necessary to highlight and discuss the importance of understanding and implementing human rights among health professionals. The overall goal for these guidelines is mental health care for asylum seekers on the same terms, as far as possible, as for Swedish citizens.

Despite the importance of increasing engagement and minimising attrition and drop‐out in parenting interventions, there is a paucity of empirical evidence examining factors related to engagement and participation. The range of factors examined in relation to engagement is generally limited in scope and variety, focusing on variables of convenience rather than utilising a theoretically‐driven approach.The aim of this article is to review the factors related to parental engagement with interventions and to describe strategies and implications for improving engagement with parenting interventions. Several policy and practice implications are identified: (1) Poor parental engagement may threaten or compromise the capacity of parenting programmes to deliver valued outcomes. Viable engagement strategies need to be a core part of prevention and early intervention parenting programmes; (2) Agencies delivering parenting services need a proactive engagement strategy, which includes strategies to prevent drop‐out, as well as strategies to actively respond to parental disengagement; (3) Research is needed to test the efficacy and robustness of different engagement enhancement strategies. Empirical tests are needed to test the effectiveness of different engagement strategies in order to ensure that the most efficient, cost‐effective and efficacious approach is used in order to engage parents. Investment of research effort to improve parental engagement is likely to have a high yield in terms of programme efficiency, utility and cost effectiveness. We conclude that research examining how to improve engagement and decrease non‐completion is needed to strengthen the population level value of parenting programmes as preventive interventions.

Much of the existing literature on shared decision making (SDM) in mental health has focused on the use of decision aids (DAs). However, DAs tend to focus on information exchange and neglect other essential elements to SDM in mental health. The purpose of this paper is to expand the review of SDM interventions in mental health by identifying important components, in addition to information exchange, that may contribute to the SDM process in mental health.

The authors conducted a systematic literature search using the Ovid-Medline database with supplementary scoping search of the literature on SDM in mental health treatment. To be eligible for inclusion, studies needed to describe (in a conceptual work or development paper) or evaluate (in any type of research design) a SDM intervention in mental health. The authors included studies of participants with a mental illness facing a mental health care decision, their caregivers, and providers.

A final sample of 31 records was systematically selected. Most interventions were developed and/or piloted in the USA for adults in community psychiatric settings. Although information exchange was a central component of the identified studies, important additional elements were: eliciting patient preferences and values, providing patient communication skills training, eliciting shared care planning, facilitating patient motivation, and eliciting patient participation in goal setting.

The review indicates that additional elements, other than information exchange such as sufficient rapport and trusting relationships, are important and needed as part of SDM in mental health. Future SDM interventions in mental health could consider including techniques that aim to increase patient involvement in activities such as goal settings, values, and preference clarification, or facilitating patient motivation, before and after presenting treatment options.

Although health-related quality of life (HRQOL) has become an important outcome, specifically in regard to the impact of illness and treatment in patients with depression, few studies have explored the HRQOL of patients from different types of hospitals. This study aimed at examining a change in HRQOL of patients from various types of hospitals

A repeated measure was used in this study. Thirty participants in psychiatric outpatient units per center from the different types of hospitals, including a psychiatric hospital, regional hospital, general hospital and community hospital, were assessed with the Thai version of the World Health Organization Quality of Life Brief (WHOQOL-BREF-THAI) questionnaire at the first visit, and after the 6th and 12th weeks of the treatment course.

The HRQOL scores for the participants were increased in each type of hospital from their first visit to the 6th week and 12th week (p < 0.001; except for the 6th week in the regional hospital, p < 0.01).

The findings reflected HRQOL in patients with depression in terms of the resources available in different types of hospitals that could be used as baseline data for the development of Thai mental health service systems.

The purpose of this paper is to increase awareness of shared decision making, the initial aim of the study was to understand how psychiatrists-in-training defined themselves as unique among physicians with an eye on how professional identity might shape approach to care. The second aim was to use those definitions and descriptions related to professional identity and tailor a brief training module to promote awareness of the shared decision making model.

The authors do this by first conducting focus groups to ascertain how psychiatric residents characterize their professional identity and unique disciplinary characteristics. The authors then designed a brief training session that exploits the relationship between how they define themselves as physicians and how they approach clinical decision making with patients.

Three major themes that emerged from the focus group data: the central role of societal and treatment contexts in shaping their professional identity and approaches to care, a professional identity characterized by a great sense of pride, and a strong commitment to systematic decision-making processes in practice. While the assessment of the training module is preliminary and lacks rigor for any generalizability or statements of causality, responses likely affirm the training tailored around professional identity as a possible vehicle for effective exposure to the concept of shared decision making and served as a useful avenue for self-reflection about needed changes to more fully embrace the practice.

More inquiry may be needed into the association between trust, relationship longevity and power and paternalism, as a way to bring greater insight into the adoption of shared decision making. Future research will have to investigate whether or not including identity-related content is empirically connected to successful training on shared decision making. Likewise, future research should also look at the reciprocal impact of effectively using shared decision making on the affirmation of professional identity among psychiatrists, and indeed all who embrace patient-centered care.

This is the one of the first papers to investigate issues of professional identity among psychiatry residents, and also among the first papers to consider the relationship between professional identity and use of shared decision making.