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This chapter seeks to shed light on the many factors that contribute to people becoming school shooters. These factors are divided into four domains: biological, psychological, social, and cultural. At the biological level, this chapter explores the potential influence of genetics, pre- and post-natal development, and body-related issues that may affect the perpetrators' sense of self. A psychological typology is presented, consisting of psychopathic, psychotic, and traumatized school shooters. Socially, school shooters often have multiple setbacks, failures, and rejections that contribute to their distress. Finally, the cultural domain includes such factors as media violence, role models for killing, and ideologies of hatred and supremacy. Rather than attributing school shootings to a simplistic cause such as bullying, this chapter discusses a wide range of potential influences that combine to cause mass attacks at schools.

Those who care for people with schizophrenia and substance use disorders (PLS-SUD) are faced with the complex demands of a long journey to recovery. For the carers, this translates into specific needs related to various areas of their lives. However, few studies have contributed to the understanding of these carers’ needs. The purpose of this qualitative evaluative study is to identify, understand and prioritize the needs of PLS-SUD carers in the context of intervention design from the viewpoint of carers themselves (n = 9), those they were accompanying (n = 5) and other key actors involved (n = 10).

A design of action research was employed. Data analysis was done in three phases: concept map analysis, thematic analysis and transversal analysis of the results from two focus groups, 28 interview transcriptions and a logbook.

Over 60 needs were identified. After review, 39 of those were selected for prioritization. For needs related to the carers’ role as clients of the health-care system, the committee prioritized the needs for support, sharing with other carers and improving their own well-being. For the role of supporter, knowledge about substance use disorders and their interactions with psychotic disorders as well as skills such as communication and problem resolution were considered priorities. Needs to be prioritized relating to the role of partner were fewer.

The results of this study highlight the diversity and complexity of the needs experienced by carers.

This is among the first needs surveys carried out by stakeholders to describe the needs of PLS-SUD carers.

Evidence suggests supported living can improve functioning and reduce need. However, its lack of a clear definition has presented significant challenges to establishing a definitive evaluation of its efficacy. This study aims to evaluate the efficacy of a defined model of supported living using in terms of reductions made to aspects of clinical and social recovery.

A naturalistic, non-controlled assessment was conducting using using the Camberwell Assessment of Need Clinical Scale with a sample of adults with severe and enduring mental illness residing with a UK-based mental health company at 1 of 12 UK locations.

Analysis regarding preliminary outcomes relating to health and social need is presented with comparison between admission and six-months post-admission (N = 90). Additional analysis relating to outcomes at 12 months is also provided (N = 39). Significant outcomes are noted at both timepoints in terms of reducing unmet need and levels of formal and informal help given/required during tenancy.

The findings support that, even in the absence of clinical recovery, opportunities exist to make meaningful and valuable improvements to unmet need and functional independence, with implications for clinical practice in the context of supported living.

The findings provide encouraging early indications of the benefits of the model in making meaningful reductions to functional and psychological needs in individuals with severe and enduring mental illness.

This paper aims to illustrate by means of a case study how HKT-R Spider reference profiles of recidivists and non-recidivists may be supportive in leave decisions.

The authors describe what is known for recidivists and non-recidivists about changes in risk factors during treatment. The HKT-R Spider is introduced. By comparing a case study to group profiles, the authors illustrate how discussions about leave may be rationalised. From a study among 278 patients to explore the profiles, the authors report the inter agreement, and differences between recidivists and non-recidivists of the clinical HKT-R factors. Intra correlation coefficients, Wilcoxon signed ranks test and independent and paired t-tests are applied. To explore which combination of factors are discriminating between both groups, the authors also performed logistic regression analyses at six treatment stages.

The inter agreement reliability and internal consistency of the clinical HKT-R scale were acceptable to good in all six stages studied. The HKT-R Spider and profiles can be used to assist in evidence-informed decision-making about leave.

Globally recidivists had somewhat higher levels of clinical risk factors at all six decision moments, but the interpretation of HKT-R Spiders profiles should always be adapted to the individual’s context.

Applying the HKT-R Spider reference profiles on individual cases may structure and rationalize discussions lead to decisions based on clinical facts.

Many psychiatrists and trainees in Aotearoa New Zealand used telepsychiatry during COVID-19 lockdowns, despite minimal experience and training in the area. Research on a culturally safe telepsychiatry framework is lacking in Aotearoa. This study aims to provide a better understanding of telepsychiatry in the Aotearoa context and identify potential gaps with the current practice, with a focus on exploring telepsychiatry use with Maori, Pacific peoples and Asians.

This qualitative study was guided by the principles of the Kaupapa Maori methodology and the “Give Way Rule” from Pan-Pacific studies, to ensure culturally appropriate analysis and outcomes. Semi-structured interviews were conducted with a sample of psychiatrists and trainees recruited from Aotearoa members of the Royal Australian and New Zealand College of Psychiatrists. The qualitative data were then analysed using general inductive thematic analysis to identify the major themes.

In total, 18 participants were interviewed. Three key themes were identified: cultural safety such as preparation for a telepsychiatry session, cultural practices and equity issues; clinical practice such as continuity of care, patient selection and limitations; and process of running a telepsychiatry service.

The analysis of the main themes gives both practical ideas for providing a culturally safe telepsychiatry appointment, as well as a wider base for developing a telepsychiatry service that works particularly for Maori, Pacific and Asians mental health users. Issues around resources and expertise in the field are lacking and further frameworks to support infrastructure and training are needed.

This rapid evidence assessment (REA) study aims to synthesise what is known about food refusal within male prison populations to aid a better understanding of why this occurs. By looking at the various functions of food refusal for this population, it is hoped that professionals can better support prisoners’ needs in this area.

A rapid review of available data within the published literature was completed. Searches were conducted on two databases (PsychInfo and MedLine), and a total of 328 articles were screened using a three-stage process. This resulted in 13 articles being identified for the final sample, which were reviewed and synthesised into themes by looking for commonalities.

Five themes were identified: “to protest”, “to achieve goals or demands”, “to manage interpersonal difficulties with prison/custodial staff”, “to end life” and “mental health and personality disorder”. The findings appear to suggest that food refusal in this context may be predominantly driven by a need to communicate or gain control.

To help prevent and cease food refusal, it will be beneficial for prison staff to use approaches that support prisoners feeling a sense of fairness, transparency, control and autonomy, as well as problem-solving skills and establishing a sense of purpose and motivation.

This REA confirmed there is a lack of good-quality research into the functions of food refusal among prisoners in the UK. Future research should involve contact with prisoners who have engaged in food refusal to understand motivations firsthand.

The UK Mental Health Act (MHA) Reform (2021) on race and ethnicity promotes new governmental strategies to tackle inequalities faced by ethnically racialised communities detained under the MHA. However, there is a scarcity in personality disorder and ethnicity research. This study aims to investigate what is available in the UK in relation to prevalence, aetiology and treatment provisions of personality disorder for ethnically diverse patients, and to understand their interconnectedness with mental health and criminal justice service provisions. Three key areas of investigations were reviewed, (1) UK prevalence of personality disorder amongst ethnically diverse individuals; (2) aetiology of personality disorder and ethnicity; (3) treatment provisions for ethnically diverse individuals diagnosed with personality disorder.

A scoping study review involved a comprehensive scanning of literature published between 2003 and 2022. Screening and data extraction tools were co-produced by an ethnically diverse research team, including people with lived experience of mental health and occupational expertise. Collaborative work was complete throughout the review, ensuring the research remained valid and reliable.

Ten papers were included. Results demonstrated an evident gap in the literature. Of these, nine papers discussed their prevalence, three papers informed on treatment provisions and only one made reference to aetiology. This review further supports the notion that personality disorder is under-represented within ethnic minority populations, particularly of African, Caribbean and British heritage, however, the reasons for this are multi-facetted and complex, hence, requiring further investigation. The evidence collected relating to treatment provisions of personality disorder was limited and of low quality to reach a clear conclusion on effective treatments for ethnically diverse patients.

The shortage of findings on prevalence, aetiology and treatment provisions, emphasises the need to prioritise further research in this area. Results provide valuable insights into this limited body of knowledge from a UK perspective.

The purpose of this paper is to provide an analysis of the life of the musician Brian Wilson from five different perspectives.

The authors used a mixed method of collaborative autoethnography, psychobiography and digital team ethnography to try and better understand the life and contributions of Brian Wilson.

Each of the five contributors provides different insights into the life and music of Brian Wilson.

While the focus of this paper is on a single individual, a case study, the long and distinguished life of Brian Wilson provides much material for discussion and theorising.

Each individual presenting to mental health services has a complex biography. The five different contributions articulated in this paper could perhaps be taken as similar to the range of professional opinions seen in mental health teams, with each focusing on unique but overlapping aspects of the person’s story.

This account shows the importance of taking a biological-psychological-social-spiritual and cultural perspective on mental illness.

This multi-layered analysis brings a range of perspectives to bear on the life and achievements of Brian Wilson, from developmental, musical, psychological and lived experience standpoints.

The purpose of this study is to determine the psychological features of providing initial psychotherapeutic assistance to victims, in particular to military servants.

Theoretical analysis of scientific works; observation of servicemen in hospital conditions; conversations with servicemen and doctors; and interviews with foreign colleagues.

As a result of theoretical and empirical research, it was found that initial psychological assistance is more effective if it is provided in a timely and comprehensive manner in cooperation with medical assistance, if the recommended exercises are performed systematically by the victim and if a certain algorithm for providing initial psychotherapeutic assistance is used.

The authors present their own algorithm for providing initial psychological assistance to military servants: psychophysiological stabilization; adjustment of emotional balance; restoration of cognitive processes and acquisition of constructive coping strategies; and formation of life meanings that provide an opportunity to survive the crisis period of life. In this paper, the authors also note the importance of providing psychological first aid to victims of extreme situations in a timely manner, which helps reduce the intensity of symptoms of acute stress disorder and reduces the likelihood of post-traumatic stress disorder.

The goal of this study was to understand which employee-focused workplace practices and priorities – more formally known as human resource (HR) practices and priorities – employees with mental health and/or addiction challenges (MHAC) valued and how they perceived the day-to-day implementation of those practices and priorities in the workplace integration social enterprises (WISEs) that employed them.

Twenty-two WISE workers who self-identified as having serious MHAC participated in semi-structured interviews. Interviews were transcribed and coded to identify ways that employees did or did not feel supported in their WISEs.

Participants identified three HR practices and two HR priorities as important to establishing an inclusive workplace that accommodated their MHAC. The extent to which individual participants felt included and accommodated, however, was shaped by interactions with their supervisors and coworkers.

By evaluating the salience of WISEs’ employee-focused workplace practices and priorities through the lens of the employees themselves, our study articulates the critical role that interactions with coworkers and supervisors have in determining whether HR practices and priorities have the intended effect on worker experience.