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A region’s transforming care partnership identified that autistic adults without an intellectual disability (ID) may be falling through gaps in services when presenting with a significant emotional and/or behavioural need in the absence of a mental health diagnosis. The region’s intensive support teams (ISTs) for adults with ID therefore piloted a short-term “behavioural support service” for this population. The purpose of this paper is to evaluate this pilot.

This study represents a mixed-methods service evaluation over a four year pilot period. The quantitative component examined referral rates and demographic data of accepted and declined referrals; and length of referral episodes and Health of The Nation Outcomes Scores (HoNOS) for accepted referrals. The qualitative component used thematic analysis to identify key themes relating to reasons for referral, clinical/therapeutic needs, and the models of support that most informed assessments and interventions at individual and systems levels.

The ISTs accepted 30 referrals and declined 53. Most accepted referrals were male (83%), and under 24 years old (57%). Average HoNOS scores were above the thresholds generally associated with hospital admission. Key qualitative themes were: transitional support; sexual risks/vulnerabilities; physical aggression; domestic violence; and attachment, trauma and personality difficulties. Support mostly followed psychotherapeutic modalities couched in trauma, attachment and second- and third-wave cognitive behavioural therapies. Positive Behaviour Support (PBS) did not emerge as a model of preference for service users or professionals.

This project represents one of the first of this type for autistic adults without an ID in the UK. It provides recommendations for future service development and research, with implications for Transforming Care policy and guidance.

The transtheoretical model (TTM) has been applied to varying areas of physical health, e.g. diabetes. However, research into its applicability to psychotherapy is mixed. The TTM is applied through the University of Rhode Island Change Assessment (URICA). Investigating the utility of the URICA is needed to improve patient care and outcomes. This study aims to assess whether the URICA scores relate to patient outcomes; patient attendance; practitioner ratings of patient readiness, appropriateness, insight, motivation and potential for improvement; and to explore practitioner’s perspectives on the URICA.

Correlational methods were used to assess the relationship between the URICA and therapeutic outcome, attendance and practitioner-rated areas. Content analysis was used to analyse practitioner qualitative data.

The URICA did not correlate with either therapeutic outcome or attendance. A significant negative correlation was found between the URICA and practitioner-rated appropriateness of the referral. This means practitioners perceived individuals with lower URICA scores to be a more appropriate referral, despite the score indicating a reduced readiness to change. Qualitative categories included positive views, negative views, ambivalence and changes to measure and process. To conclude, the URICA does not explain a patient’s outcome or attendance. The URICA may not be appropriate to use in its current format in mental health services; therefore, assessing the TTM verbally may be more helpful.

This study provides research into suitability of using the URICA to assess the TTM and its applicability to attendance and outcome in psychological therapies.

Building on the introduction to positive psychology and positive education in Chapter 1, the aim of Chapter 3 is to focus on wellbeing and positive education in secondary schools. This includes an overview of approaches to intervening in mental health (‘traditional’ and those which draw on the principles of positive psychology) that have been used in schools, and the factors that can influence their outcomes. When and how to apply interventions across three levels: the system, the community, and the individual, are also explored, alongside four different approaches: whole school, whole class, small group, and one-to-one. The chapter draws on up-to-date research and practical experience in secondary school settings, and includes a case study of Positive Psychology in Practice, based on the delivery (by the author) of a multi-component PPI (mPPI) – The Hummingbird Project, which has now been delivered to approximately 4,000 students in 24 secondary schools across the North West of England. The effectiveness of the mPPI, key lessons learned and insights gained are shared, including how to overcome the challenges of working in a culture not conducive to positive education.

This paper aims to explore the intersection of cultural processes and immigration in parental understanding of adolescent mental health and mental health seeking behaviors among African immigrants in Western countries. The present study examines the perspectives of Congolese immigrant parents on adolescent mental health in Brussels, Belgium, and Raleigh, North Carolina, USA – two geographic regions with relatively large Congolese migrant populations. This study highlights a needed understanding of cultural and acculturative context in shaping the beliefs of Congolese immigrants and explores potential barriers of seeking health services. Additionally, it recognizes health issues among this underrepresented and underserved population.

Fifteen Congolese immigrant parents, eight in the USA and seven in Belgium, participated in structured qualitative interviews using an adapted version of Kleinman Questions and behavioral scenarios on depression, post-traumatic stress disorder and oppositional defiant disorder. Interviews were audio recorded, and participants were assigned pseudonyms to de-identify responses. English interviews were transcribed verbatim by a trained team of undergraduate research assistants, and French interviews were transcribed verbatim by the first author and a graduate research assistant. Following transcription, the first and second authors used a rapid analytic approach (Hamilton, 2013). The first and second authors conducted a matrix analysis to observe thematic patterns.

Parents interpreted adolescent behavior to be more problematic when the scenarios were overtly outside of their cultural realm of values and beliefs. Parents preferred methods of intervention through religious practices and/or family and community efforts rather than seeking mental health services in their host countries as a secondary option. The authors’ findings provide an understanding of the values and beliefs of this underrepresented demographic, which may be useful to guide health professionals on how to support this community in a culturally responsive way.

Limitations to the current study include the structured nature of the interview guide that did not allow for in-depth qualitative exploration. Interviewed participants had lived in their host countries for more than 10+ years. Thus, the authors’ findings are not reflective of new immigrants’ experiences. Parents’ perspectives were likely shaped by exposure to Western beliefs related to support for mental health (e.g. knowledge of psychologists). Future studies should focus on recent refugees due to exposure to traumatic events and experiences reflective of the Democratic Republic of Congo’s (DRC’s) current socio-political situation, and how these are understood in the context of adolescent mental health. Further, due to the hypothetical nature of the scenarios, the authors cannot be sure that participants would engage in the identified approaches with their children. Additionally, hearing from the youth’s perspective would provide a clearer insight on how mental health and seeking professional help is viewed in a parent–child relationship. Finally, the data for this study were collected in 2019, prior to the COVID-19 pandemic. Although the authors cannot speak directly to Congolese refugee and immigrant experiences during this significant historical period, given the rise in mental health concerns in refugee populations more broadly (Logie et al., 2022), the authors’ findings speak to how parents may have responded to increased mental health symptoms and point to additional barriers that these populations may have faced in accessing support. The authors’ study emphasizes the need for dedicating resources and attention to this population, especially the development of culturally tailored messaging that invites community members to support the mental health needs of their community.

The authors’ findings provide important implications for mental health professionals. This study provides a clearer understanding of how Congolese immigrant parents view mental health and help-seeking within their cultural frame. Although parents may seek professional help, a distrust of mental health services was expressed across both cohorts. This suggests that mental health professionals should acknowledge potential distrust among this population and clarify their role in supporting the mental health of adolescent immigrants. Clinicians should inquire about familial cultural beliefs that are parent- and child-centered and modify their interventions to fit these belief structures.

This paper addresses the gap in knowledge about mental health perspectives of Sub-Saharan African immigrant populations, specifically those from the DRC.

Clinical staff working in mental health services experience high levels of work-related stress, burnout and poor well-being. Increased levels of stress, burnout, depression and anxiety and poorer mental well-being among health-care workers are associated with more sick days, absenteeism, lower work satisfaction, increased staff turnover and reduced quality of patient care. Virtual reality (VR) relaxation is a technique whereby experiences of pleasant and calming environments are accessed through a head-mounted display to promote relaxation. The purpose of this paper is to describe the design of a study that assesses the feasibility and acceptability of implementing a multi-session VR relaxation intervention amongst mental health professionals, to improve their relaxation levels and mental well-being.

The study follows a pre–post-test design. Mental health staff will be recruited for five weeks of VR relaxation. The authors will measure the feasibility and acceptability of the VR relaxation intervention as primary outcomes, alongside secondary outcomes evaluating the benefits of VR relaxation for mental well-being.

The study aims to recruit 20–25 health-care professionals working in both inpatient and specialist community mental health settings.

Research indicates the potential of VR relaxation as a low-intensity intervention to promote relaxation and reduce stress in the workplace. If VR relaxation is shown to be feasible and acceptable, when delivered across multiple sessions, there would be scope for large-scale work to investigate its effectiveness as an approach to enable health-care professionals to de-stress, relax and optimise their mental well-being. In turn, this may consequently reduce turnover and improve stress-related sick leave across health-care services.

People who identify as transgender face stigma, isolation and harassment while often struggling to come to terms with their gender identity. They also disproportionately experience mental health difficulties. The purpose of this paper is to present the voices of transgender people in the Republic of Ireland (RoI) in regard to the issues they are facing, improvements they would like to see made to schools, workplaces, services and society in general and whether mental health supports fulfil their needs.

Ten open questions were embedded within a quantitative online survey (LGBTIreland study) on factors impacting social inclusion, mental health and care. These open questions were re-analysed with exclusive focus on the transgender participants (n = 279) using content/thematic analysis.

The participants in this study reported significant signs of mental distress. The following themes emerged: impact of stigma, deficiencies in mental health services, need for education on transgender identity, importance of peer support, achieving self-acceptance and societal inclusion questioned.

Efforts to recruit young participants have led to a possible over-representation in this study.

The findings suggest the need for improvement in mental health support services, including further education in how to meet the needs of transgender individuals.

Transgender people in Ireland experience social exclusion. The need for more inclusivity was emphasised most in secondary schools. Education on transgender identities in all contexts of society is recommended by the participants.

This study reports on the largest group of transgender participants to date in RoI. Their voices will affect perceptions on social inclusion and mental health care.

Public safety (communicators; e.g. 9-1-1, police, fire and ambulance call-takers and dispatchers), like many other public safety personnel (e.g. police, paramedics), (re)suffer operational stress injuries (OSIs) that are too often hidden and at a prevalence higher than the general population. Unfortunately, there are very little data for OSI rates in Canadian communicators. To the authors’ knowledge, this is the only pan-Canadian study focusing on organizational culture, and its potential influence on OSIs, within the communicator context.

The authors conducted a 179-item online survey of Canadian communicators comprising 17 validated screenings for occupational stress injuries and symptoms and four open-ended questions relating to their agency's organizational culture. The authors thematically analysed participants' open-ended responses and their screening scores.

A semi-grounded thematic approach revealed that managers and supervisors were significant contributors to negative perceptions (n = 165) of organizational culture, potentially resulting in or worsening existing OSIs. Specifically, leadership was viewed as ineffective, inconsistent, unsupportive, abusive and toxic, with limited understanding of communicator roles. Communicators described feeling devalued, particularly when leaders fail to recognize communicator OSIs, which can perpetuate stigma. Conversely, positive leaders (n = 24) were described as supportive, communicative and encouraging.

The findings suggest that while leadership behaviours are a key factor in employee well-being, it varies considerably across agencies, impacting treatment-seeking behaviours. The authors’ new understandings of leaders' roles in OSIs may help reduce the frequency and severity of communicator OSIs, helping ensure that emergency services are delivered to Canadians.

This study aims to construct a mental health service system for middle school students in the post-COVID-19 era with the framework of Six Sigma DMAIC (define, measure, analyze, improve and control) and analyze the influencing factors of the mental health service system to study the implementation strategies of quality-oriented mental health services in middle schools.

This study was conducted in Tianjin, China, from September to November 2022, and 350 middle school students from Tianjin Public Middle School were selected as subjects. A questionnaire survey was used to collect data. In this study, the Six Sigma DMAIC method, sensitivity analysis method, exploratory factor analysis and principal component analysis were used to analyze the mental health services provided to middle school students.

Based on the Six Sigma DMAIC framework, this study indicates that the contribution rate of the mental health service process factor is the largest in the post-COVID-19 era. The mental health cultivation factor ranks second in terms of its contribution. Mental health quality and policy factors are also important in the construction of middle school students’ mental health service system. In addition, the study highlights the importance of parental involvement and social support in student mental health services during the post-COVID-19 era.

To the best of the authors’ knowledge, a study on middle school students’ mental health in the post-Covid-19 era has not yet been conducted. This study developed a quality-oriented mental health system and analyzed the influencing factors of mental health for middle school students based on data analysis and the Six Sigma DMAIC method.

This study aims to evaluate how a community psychiatry model, referred to as the Mental Health Action Trust (MHAT) in India, provides decentralized care and comprehensive services to people with severe mental illness living in poverty. Using the complex adaptive system (CAS) framework, the authors aim to understand the factors that contribute to the diverse outcomes of the MHAT community mental health programme as observed in four different locations.

Four MHAT clinics were purposively chosen from two districts in Kerala. A comparative case study methodology was used to document each clinic’s MHAT services and activities, as found during field visits and interviews with staff members and volunteers.

The study shows that all four clinics met the basic aim of providing free, quality mental health care to the poorest populations, although not all aspects of the comprehensive model could be equally provided. Alignment with the MHAT vision, appropriate leadership, the relationship with partners and their level of community engagement determined the varied success between clinics.

The current study evaluation stresses that community ownership is crucial. Careful attention must be paid to the characteristics of selected partners, including their leadership styles and ability to garner resources.

Mental health recovery across cultures lacks understanding and suitable measures. The Questionnaire about the Process of Recovery (QPR) is a self-report instrument measuring personal recovery outcomes for consumers of mental health services. However, the extent of its relevance among culturally and linguistically diverse (CALD) communities is unclear. This pilot study aimed to examine the relevance and utility of the QPR among CALD consumers of primary mental health services in Australia.

Eleven individual, semi-structured interviews were conducted with two general practitioners (GPs) and nine consumers from two clinics, at locations with high Iranian and Burmese refugee or asylum seeker populations. Interviews were transcribed and analysed using a thematic framework approach.

Although almost all consumers had little or no understanding of the concept of personal recovery, they found the QPR culturally acceptable and understandable. Using the QPR during mental health consultations can help with needs identification and goal setting. Challenges in using the QPR included completion time, cross-cultural differences in concepts and norms for some items, and need for careful translation. Consumers suggested additional items regarding family reputation, sexuality, and spirituality.

The QPR is potentially a valuable tool to support mental health consultations with CALD consumers, from the perspectives of both GPs and consumers.