Substance use and mental health challenges are common in youth and may result in co-occurring disorders. Yet prevention, screening, and treatment services for mental health and for substance use often are delivered separately, creating missed opportunities for effective integrated, co-occurring competent care. This Fresh Focus Policy and Practice commentary makes the case for a more intentional and systematic recognition of mental health drivers of substance use initiation and escalation to substance use disorder and of substance use drivers of mental health challenges and progression to mental health disorders, particularly among young people. A targeted, non-systematic review of relevant literature illustrates that the interplay between mental health and substance use often is recognized only in hindsight by people in treatment – and by those who care for them, which may limit the provision of appropriate interventions and the prevention of co-occurring disorders. An integrated approach to prevention, early identification, and intervention for both substance use and mental health challenges in youth is grounded in research, practical, and cost-effective, yet its implementation continues to lag behind the evidence. This commentary highlights concrete opportunities for prevention professionals, educators, clinicians, and policymakers to advance earlier, more integrated, co-occurring competent care.
Sexual health is integral to mental well-being, yet it remains under-addressed in psychiatric care. Mental disorders and psychotropic medications can cause sexual dysfunctions. Despite its clinical relevance, sexual health is often not routinely assessed or discussed in psychiatric assessment and treatment, possibly due to insufficient training, stigma, and clinicians’ uncertainty. This pilot study examined how sexuality is addressed in psychiatric treatment and how relevant the topic is perceived, integrating patient and clinician perspectives. A cross-sectional, anonymous online survey was conducted between February and July 2025 in two German academic psychiatric hospitals. Psychiatric patients and mental-health professionals completed questionnaires tailored to their perspectives. Patients completed measures of sexual functioning, well-being, and communication about sexuality, whereas mental-health professionals completed measures of attitudes, clinical practice, and professional training. Data were analysed using descriptive and inferential statistics. A total of 231 patients and 194 clinicians participated. Nearly all patients reported at least one sexual dysfunction (100
Recovery-oriented practice emphasizes collaborative, person-centered relationships. However, culturally grounded frameworks describing how therapeutic relationships support recovery in Japan remain limited. This study explored the perspectives of Japanese community mental health service users to identify relational components that facilitate recovery and develop a culturally responsive conceptual framework. Using a phenomenological-qualitative design, semi-structured interviews were conducted with ten service users receiving community-based care. The data were analyzed through reflexive thematic analysis. Seven components were identified and organized into a two-stage structure. The listening, individuality, friendliness, and empowerment (LIFE) stage describes relational processes that build psychological safety through respectful communication, personal identity recognition, approachable interpersonal interaction, and self-determined decision-making support. The awareness, commitment, and exposure (ACE) stage captures subsequent processes that promote recovery-oriented action, including gaining new perspectives, setting and pursuing personally meaningful goals, and engaging in social roles and group interactions. Together, the LIFE-ACE framework illustrates the transformation of therapeutic relationships from trust-building to fostering social participation. It aligns with recovery principles while reflecting Japanese cultural values such as interpersonal harmony, empathy, and relational subtlety. The findings highlight the importance of approachable communication, recognition of individuality, and supportive opportunities for social engagement in cultivating recovery-oriented practice. The framework offers practical guidance for mental health professionals seeking to create culturally responsive therapeutic relationships that enhance psychological safety, autonomy, and meaningful participation in community life.
Youth mental health emergencies are an increasingly prevalent problem, with many families experiencing barriers to accessing mental health resources after a hospital visit for a mental health emergency. This study aims to evaluate the feasibility of a post-discharge telephone contact pilot program designed to assist caregivers of youths experiencing mental health emergencies in navigating these resources. The pilot initiative was retrospectively evaluated after being integrated into routine clinical care across inpatient, ambulatory, and emergency settings within a children’s hospital in Baltimore, Maryland, from August 2022 to August 2023. The primary outcomes evaluated included: (1) the successful contact of caregivers, (2) the establishment of an initial mental health appointment for their child after a mental health emergency, and (3) the solicitation of additional assistance. Over the course of one year, a dedicated social worker, contributing 10 h per week, contacted nearly 1,000 caregivers. The program successfully reached 55
Psychological treatment is a pressing unmet need, especially in rural areas. One potential means of addressing this need is to enhance informal care, a form of care frequently relied on by rural adults with psychological symptoms. In this study, 150 participants were randomized to either a group based psychological intervention or a waitlist control condition. Primary analyses evaluated potential condition differences in informal care skills, coping skills, and mental health symptoms. Intervention participants experienced greater informal caregiving skill gains following the program, though these gains were not maintained at the two-month follow-up assessment. Additionally, those in the intervention condition perceived depression to be more responsible for their functional impairment following participation in the program, but not at the two-month follow-up. Participants did not report changes following the intervention or at the two-month follow-up to coping skills, anxiety symptoms, or depression symptoms. Attrition prior to the intervention was high for those in the intervention condition. Findings demonstrate that the friends and family for mental health program improves informal caregiving skills, but limitations related to attrition suggest caution is warranted when interpreting these findings. Additionally, intervention benefits were only short-term. Future efforts evaluating interventions directed at informal caregivers in rural communities are encouraged to consider ways to maintain benefits and reduce attrition.
Marginalized urban communities are affected by both high levels of violence and pervasive police presence. This qualitative study examined the dual burden of violence and over-policing, which contributes to hypervigilance and stress among community members. To explore the experiences of individuals residing in a large urban city, we employed photovoice and interviews with 22 participants. Five topic-driven sessions were held with four cohorts. Participants took photos reflecting weekly topics during the week and met for group discussion. During group sessions, participants discussed the meanings of their photos. Sessions lasted approximately 60 min. The group discussion sessions were recorded and transcribed. An inductive coding process was used to identify themes. Four key themes were identified: (1) community violence and over-policing, (2) legitimacy and distrust in law enforcement, (3) adverse effects of dual threats of violence and over-policing on health, and (4) desire for community-led solutions and lack of resources. Participants described their experiences of navigating high crime and violence while attempting to avoid unwanted law enforcement encounters. The ambient police presence in the community did not provide safety for community members who felt exposed to pervasive threats of violence; rather, it contributed to distrust of law enforcement. Duality of legal vs. extralegal aspects of police presence, probable cause vs. excessive police surveillance, and legitimacy vs. distrust of the police created a community environment where people experienced lingering anxiety and stress. Community-led solutions may help improve community safety, stability, and trust.
Evidence indicates disparities in mental health outcomes among Black youth compared to other racial and ethnic groups. These disparities may be related to gaps in the quality of mental health services and inadequate culturally safe practices, which hinder the ability to appropriately support the mental health needs of Black youth. This study aimed to develop a guidance document with recommendations for the delivery of mental health services for Black youth in Canada, focusing on community, primary care, and educational settings, informed by a knowledge synthesis and the perspectives of Black youth in Canada. A participatory research approach was used, consisting of five phases: (1) establishment of an advisory committee, (2) a scoping review, (3) development of a draft guidance document, (4) four focus groups involving 18 Black youth participants, and (5) integration of youth perspectives into the final guidance document. The final document included recommendations across four stages of mental health service delivery: Preparation (16 recommendations), Assessment and Diagnosis (22 recommendations), Intervention (23 recommendations), and Evaluation (5 recommendations). Of the 66 recommendations, 11 emerged exclusively from the focus groups and 18 were informed by both the literature review and focus groups. These recommendations provide consistent guidance for more equitable mental healthcare and represent a step toward broader social equity and inclusion in Canada.
This study presents a qualitative exploration of the first national Ex-In (Experience Involvement) training programme for peer support workers (PSWs) implemented in Italy. Funded by the Ministry of Health and delivered in 2023–2024, the programme represents the first EX-IN training evaluated at a national level within a context where the PSW role is not yet formally institutionalised. Data collection included semi-structured individual interviews with 18 participants, participant observations during two residential training weekends, and a six-month follow-up telephone survey focused on employment status. Data were analysed using reflexive thematic analysis within an interpretive qualitative framework, privileging participants’ meaning-making processes over predefined outcome measures. Three interpretive themes were developed: (1) from lived experience to situated knowledge, describing the epistemic repositioning through which personal biography was reworked as a professional resource; (2) proximity and boundary, highlighting how participants constructed professionalism by regulating experiential closeness, self-disclosure, and emotional involvement; and (3) between mediation and advocacy, showing how the PSW role was understood as a third position within services, requiring critical independence, ethical responsibility, and collective recognition. The training programme supported a collective reworking of personal narratives, enabling lived experience to be transformed from private biography into situated professional knowledge. Participants reported increased self-awareness, recognition of recovery trajectories, and a strengthened professional identity, fostered by the residential and participatory group-based format. At the same time, challenges emerged related to emotional sustainability, managing openness without over-identification, and maintaining autonomy in the mediating role. Overall, the findings highlight the need for training adapted to local contexts, targeted preparation of mental health professionals to support interprofessional collaboration, ongoing supervision to sustain professional boundaries, and greater job stability to enable the sustainable integration of PSWs within Italian mental health services.
Serious mental illness (SMI) significantly impacts both patients and their families, particularly in persistent cases. Family programmes have shown benefits, but adherence is often poor, and even motivated family members may disengage when intervention formats do not adequately fit their needs, circumstances, or expectations. The Family Recovery Programme for Serious Mental Illness (FAM-RESMI), a programme based on systemic and relational theory developed within a Community Rehabilitation Service (CRS), is a brief intervention format that, addressing previously identified needs, is designed to promote recovery and improved quality of life (QoL) for people with SMI and their families. This exploratory single-arm pre–post evaluation describes a sample of service users and family members who participated in a FAM-RESMI intervention. We observed significant pre–post changes in QoL in both groups, as well as increased resilience and reduced caregiver burden in the family members group. Adherence was encouraging, although variable, and satisfaction with the programme was high. Although exploratory, our findings provide preliminary practice-based evidence that the FAM-RESMI, based on a brief, structured format, is feasible in public mental health settings with historically low adherence. Larger samples, comparison groups, and follow-up assessments are warranted to consolidate these results.
Homelessness is widely regarded as one of the most severe forms of social exclusion and represents an urgent public health challenge. Notably, compassion has been proposed as a construct of social cognition closely linked to emotional well-being and as a facilitator of community integration. Although the importance of compassion within intervention teams and public attitudes toward people experiencing homelessness (PEH) has been emphasized, little is known about the processes of compassion and self-compassion among PEH. Hence, a systematic review was conducted with two main objectives: (a) to examine the processing of compassion and self-compassion in PEH, (b) to analyze the effects of compassion-based interventions on community integration and emotional well-being among PEH. Following PRISMA guidelines, quantitative and qualitative studies were included, identified through an unrestricted search of three major multidisciplinary databases: PubMed, PsycINFO, and Web of Science. Fourteen articles, comprising 1,591 participants, met the inclusion criteria. Depending on study characteristics, three risk-of-bias tools (ROBINS-E, RoB 2, and JBI) were applied, and all studies met the pre-established standards for their respective assessments. The findings highlight the multifaceted influence of compassion and social cognition in PEH. Higher levels of self-compassion and adaptive social-cognition skills were found to function as protective factors against psychological distress and depressive symptoms. With special relevance to the primary subgroups identified in the literature, these capacities were generally associated with better community integration, resilience, and overall emotional well-being. Furthermore, while the reviewed interventions suggest a potential to foster self-compassion in PEH, limited sample sizes and model heterogeneity prevent definitive conclusions regarding their impact on social exclusion. Overall, these results suggest a significant role for compassion and self-compassion within both the mental health and social domains of PEH, indicating that fostering these capacities may be key to building a more inclusive society and a more effective support system for this population.
Mobile behavioral health crisis response services, staffed by clinicians and specialists, can support individuals experiencing urgent mental health or substance use issues. While Medicaid coverage for these services since 2021 has supported growth in their availability, research on family caregivers’ experiences with mobile crisis services remains limited. Family caregivers often participate in encounters with crisis services when the person in crisis cannot seek help independently due to their symptoms. This study aimed to explore family members’ experiences with a mobile crisis program in the US using qualitative methods. The study examined an expanding, county-level mobile crisis program designed according to SAMHSA guidelines and Medicaid-qualifying standards, staffed by clinicians and peer support workers. We used qualitative methods to understand family caregiver experiences with these services. Data was collected through in-depth interviews with family caregivers (N = 11), the primary source for this analysis, and ethnographic field observations of mobile crisis response teams (N = 29 observation days), which provided contextual information about service delivery and family involvement during crisis. Transcripts and field notes were analyzed for recurrent themes. Family members expressed feeling isolation and being overwhelmed while managing loved ones’ constant care. Many worried that without their support, loved ones would face homelessness and worsened mental health. Families identified the mobile crisis service as a substantial improvement over the other options they could turn to for help. They reported that crisis services alleviated isolation, appreciated providers who understood home dynamics, and found comfort in having a safe and responsive resource to call when needed. Families identified the availability mental health responders as a source of relief both during and after crisis episodes. Understanding how features of crisis response service are experienced by family caregivers can inform impact studies by highlighting potential mechanisms of effectiveness.
Peer support is a prominent recovery-oriented innovation in mental healthcare, with implementation efforts to integrate peer support workers reported worldwide. However, its sustainment, including the factors that shape it, remains underexplored. Sustaining evidence-informed innovations and their associated benefits is a global policy priority and a complex challenge for health care systems. Although recent research has advanced theoretical frameworks and tools to support sustainability planning and assessment, there is a growing need for empirical studies that examine how sustainment unfolds in practice. Drawing on qualitative interviews, this study explores the sustainment of peer support two years post-implementation in a mental health service overseeing community housing for adults with mental health challenges in Canada. During 2022 and 2023, nineteen individuals including managers, service providers and peers, and housing proprietors involved in implementing and sustaining peer support were interviewed. Data collection and analysis were guided by the Consolidated Framework for Sustainability Constructs in Healthcare to explore determinants influencing sustainment. Sustainment was influenced by a constellation of factors spanning the design and delivery of peer support, organisational setting and processes, involved actors, available resources, and external contextual conditions. These factors exerted positive, constraining, or ambivalent influences on sustainment. Positive influences included staff belief in peer support values, funding availability, perceived effectiveness of peer support, peer workers’ expertise, integration of peer support innovation and peers into organisational policies and routine practices, organisational leadership, and participant satisfaction with being involved in peer support implementation. Key challenges included limited human resources, high staff workload, and union and administrative constraints, particularly those related to the lack of formal employment regulation of peer support workers. The interplay of additional contextual factors, such as provincial (regional) policy guidelines, training efforts, and organisational culture, highlights the context-dependent nature of sustaining peer support. This study advances understanding of peer support sustainment by demonstrating that it emerges from a dynamic interplay of influences across multiple and interrelated levels. By conceptualising sustainability determinants as context-dependent and evolving influences rather than fixed barriers or facilitators, the study offers a refined lens for examining peer support sustainment in practice. These findings have important implications for policy, research and practice in supporting the long-term integration of peer support workers in mental healthcare.
The use of coercive measures in psychiatry raises ethical and clinical concerns, particularly given their potential psychological harm and long-term consequences. While most studies focus on inpatient settings, little is known about coercion applied earlier in the care pathway. This retrospective observational study included all patients (N = 695) admitted through the psychiatric emergency department (ED) to the adult psychiatry division of Geneva University Hospitals in 2019. Data were extracted from electronic medical records and included sociodemographic variables, clinical characteristics, and the use of coercion (seclusion, restraint, or forced medication) in three settings: ambulance, ED, and inpatient wards. Bivariate analyses and logistic regressions were conducted to identify predictors of inpatient coercion. Overall, 33.7
While family peer support workers are increasingly put forward as a means of enhancing family involvement in adult mental health care, research on their impact and implementation remains scarce. This study explores both the added value of, and the preconditions for, the successful implementation of family peer support workers in adult mental health care. A qualitative design was employed, consisting of semi-structured interviews with four family peer support workers, six hospital policymakers, and ten mental health professionals from two psychiatric hospitals in Flanders, Belgium, that recently employed family peer support workers. Participants perceived family peer support workers as contributing to improved family engagement and more family-sensitive care. However, successful implementation was found to depend on a set of interrelated macro-, meso-, and micro-level preconditions, including: (1) a co-created and well-considered policy vision and implementation framework; (2) a clear yet flexible role description and competency profile; (3) a conducive organisational culture and departmental climate, as well as supportive professional attitudes; and (4) adequate time and resources. These preconditions provide a foundation for the everyday legitimacy of family peer support workers, which is realised through relational trust and collaborative practice. At the same time, their implementation remains pioneering work, characterised by ongoing negotiation, with stigma still surrounding both family involvement and experiential knowledge.
Depression is prevalent among people who use opioids (PWUO) and may hinder mental healthcare access not only through reduced engagement but also through difficulty identifying where to obtain services. Information about available mental health care is often obtained through disclosure of symptoms and help-seeking interactions with providers or others. Concerns about how others may react to seeking care may discourage these interactions and limit guidance opportunities for care. However, few studies have examined whether depressive symptoms and anticipated stigma related to help-seeking perceived as a barrier to care are associated with reporting a mental health care service navigation knowledge barrier among PWUO. We analyzed data from a cross-sectional survey of 199 PWUO conducted in New Haven, Connecticut. Participants reported whether “being unsure where to go to get mental healthcare” was perceived as a barrier (mental health care service navigation knowledge barrier) and whether “being concerned about what others might think, say, or do” was perceived as a barrier (anticipated stigma related to help-seeking perceived as a barrier). Depressive symptoms were assessed with the PHQ-9 (score ≥ 10). Using adjusted multivariable logistic regression models, we examined separate and jointly adjusted associations and tested an interaction by depression screening status. Nearly 59
People in mental distress are best supported by mental health services, yet initial contact often occurs with the police. In many jurisdictions, police may detain and transport individuals at risk to healthcare providers (e.g., emergency departments). This article reviews the literature on models of transfer of care from police to healthcare to identify the types of models reported, the outcomes associated with their implementation and possible factors influencing outcomes. A rapid review was conducted. Embase, Medline, Web of Science, and Google Scholar databases as well as grey literature and hand searches were explored to identify primary research studies published in English during January 2010-January 2025. Eligible articles were empirical evaluations or descriptions of models of transferring of care, regardless of methodology. Twenty-four studies were included, most utilising data from crisis response professionals and administrative records. Identified models tend to fall into one of four categories: co-response models, liaison models, designated places of safety models, and screening tools. A range of outcomes that the transfer of care models might influence has been reported including time under police care, rates of police calls and detention/sanctions, quality of care during call and/or transportation, emergency department utilisation/attendance duration, hospital diversion, and treatment admission. Effective communication and inter-service collaboration were identified as key factors in the effectiveness of the models. The identified models of transfer of care show promising outcomes, however, the absence of robust methodological evaluation indicates that the evidence base is not yet sufficiently developed to demonstrate their broader value.
Severe mental illness (SMI), such as schizophrenia, is associated with high physical health morbidity, extensive healthcare utilization, and substantial economic costs. This naturalistic study examined changes in resource utilization, measured as direct costs, following a psychosocial health promotion program (MINT) across social services and physical and psychiatric healthcare. Resource utilization patterns for 77 participants were assessed using the Resource Utilization of Mental Illness (RUMI) instrument during the 6-month intervention and a 6-month follow-up. Data were collected on physical and psychiatric care, social services, and contacts with the justice system. We observed significant changes in both costs and patterns of resource utilization. As anticipated, costs related to social services were unchanged. Total costs increased during the intervention period and decreased at follow-up. Costs associated with physical and psychiatric healthcare decreased during the intervention and continued to decrease during follow-up. At a profession-specific level, significant differences were observed in primary care visits: costs associated with physician visits decreased during the intervention and increased at follow-up, whereas costs related to nurse visits increased during both the intervention and follow-up. Overall, these findings suggest that the MINT intervention may modify patients' patterns of resource utilization across services in ways that better align with patients' needs.
Improving medication adherence in first-episode psychosis is a clinical priority. However, existing interventions have not provided a brief, adherence-focused delivery model, and the mechanisms through which these interventions work remain unclear. Nurse-led approaches are theoretically well suited to address these needs; however, such interventions have not been established. This study aimed to evaluate the perceived changes, acceptability, and preliminary outcomes associated with a nurse-led medication adherence support program for patients with first-episode psychosis and their families. A nurse-led medication adherence support program was implemented with 11 patient-family dyads. Qualitative interviews were conducted to explore perceived changes attributable to the interventions. Acceptability was assessed through satisfaction, and preliminary outcomes were assessed through medication adherence, attitudes, and beliefs about medication. Thematic analysis indicated that the program was associated with multifaceted changes in how patients and families perceived pharmacotherapy-centered care and family support. Quantitative findings showed high levels of acceptability among both patients and families. Pill counts, patient-rated medication adherence, and family-rated adherence showed no statistically significant changes across time points and remained at favorable levels. Among the measures of attitudes and beliefs about medication, only patients' drug attitude scores improved significantly at the 12-week follow-up, whereas the other measures remained unchanged over time. This pilot study suggests that a brief nurse-led medication adherence support program for patients with first-episode psychosis and their families is acceptable and warrants further evaluation in controlled studies.
