Despite the substantial burden of mental health disorders in Ethiopia, access to mental health services remains limited and unevenly distributed. This study aimed to examine the spatial distribution of mental health services in Ethiopian health facilities and identify factors contributing to their availability. Data were drawn from the 2021–2022 Ethiopian Service Provision Assessment-Plus (ESPA+) survey, which included a census of hospitals and a representative sample of health centres, posts, and clinics. Spatial patterns were assessed using the Global Moran’s Index (Moran’s I) to evaluate spatial autocorrelation, while hotspot analysis employing Getis-Ord Gi* statistics identified areas with high and low service availability. A Poisson regression was conducted to assess factors associated with mental health service availability. Analysis of 1,158 health facilities revealed a significant clustering of mental health services in Ethiopia, with a Global Moran’s I value of 0.09 (P < 0.01). Hotspot analysis identified areas of high mental health service availability in Addis Ababa, central and south-western Oromia, and north-western Amhara, while areas with low availability were found in Afar, Benishangul-Gumuz, Gambella, Harari, Dire Dawa, northern Somali, and northern SNNPR. Factors negatively associated with mental health service availability included rural location, primary facility status, a small catchment population (< 10,000), and facilities charging service fees. This study highlights significant disparities in the availability of mental health services in Ethiopia, particularly in rural and underserved regions. Expanding mental health services within primary healthcare units, and revisiting task-shifting strategies to mitigate shortages in the mental health workforce may help to improve access to mental health care. Integrating innovative delivery models,such as telemedicine and community-based initiatives,will be helpful in fostering equitable mental healthcare nationwide.
Abstract Background Cognitive behavioral therapy (CBT) is an evidence-based treatment for substance use disorders (SUDs), yet standard protocols may have limited cultural relevance for ethnoracially diverse populations. Cultural adaptation may enhance the fit and relevance of interventions; however, the scope, characteristics, and outcomes of ethnoracial adaptations of CBT for SUD remain underexamined. This scoping review mapped the global evidence on ethnoracially adapted CBT for SUDs, including strategies, implementation characteristics, and treatment outcomes. Methods Following PRISMA-ScR guidelines, we systematically searched nine databases for peer-reviewed empirical studies evaluating ethnoracially adapted CBT interventions for SUDs. Studies were included if they explicitly described an ethnoracial adaptation to CBT. Extracted data included study design, population characteristics, strategies, comparator conditions, implementation indicators, and substance use outcomes. Results Of 671 records identified, 12 studies met the inclusion criteria, representing populations in the United States and Kenya. Most studies focused on Latino/Hispanic populations living in the United States, with comparatively limited representation of other ethnoracial groups and low- and middle-income country contexts. Adaptations included both surface-structure modifications (e.g., language translation, culturally relevant examples, and tailored delivery formats) and deep-structure modifications that incorporated culturally relevant values, belief systems, and lived experiences into core CBT content and delivery. Most studies reported favorable substance use outcomes following participation in ethnoracially adapted CBT interventions. Several studies also identified culturally salient factors, including ethnic identity, familismo, and religiosity, as moderators or correlates of treatment response. However, implementation outcomes such as feasibility, fidelity, and acceptability were inconsistently reported, long-term follow-up data were limited, and only a small number of studies directly compared ethnoracially adapted CBT with standard CBT. Conclusions The current literature suggests that ethnoracially adapted CBT is a promising approach for addressing SUDs among diverse populations. However, limitations in implementation reporting, long-term outcome assessment, geographic representation, and direct comparisons with standard CBT constrain conclusions regarding the specific contribution of cultural adaptation to treatment outcomes. Future research should expand representation across ethnoracial groups and geographic regions and clarify how cultural adaptations influence treatment engagement, implementation, and substance use outcomes.
Digital mental health services (DMHS) can increase the accessibility and scalability of evidence-based mental health care. DMHS have been integrated within health systems and shown to be clinically effective for anxiety and depressive disorders, but the nature of service reach within routine community care remains under-explored. This study aimed to characterise reach and uptake of an Australian digital mental health service (THIS WAY UP), describe the socio-demography of routine service users and investigate predictors of treatment uptake in a large community sample. A naturalistic, observational evaluation of routine service provision was conducted over a two-year period (July 2020–2022), including all adults who registered for a THIS WAY UP digital mental health program within routine care. Service reach and uptake were quantified via the number of program registrations, and commencements, respectively. Descriptive statistics and multivariable logistic regression were used to describe users’ socio-demography and examine predictors of treatment commencement. There were 66,004 registrations for a THIS WAY UP program during the study period, (averaging 2640 ± 557 each month); most commonly for mixed anxiety and depression (23
Adolescents living in conflict-affected areas have higher rates of suicidal behaviors and lower subjective mental well-being than adolescents living outside war-affected areas. However, the extent of the problem might be much greater than we can imagine in northern Ethiopia due to severe impacts of the war among high school students. This study aimed to examine the predictors of suicidal behavior and subjective mental well-being among high school students in conflict-affected areas in the North Wollo Zone, Ethiopia. A school-based cross-sectional survey was carried out among 3400 high school students in the North Wollo Zone, Ethiopia. Multistage stratified random sampling was used to recruit study participants. The analysis focused on two binary outcome variables: suicidal behavior and subjective mental well-being. Multilevel logistic regression analysis was used to identify factors influencing students’ suicidal behaviors and poor mental well-being. In the final model, all significance tests with a p-value < 0.05 were considered significant factors associated with suicidal behaviors and poor mental well-being. The prevalence of suicidal behaviors was 6.9
Growing appreciation for the role of System Dynamics Modelling (SDM) in mental health decision-making is yet to translate into its widespread application. This article investigates why this is the case, aiming to identify and overcome barriers to its successful future use in supporting better decision-making. We describe a three-stage participatory process developed iteratively across multiple regions in Australia: (1) identifying priority interventions through rapid evidence reviews and collaborating with stakeholders to understand regional needs and imminent funding decisions; (2) developing intervention-specific model parameters through the synthesis of research evidence and local contextual knowledge; and (3) using simulation scenarios as thinking tools to support critical reflection and deliberation on youth mental health investment strategies. We draw on an implementation narrative to demonstrate how this approach works in place-based regional planning practice. The participatory processes built stakeholder capacity for systems thinking and enabled critical engagement with SDMs. Through exploring simulation scenarios, decision-makers developed appreciation for combining interventions versus implementing them separately; decision points shifted from questions of whether to fund interventions to strategic discussions about resource allocation and how to collaborate to achieve impact in the region. This methodology highlights the critical role of ‘backstage work’ beyond participatory workshops in which diverse forms of evidence and local contextual knowledge are translated into the formal SDM, building trust in the model while fostering capacity for model use. System Dynamics Models can be the thinking tools that support deliberative decision-making practices. Augmenting SDMs with local expertise through these participatory practices delivers an effective method to embed these models in regional mental health decision-making, for better resource allocation and strategic planning of local mental health services.
Mental disorders contribute substantially to global disease burden, yet persistent deficiencies remain in medical trainees’ readiness to identify, diagnose, and treat patients with mental health conditions. Main barriers include stigma, outdated curricula, insufficient clinical practice, and regional differences in mental health services. This scoping review systematically mapped existing research on educational innovations, learning approaches, and evaluation instruments in psychiatric education for medical learners (2015–2026), with formal quality appraisal using a JBI-adapted tool. Following JBI methodology and PRISMA-ScR guidelines, a systematic search was conducted across MEDLINE, Embase, PsycINFO, and Scopus. The PCC model guided eligibility. Two reviewers independently selected articles and extracted data. A ten-item JBI-adapted quality appraisal checklist was applied to all included studies. The evidence base comprised 34 primary empirical studies (77.3
Service collaboration ensures care continuity and recovery-oriented care for individuals with mental disorders (MD). A recovery-oriented system of care (ROSC) encompasses diverse person-centred services that collaborate to address individual needs and foster social integration. We examined the characteristics of care provision for individuals with MD in Belgium with regard to ROSC principles. Specifically, we analysed the structure of collaboration within existing mental health service networks, focusing on the division between mental health services and specialised services for substance use disorders (SUD). We conducted an online survey involving 309 services across five networks, of which 190 participated. We collected data on referrals and service characteristics. We used Social Network Analysis (SNA) to assess collaboration patterns within service networks, considering network density (i.e. number of ties), transitivity (i.e. tendency toward clustered collaboration), degree distribution (i.e. concentration of ties around certain services), service attributes (e.g. category, care function, and exclusion criteria), and homophily (i.e. tendency to connect with similar services). Exponential Random Graph Model (ERGM) was used to test whether observed collaboration patterns differed from random collaboration. Hospital units and specialised SUD services were central services. Specialised SUD services and generic mental health services were more likely to collaborate with similar services. Likewise, services with the same care function were more likely to collaborate, except hospital units. Networks showed significant transitivity. Mental health service networks appear to be structured around organisational boundaries, with limited collaboration between complementary services and a highly hospital-centred configuration. These patterns suggest a misalignment with ROSC principles and may constrain the capacity of care systems to support recovery processes.
Stepped models of care provide a sequential approach in the treatment of mental health conditions, with the level of care prescribed varying in intensity according to the severity of mental health concern for the individual. This systematic review and meta-analysis evaluate the effectiveness of stepped care compared to usual care for mental health-related clinical outcomes, quality of life, cost-effectiveness and satisfaction across mental health conditions. A systematic literature search across eight databases (February 2024) identified randomised controlled trials of stepped care models for diagnosed mental health conditions. Standardised mean differences (SMDs), risk ratios (RR) and 95
To develop and validate a mental health personal recovery measure for people with severe mental health conditions (MHCs) in Ethiopia that is grounded in their recovery journey. The study stages were: reviewing existing measures; qualitative exploration of the concept in Ethiopia (n = 25 interviews); expert workshops (n = 3 involving 28 experts); cognitive interviewing for semantic and content validity (n = 20); pilot study for item reduction and exploratory factor analysis (n = 213) and parallel analysis to determine the dimensional structure (n = 213); and assessment of construct (confirmatory factor analysis) and construct validity in an independent sample (n = 401), and test-retest reliability in a sub-sample (n = 48). Construct validity was assessed against symptom severity and disability. Participants gave greater emphasis to social recovery than self-actualisation or empowerment; hence, no existing measures had face validity. We piloted 26 items from existing measures and 19 newly developed items. The draft measure was unidimensional, explaining 71
The transformative role of Large Language Models (LLMs) in youth mental health care as intelligent agents that can support patient engagement and augment healthcare delivery has been explored in this commentary. By acting as personalized virtual assistants for both patients and providers, LLMs have the potential to offer real-time, context-aware support, improving administrative workflows within mental health services. However, there is increasing concern within the research community regarding overinflation of claims surrounding large language models in mental healthcare. Technology companies often overstate their capabilities, creating unrealistic expectations that may lead to detrimental outcomes for patients. This paper critically examines the opportunities and limitations, advocating for greater transparency and rigorous scrutiny in the application of AI within sensitive domains such as mental health. It underscores the need for developmentally appropriate engagement, cultural sensitivity, and the integration of human expertise alongside AI to ensure ethical and effective collaboration in mental healthcare interventions.
One key question for current psychotherapy research is how limited resources should be used efficiently to optimise treatment pathways. We examined how primary care level (PCL) psychotherapy, a history of mental disorder, and sociodemographic factors are associated with the later probability of receiving long-term rehabilitative psychotherapy. This longitudinal observational cohort study based on a register data from the Gaps in Mental Health-Related Work Disability and Treatment Outcomes (GapMind) project, which combines data from national registers (Statistics Finland and the Social Insurance Institution of Finland) and the largest occupational health service (OHS) provider in Finland. The study population comprised Finnish occupationally active individuals aged 15–65 (N = 1,261,320). Data on the use of PCL psychotherapy in the OHS between 2019 and 2020 were combined with data on age, gender, socioeconomic status, education, history of mental disorders (including psychotropic medication purchases, sickness absences, pensions, and use of OHS due to mental disorders), and somatic disabling comorbidities and four-model logistic regression analyses were conducted. The primary outcome was the use of long-term psychotherapy during 2020–2022. Participation in PCL psychotherapy (OR 7.05–15.51) and a history of mental disorders (OR 1.67–4.25) were associated with a higher probability of receiving subsequently long-term rehabilitative psychotherapy. Higher age, female gender, and higher socioeconomic status were also associated with an elevated likelihood of engaging in long-term rehabilitative psychotherapy. Participation in PCL psychotherapy, and various clinical and sociodemographic factors were associated with an increased probability of receiving later long-term psychotherapy. These findings may support healthcare systems in leveraging this information to better anticipate the need for long-term psychotherapy.
Abstract Background Youth mental health systems worldwide face increasing demand, workforce shortages, and fragmented pathways to care. Addressing these challenges requires approaches that extend beyond specialist clinical treatment to incorporate prevention, participation, education, and recovery-oriented support. While Recovery Colleges are increasingly established within adult mental health services, their youth-adapted counterparts commonly referred to as Discovery Colleges remain underexplored within youth mental health systems research. This narrative review synthesises emerging literature to examine the conceptual foundations, developmental adaptations, and potential system-level role of Discovery Colleges within youth mental health care. Methods A narrative review approach was employed to synthesise emerging literature on Discovery Colleges and related recovery-oriented educational initiatives. Peer-reviewed publications, programme descriptions, and implementation reports were analysed to examine the defining principles, developmental relevance, organisational characteristics, and system-level implications of Discovery Colleges within youth mental health contexts. Results The synthesis identified four interrelated conceptual domains characterising Discovery Colleges: (1) recovery-oriented learning models and developmental adaptation; (2) mechanisms of engagement and participation; (3) organisational and professional implications; and (4) cross-sector positioning within youth mental health ecosystems. The findings suggest that Discovery Colleges can be conceptualised as developmentally responsive and recovery-oriented learning environments operating at the intersection of education, community support, and mental health care. The review further highlights important tensions relating to implementation, safeguarding, fidelity, sustainability, and cross-sector integration. Conclusions Discovery Colleges may represent a promising recovery-oriented innovation within youth mental health systems by reframing mental health support as a collaborative, participatory, and educational process rather than solely a clinical intervention. However, the current evidence base remains limited and largely exploratory. Further empirical, developmental, and implementation-focused research is required to evaluate their effectiveness, sustainability, and long-term contribution to integrated youth mental health systems.
This article examines the relationship between behavioral and Environmental, Social, and Governance (ESG) variables and the Mental Health Index (MHI) of Italian regions from 2016 to 2023. The use of descriptive statistics, cluster analysis, and forecasting models is employed for descriptive and exploratory purposes, as well as for forecasting regional disparities in mental health. Relative stability at the state level and persistent territorial variability are evident in the MHI derived from the ISTAT-BES indicators, with the North and Centre performing better than the South, except for notable improvements in disadvantaged regions such as Calabria and Campania. Behavioral factors, particularly sedentariness, smoking, and multimorbidity, are consistently associated with adverse trends for mental health, while adequate nourishment and exposure to urban green spaces are found to be protective. ESG-related factors, including occupational security and judicial efficacy, also contribute to these inequalities, attributing mental health status as part of the more general system effects of institutions and environments. Cluster analysis identifies distinct regional typologies based on aggregated behavioral and ESG patterns, while the predictive model highlights multimorbidity, smoking, and sedentary behavior as the most relevant factors negatively associated with the Mental Health Index (MHI), and urban green availability as a key factor positively associated with it. They point out that Italian mental health disparities are not only associated with behavioral determinants of individuals, but must be addressed from a multi-faceted ESG perspective. Policy reactions also mean that public health responses must attend not only to lifestyle risk factors but also structural determinants and incorporate active living promotion, reduction of smoking prevalence, investment in green infrastructures, and improvement of governance efficiency.
To assess mental health literacy and its association with professional variables among community health center (CHC) nurses. Mental health problems are highly prevalent in post-conflict countries, but access to treatment is acutely limited. The integration of mental health care into primary healthcare (PHC) is one of the key recommended strategies to scale up access to treatment. However, little is known about PHC nurses’ mental health literacy (MHL). Seventy-four nurses (46 women, 28 men) were recruited from 13 CHCs in the western province of Rwanda. Participants answered a questionnaire about their professional characteristics and MHL, namely, the recognition of mental disorders depicted in clinical vignettes, knowledge of risk factors for mental disorders, and knowledge of helpful people and interventions. Most participants correctly identified Posttraumatic Stress Disorder (63.5
The 2023 SDG Report reveals a concerning trend: weak progress on over 50% of SDG targets in the last three years, with 30% stalled or regressing. Failure to make progress towards goals may lead to a rise in negative affective states, including anxiety and depression. Hope is a teachable skill that leads to positive outcomes in psychiatric and medical health, education, the workplace, and overall well-being. Teaching hope globally using established programming and dissemination of hope science is vital for SDG progress by teaching everyone the essential skill of hope. Literature for this narrative review was compiled based on keyword relevance, relevancy, and recency. Findings on hope's relationship to the SDGs and actionable strategies are discussed.
Participatory Systems Modelling (PSM) offers an opportunity to deliver robust, contextually relevant, and suitable models for informing strategic responses to complex public health challenges. For mental health care systems, PSM benefits from multi-sectoral participants’ social and emotional capital for building consensus on priorities and policy objectives that can influence decision-making. In Bogotá, Colombia, we evaluated a PSM process that developed an interactive decision support tool that can inform policymaking on the selection of programs and services to mitigate social, economic, and health system drivers of youth mental health outcomes including suicidal behaviour. Using the CHaRL Framework, we explored changes in perceptions or beliefs of participants on the functionality of the (mental health) system and its drivers. Multi-sectoral participants including youth with lived experience participated in three workshops to collectively inform the building of the model. Pre-post-tests, a survey and observations of the PSM process were conducted. Through the participatory process, participants increased knowledge and understanding of the mental health care system, its drivers and constraints of performance for youth in Bogotá. Due to active engagement, a credible and comprehensive tool was created, reflective of the complexity of the system, and focused on what participants and evidence show are high priority interventions. Participants’ concerns around trust in the model shifted positively over the course of the workshops. Skepticism in policymakers’ capacity to use the model increased participant recognition of the need to advocate for its use. Participatory processes help to overcome stakeholder hesitancy by offering an important starting point for building trust and partnership for effecting change in health systems. Consideration of participant bias at the start of the process could strength the validity and use of the results in the longer term.
The practice of electroconvulsive therapy (ECT) is constrained by limited resources. Anticipating recurrent peaks in demand is therefore essential for optimizing resource planning within public healthcare systems. This study examined seasonal patterns of ECT utilization in France over an extended period. We analyzed data from the French national administrative and medical database. Seasonal patterns in monthly ECT utilization time series from 2017 to 2023 were investigated using robust statistical methods. We observed a clear seasonal pattern with a 12-month periodicity in monthly ECT utilization, accounting for 16
BACKGROUND:Hindered by staff shortages, high workloads and rising waiting lists, mental healthcare services across Europe struggle to provide accessible, appropriate, and timely care for those who need it. In the past, governments tried to tackle large-scale issues in mental healthcare with profound policy changes, such as deinstitutionalization, decentralization and marketization. In the Netherlands, where mental healthcare is also under pressure, many policymakers and other influential stakeholders believe that policy changes aimed at stimulating collaboration between providers, third-party payers and other domains are a solution to the increasing challenges. This research analyses how a collaborative logic unfolds in a complex sector dominated by a market logic. METHODS:By analyzing policy documents and conducting interviews with representatives of healthcare organizations and health insurers, we explored both the systssemic and cultural barriers that challenge collaboration in mental healthcare. RESULTS:Findings show that, while collaboration is framed as a key strategy to resolve issues in mental healthcare, the entrenched market logic has fostered negative perceptions and lasting mistrust between mental healthcare stakeholders. These perceptions make collaboration difficult. CONCLUSION:Challenges related to collaboration are not only systemic or financial in nature but are deeply rooted in belief systems, norms and values. A fundamental shift in these areas is essential to foster a more cooperative practice in mental healthcare.
Abstract Introduction Social and economic needs are greater in populations living with mental ill-health compared with the general population. However, these needs are often not routinely or adequately assessed in practice, and there is a lack of corresponding support available for a range of social and economic needs. A practical roadmap is required to work towards social and economic inclusion as a central component of mental health services. Methods We used the participatory Theory of Change method to conduct two qualitative workshops with health care professionals, third-sector providers, academics and lived experience experts (Workshop 1, n = 16; Workshop 2, n = 14) in the area served by the South London and Maudsley NHS Trust. We co-developed a Theory of Change model which aimed to outline the key steps needed to put social inclusion at the centre of mental health care services in relation to the largest mental health Trust in the United Kingdom, yet with generalisable elements for mental health services in the United Kingdom more broadly. Results A shared goal for services was developed and agreed by participants of securing “a consistent mental health system that enables individuals to feel loved, valued, and capable of thriving beyond their basic needs”. To progress from the current context to this shared goal, six objective pathways were co-produced to act as a roadmap: (1) Provision of person-centred culturally appropriate care; (2) Advocacy for funding for effective social inclusion services in line with need; (3) Advocacy for funding and support of social and peer programmes; (4) Co-located and localised community-based support hubs; (5) A shared feedback system with social inclusion Key Performance Indicators (KPIs) with an ability to include positive outcomes and drive accountability; and (6) A collaborative community service network. Conclusions This Theory of Change model offers a tangible framework to put social inclusion at the centre of mental health services. This model can be adapted and translated to other services and settings that are aiming to make social inclusion a core feature of their provision, beyond those in which it was developed.
Abstract Background In response to the global prevalence and societal impact of mental health problems, innovative healthcare policies have improved access to psychological therapy interventions. Yet, the indirect effects of these access policies on labour force participation gaps related to mental health problems remain unclear. This study assessed the relationship between one of the first major policies to improve access to psychological therapies, the NHS Talking Therapies service, and the economic activity of individuals with long-term mental health problems. Methods In this retrospective observational study, we derived a national sample of the English working-age population from Annual Population Survey data for the period 2015–2020 (N = 535068). Data included information on economic activity and health status, but not the use of healthcare services. The outcome of the study was labour force participation. The volume of appointments per referral received by NHS Talking Therapies services across healthcare commissioning regions in England was used to measure the regional supply of psychological therapy interventions. We used linear regression models, adjusting for a comprehensive set of individual and area-level controls, to estimate the association between the regional supply of psychological therapy interventions and labour force participation for those with and without a long-term mental health problem at the population level. Results We find a labour force participation gap of 36% between individuals reporting long-term mental health problems and otherwise similar individuals with no reported mental health problems. Holding all else equal, we find an increase in the regional supply of NHS Talking Therapies of one appointment per referral is associated with a 0·92 percentage point (CI: 0·0018 − 0·0165) reduction in the probability of labour force participation gap. Results of sub-sample analyses suggest this association was driven by individuals who were not claiming benefits, aged between 45 and 65, and reported male gender. Conclusions Policymakers should consider the indirect effects of policies that improve access to psychological therapy interventions as a potential moderator of the labour force participation gap related to long-term mental health problems.
