Artificial intelligence (AI) is increasingly integrated into mental health care, legal decision-making, and forensic practice. Proponents argue that AI can augment professional judgment by improving prediction, efficiency, and consistency. Yet AI operates fundamentally differently from human reasoning: AI predicts, whereas clinicians and lawyers understand. Predictions alone cannot replace the human reasoning, contextualisation, and justification that clinical and legal decision-making require. This article examines four central tensions that arise when integrating AI into mental health and legal contexts: epistemic, ethical, relational, and legal tensions. These tensions illustrate the limits of purely algorithmic decision-making and the critical importance of maintaining meaningful human oversight. To assist clinicians, lawyers, and institutions navigate these challenges, the HUMAN framework provides a structured approach grounded in five core principles: Human judgment, Understand the model, Monitor performance, Accountability, and Narrative. Each component places human reasoning and ethical responsibility at the centre of AI-supported practice, ensuring that technological innovation strengthens rather than undermines the foundations of psychiatry and law. While AI may transform certain aspects of practice, human professionals retain overall responsibility, with particular emphasis on compassion, empathy, care, presence, and moral reasoning. Ultimately, these are the qualities that matter most.

Founded in 1810, the Richmond District Lunatic Asylum at Grangegorman, Dublin, Ireland, admitted tens of thousands of patients over the course of almost two centuries. Staff introduced many new treatments for mental illness, ranging from ‘moral management’ in the early 19th century to the biological treatments of the 20th century (e.g. malaria therapy, insulin coma, lobotomy). The Richmond was a model for the network of district asylums established across Ireland during the 19th and early 20th centuries. This article summarises the legislative underpinning of Ireland's high committal rates in the late 19th and early 20th centuries; draws on the Richmond's archive to present two clinical cases of women who were committed to the Richmond in 1907 and 1908 but had different outcomes; and explores the nature of ‘institutional careers’ in Ireland's ‘mental hospital’ system in the early 20th century as one element within Ireland's cultures of confinement during this period.

Abstract This chapter introduces the interdisciplinary nature of ethics, morality and rights for the disciplines that work in the realms of psychology and psychiatry. It considers personal morality, professional ethics, and national and international laws and human rights instruments. What happens when these conflict and practitioners need to make decisions? We consider the role of values and identities, position and power, in influencing decisions. We also explore the ideas of justice, of trauma-informed services, the role of civil society and the importance of clinicians engaging meaningfully in reflective practice. To aid this we provide a framework of Critical Practice Questions, across six domains, that can be used to assess the case studies presented throughout this volume and also applied to everyday dilemmas in practice. We conclude with a brief review of the chapters in this book.

Abstract Assisted decision-making policy is an evolving area internationally. The current ideal is to transition from a ‘best interests’ decision-making framework to a ‘will and preference’ framework. This has been influenced by the United Nations Convention on the Rights of Persons with Disabilities which seeks to promote, protect, and ensure the full and equal enjoyment of all human rights and fundamental freedoms by everyone with disabilities. This chapter describes the changing landscape of capacity legislation in the Republic of Ireland, comparing this to the neighbouring jurisdiction of England and Wales. The importance of moving from substitute decision-making to individualized supported is illustrated through two case-studies. Balancing an individual’s right to autonomy and privacy with their right to basic necessities such as health care and appropriate shelter is complex. In many jurisdictions, legislation requires that the individual’s capacity to make specific decisions is assessed only if there is a reason to question their decision-making capacity in relation to the matter at hand. If capacity is lacking, primary consideration must be given to the individual’s will and preference, as well as the beneficent and non-maleficent qualities of any subsequent decision-making on that person’s behalf. At population level, there is a need for greater systematic appraisal of the utilitarian nature of any proposed legislation and to minimize potential for socio-economic inequalities. There is a particular need to study outcomes of programmes of supported decision-making which are often implemented based on current normative ideas rather than rigorous, systematic studies of how well they function.

Niall Crumlish (1974 – 2025) was a profoundly compassionate psychiatrist, uniquely gifted music journalist, and cherished husband, father, son, brother, and friend. He embodied humility, kindness, and compassion in all he did. Niall qualified in medicine from University College Dublin (UCD) in 1997; obtained membership of the Royal College of Psychiatrists in 2002; graduated with a Masters degree (MSc) in Transcultural Mental Healthcare from Queen Mary University of London in 2009; and obtained the degree of Doctor of Medicine (MD) from UCD in 2014. During his clinical training, Niall spent 18 months at St John of God Mental Health Services in Mzuzu, Malawi, a country which left a deep impression on him. In 2010, Niall was appointed as Consultant General Adult Psychiatrist at St James’s Hospital, Dublin with the Camac sector where his sense of humour and generosity left a lasting impression on all who worked with him. Niall was an especially gifted writer about music with an unrivalled depth of knowledge and sensibility. He wrote voraciously for Hot Press magazine from 1993 onwards, where his contributions were widely acclaimed. Through his writings in various publications and on his blog ‘Psychiatry and Songs’, Niall created a body of work that is elegant and intelligent, eloquent and heartfelt, intimate and universal.

Advance healthcare directives are the subject of increased interest in psychiatry. A new legislative framework for advance healthcare directives came into effect in Ireland in 2023 in the Assisted Decision Making (Capacity) Act, 2015. To investigate levels of knowledge about, and attitudes towards, advance healthcare directives among multidisciplinary psychiatry inpatient staff in Ireland one year after commencement of the new legislation. A survey was completed among psychiatry inpatient staff (n = 51) in Tallaght University Hospital, Dublin, Ireland between June and August 2024. Majorities of psychiatry inpatient staff have heard of advance healthcare directives (84.3

BACKGROUND:Many consultations in primary care involve patients with mental health problems, and primary care is typically the place where many such patients initially seek help. While considerable research has examined the prevalence of mental health disorders in primary care, relatively few papers have examined this issue in recent years. This study aims to address this gap by reviewing contemporary literature from 2014 to 2024 on the prevalence of mental health disorders among general practice patients. METHODS:A comprehensive search across PubMed, PsycINFO, and Google Scholar was conducted, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for article selection and assessment, examining the prevalence of mental health disorders in general practice. RESULTS:Studies varied in methodologies and healthcare settings, with reported prevalence rates of mental health disorders ranging from 2.4% to 56.3%. Demographic characteristics (female gender, older age) were associated with a higher prevalence of mental health disorders in the studies identified. Studies based on patient interviews reported broader prevalence (2.4-56.3%) compared to studies using electronic medical record reviews (12-38%). Prevalence also varied between countries. Notably, there has been a lack of post-COVID-19 studies, especially within Europe, examining the prevalence of mental health prevalence in primary care. CONCLUSIONS:Mental health problems are still common among patients attending general practice; the approach to data collection (i.e., prospective interviews with patients), female gender and older age appear to be correlates of higher estimates. Further research involving a large-scale study with multiple sites is a priority.

The current and potential impact of various applications of artificial intelligence (AI) to the field of academic publishing in psychiatry is the subject of increasing attention. At present, AI algorithms assist in data analysis, allowing researchers to process large datasets quickly and uncover complex patterns that would be challenging to detect manually. In psychiatry, this capability can potentially help integrate data from genetics, neuroimaging, and clinical assessments. AI-driven natural language processing (NLP) tools might also facilitate systematic reviews and meta-analyses by automating the extraction and synthesis of information from vast bodies of published literature. In publishing, AI can potentially help to streamline the publication process in certain ways. Automated systems might screen manuscripts for methodological rigor, ethical compliance, and potential conflicts of interest, thereby reducing the burden on editors by prompting them to consider certain matters, and possibly accelerating the publication timeline. AI-powered tools are already used to help with dissemination of research findings by generating summaries and identifying key insights, making information more accessible to a broader audience. In the future, AI has the potential to enhance psychiatric publishing in various other ways. Predictive analytics might identify emerging trends and research gaps in the literature, guiding future studies and funding priorities, although this remains speculative for now. AI could also facilitate more robust collaborations by connecting researchers with complementary expertise and interests. Additionally, the integration of AI in digital platforms could democratise access to cutting-edge research, promote global knowledge sharing, and accelerate advancements in clinical care. As AI continues to evolve, its applications in research and publishing hold the potential to drive significant progress in understanding and treating mental disorders. It is essential that these developments are accompanied by openness about the use of AI in publishing, with clear declarations by authors and publishers about the use of specific applications in published work.

OBJECTIVES:To explore current and potential upcoming legal provisions concerning advance healthcare directives in psychiatry in Ireland, with particular focus on clinical challenges and ethical issues (e.g., self-harm, suicide). METHODS:Review and analysis of selected relevant sections of the Assisted Decision-Making (Capacity) Act 2015, Assisted Decision-Making (Capacity) (Amendment) Act 2022, Mental Health Act 2001, Mental Health Bill 2024, and Criminal Law (Suicide) Act 1993, and relevant publications from Ireland's Medical Council and Decision Support Service. RESULTS:The Assisted Decision-Making (Capacity) Act 2015 outlined new procedures for advance healthcare directives. The Assisted Decision-Making (Capacity) (Amendment) Act 2022 specified that advance healthcare directives relating to mental health are binding for involuntary patients unless involuntary status is based on Section 3(1)(a) of the Mental Health Act 2001 (i.e., the 'risk' criteria). The Mental Health Bill 2024 proposes making advance healthcare directives binding for all involuntary patients. In relation to suicide and self-harm, the Criminal Law (Suicide) Act 1993 states that 'a person who aids, abets, counsels or procures the suicide of another, or an attempt by another to commit suicide, shall be guilty of an offence', and the Decision Support Service advises that healthcare professionals are exempted from criminal liability if complying with a valid and applicable advance healthcare directive that refuses life-sustaining treatment, even where the directive-maker has attempted suicide. CONCLUSIONS:Considerable public and professional education are needed if advance healthcare directives are to be widely used. The ethical dimensions of certain advance directives require additional thought and, ideally, professional ethical guidance.

BACKGROUND:Cancer has adverse consequences for mental health, especially in women. Lack of awareness of services and stigma diminish access to psycho-oncology services. AIMS:To assess psychological distress and willingness to engage in multidisciplinary psycho-oncological services among cancer patients. METHODS:Cross-sectional survey of attitudes towards psycho-oncology services in 142 cancer patients. RESULTS:Women experienced more extreme distress than men, with 46.4% of females and 17.8% of males reporting "extreme" distress. Under one third of cancer patients (30.3%) knew the meaning of 'psycho-oncology'; one quarter (25.6%) knew of the psycho-oncology service, and two thirds (67.2%) were unsure if referral would be beneficial. One fifth (21.0%) would be somewhat/extremely uncomfortable disclosing attending palliative care, compared to 17.9% for psychiatry, 14.4% for psychology, and 5.8% for cardiology. On multivariable analysis, pre-existing psychiatric/psychological difficulty was the only variable independently associated with belief that a psycho-oncology referral would be beneficial. CONCLUSIONS:Limited awareness of psycho-oncology services exist despite high rates of extreme distress among women with cancer.. Given that women have higher levels of extreme distress, it would be prudent to offer them enhanced psycho-oncological care.

OBJECTIVES:To investigate levels of knowledge and attitudes towards advance healthcare directives among inpatient psychiatry service users in Ireland. METHODS:A survey was completed among adult inpatient psychiatry service users (n = 47) in Tallaght University Hospital, Dublin. RESULTS:Just over one in ten (11%) inpatient psychiatry service users had heard of advance healthcare directives. None had created an advance healthcare directive, but over a quarter (25.5%) had written down or verbally told someone what they would like to happen when they became unwell. When asked 'if you were supported by your healthcare provider to make an advance healthcare directive, would you like to make one?', over two thirds responded either 'definitely yes' (34%) or 'probably yes' (34%). On multi-variable testing, future willingness to make an advance healthcare directive was significantly associated with younger age but not with ethnicity, gender, education, employment status, or prior knowledge of advance healthcare directives. All respondents would involve someone else in making an advance healthcare directive. There was high confidence that healthcare practitioners would respect an advance healthcare directive (87%). CONCLUSIONS:There are high levels of interest in advance healthcare directives, but low levels of knowledge and use among inpatient psychiatry service users in Ireland. Our findings indicate a need for educational initiatives and resources to increase awareness. Such efforts could usefully focus especially on appropriate use of advance healthcare directives in psychiatric care and seek to bridge the gaps between evidence of benefit, legislative reform, and their use in mental healthcare.

Admission without consent and treatment without consent are topics of prolonged discussion throughout the history of psychiatry. These practices raise significant issues pertaining to human rights to liberty, bodily integrity, and treatment. Balancing rights is always challenging, especially when people lack decision-making capacity owing to the impact of mental illness. In 1979, the European Court of Human Rights outlined criteria required to justify lawful admission without consent owing to mental disorder in Winterwerp v. the Netherlands. These criteria were: (a) a competent national authority needs to demonstrate the existence of a true mental disorder based on objective medical expertise; (b) the extent of the mental disorder needs to warrant compulsory confinement, and (c) continued detention needs to be validated by the persistence of the disorder. Since then, the Court has delivered multiple judgements relating to psychiatric committal and detention in various facilities, but the most significant potential addition to the Winterwerp criteria occurred in 2019, in Rooman v. Belgium. In this case, the Court stated, "that there exists a close link between the 'lawfulness' of the detention of persons suffering from mental disorders and the appropriateness of the treatment provided for their mental condition". The Court stressed 'that, irrespective of the facility in which those persons are placed, they are entitled to be provided with a suitable medical environment accompanied by real therapeutic measures'. On this basis, this paper proposes adding a fourth requirement to the Winterwerp criteria to justify lawful admission without consent owing to mental disorder: '(d) real therapeutic measures must be provided'. The absence of 'real therapeutic measures' should undermine the legal basis of admission without consent on the basis of mental disorder. This would mean that there could be no involuntary admission owing to mental disorder without treatment being appropriate and available. Such an addition to criteria for involuntary admission in national mental health legislation would protect, rather than erode, human rights, and would more accurately reflect the core purpose of psychiatry: the treatment of mental illness and the consequent alleviation of suffering.

OBJECTIVES:This paper examines rates of physical restraint and seclusion under the Mental Health Act 2001 in acute adult psychiatry inpatient facilities ("approved centres") in Ireland. METHODS:Analysis of rates of physical restraint and seclusion in acute adult approved centres in Ireland in 2023, based on data made publicly available by the Mental Health Commission, Health Research Board, and Central Statistics Office. RESULTS:Rates of physical restraint vary 16-fold between approved centres, ranging from 116 episodes of physical restraint per 100,000 population per year to 7 per 100,000 population, with a national rate of 39 per 100,000 population. Among the six approved centres with the highest rates of physical restraint, five are in Dublin (i.e. urban). Among approved centres that use seclusion, rates vary 19-fold, ranging from 38 episodes of seclusion per 100,000 population to 2 per 100,000 population, with a national rate of 15 per 100,000 population. CONCLUSIONS:There are within-country variations in rates of physical restraint and seclusion in Ireland, but these are of a lesser magnitude than between-country variations. Overall, Ireland's rates of restrictive practices are lower than those in other jurisdictions, consistent with Ireland's low rate of involuntary admission. Future research could usefully focus on the relationship between restrictive practices and urbanicity, among other themes.

Background:Long COVID remains a significant burden for patients, clinicians, employers, and the U.S. healthcare system. Despite substantial resources and scientific studies directed at understanding and treating long COVID, its cause, and thus targeted treatment remains elusive. Conventional medicine focuses on symptom evaluation to rule out other etiologies. Intervention typically offers the patient current understanding and education and provides reassurance and context for their symptoms. Treatment is mostly supportive care directed at symptom management to improve quality of life, including occupational and physical therapy, breathing exercises, pulmonary rehabilitation, and mental health therapy. Classical Chinese Medicine (CCM) can help make sense of an individual's response to COVID-19 infection, as each pathophysiological change caused by COVID can be correlated with CCM principles, therefore a corresponding treatment approach is available. Methods:A case series of four representative patients with long COVID treated with CCM is presented. Symptom complex, CCM diagnoses and treatment, and response to treatment are provided for each case, and the rationale for the selected therapy approach is explained. Results:All four patients recovered fully from long COVID after treatment with CCM therapy. These cases are representative of 56 patients successfully treated thus far with CCM for long COVID. Conclusion:There is no single treatment for long COVID in Western or Chinese medicine. Western medical treatment centers around reassurance and supportive care, whereas CCM treatment can be more directly targeted and individualized to underlying causes and increase the probability of recovery. These cases indicate the potential of CCM for treating long COVID. However, more research is needed to evaluate the effectiveness of this approach to long COVID recovery.

The island of Ireland is partitioned into Northern Ireland and the Republic of Ireland. In both jurisdictions, there have been important developments in mental health and mental capacity law, and associated policies and services. This includes an emphasis on developing more comprehensive approaches to collecting data on outcomes and so there is an opportunity to align these processes to enable comparison and shared learning across the border. This article explores: legal and policy developments; international approaches to mental health outcomes; and the type of data that would be helpful to collect to better understand the use of mental health and mental capacity laws. It is argued that an inclusive strategy to developing a comprehensive, integrated and aligned approach to collecting and analysing data would benefit citizens, policy makers and professionals.

Therapeutic security in inpatient psychiatric settings requires careful planning and implementation if it is to support patients' safety and dignity. This commentary on a case considers patients' dignity experiences when restrictions on their freedom are used to keep them safe.