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Geriatric (old age) psychiatry faces growing challenges amid Europe’s ageing population. This editorial emphasises the need for specialised training, mentorship and subspecialty recognition to attract young psychiatrists. By addressing structural gaps and fostering innovation, the field offers a rewarding career in enhancing older adults’ mental healthcare and quality of life.
This paper highlights systemic research and clinical deficiencies in addressing eating disorders among males and men, focusing on societal stigma, gender-biased diagnostics and barriers to care. It advocates for comprehensive reforms, including addressing systemic underfunding, closing research gaps, improving clinician training and tailored interventions to reduce disparities and improve outcomes.
Workforce planning aims to model and predict supply and demand in medical specialties. In Scotland it is undertaken jointly by the Scottish Government and the Royal College of Psychiatrists in Scotland to ensure workforce sustainability. The survey described in this paper aimed to ascertain why doctors continue to choose to take a break from/delay training programmes or pursue alternative jobs and career pathways. Career breaks, time out of training, less than full-time working patterns, dual training and non-clinical careers need to be taken into account during workforce planning not only to make psychiatry an attractive specialty to work in, but to ensure robust future sustainability in the psychiatric workforce in Scotland and the UK.
In the UK, Black doctors experience higher levels of discrimination, bullying and harassment compared with other doctors. This study aims to explore the impact of this on perceived well-being and mental health. A UK survey of 109 Black psychiatrists asked about racism, othering, microaggressions, bullying and harassment, plus any links to career progression or mental well-being.
Results
Sixty-three survey participants (57.8%) had faced workplace microaggressions, 44 (40.4%) had experienced workplace bullying and 41 (37.6%) had faced workplace harassment. Forty-seven (43.1%) participants reported a detrimental impact on their mental health, with 35 (32.1%) considering quitting and 24 (22%) reporting a poorer work performance.
Clinical implications
These experiences are unacceptable and can be traumatic. The impact of racism and discrimination can also undermine effective service delivery. Barriers to reporting can prolong mistreatment and deter professional aspirations among Black psychiatrists. Collective action is needed to drastically improve the workplace environment, including the widespread institutional adoption of an anti-discriminatory stance.
Racism is increasingly recognised as a key contributor to poor mental health. However, the existing literature primarily focuses on its effects on adults.
Aim
To identify literature on the association between experiences of racism and mental health in children and young people in the UK.
Method
Inclusion criteria were: (a) peer-reviewed publications containing original data; (b) UK-based research; (c) included examination of associations between mental health and experiences of direct or indirect racism (quantitative or qualitative); (d) inclusion of an assessment of mental health outcomes; (e) participant ages up to and including 18 years of age or (if the range went beyond 18) with a mean age of 17 years or less. Six databases were searched between 2000 and 2022; an initial 11 522 studies were identified with only eight meeting the inclusion criteria.
Results
Five of the identified studies provided quantitative data and three provided qualitative data. The majority of studies (7/8) focused on children and young people aged 10 years and over; only one focused on children under the age of 10 years. Measurements of racism varied among the studies providing quantitative data. Only four studies directly focused on the effects of racism on the mental health of children and young people.
Conclusion
Although the included studies highlighted potential negative impacts of experiences of racism on children and young people in the UK, this review shows the lack of available literature to inform policy and practice. No studies examined the impact of internalised racism, systemic and institutional racism, or intersectionality.
Paediatric functional gastrointestinal disorders (P-FGIDs) are common, affecting up to 25% of children worldwide. They are characterised by chronic abdominal pain and/or altered bowel habits without an underlying disease pathology. P-FGIDs are often associated with co-occurring anxiety and depression across all ages and treating P-FGIDs may provide an opportunity to develop a young person's wider emotion regulation capacities. Using a fictitious case vignette, we outline the range of psychosocial and biomedical treatments for the disorder and the need for an integrated and holistic approach. We propose that by intervening early and enabling children to be curious about, rather than fearful of, their bodily sensations, clinicians may be able to alter harmful illness trajectories in both pain and psychiatric domains.
Patient involvement in psychiatry education struggles to be representative of the patients that doctors will treat once qualified. The issues of mental health stigma, cultural perspectives of mental health and the unique role of teaching, required exploring to establish the barriers and facilitators to increasing the diversity of patients involved in psychiatry education. To explore the causes of this lack of representation, a roundtable event with 34 delegates composed of people with lived experience of mental health issues, people from underserved communities, academics, mental health professionals and charity representatives met to discuss the barriers to involvement in psychiatry education and possible solutions. Themes were further developed in a context expert focus group. Notes from the roundtable and focus group were analysed and developed into recommendations for medical schools and mental health professional teaching departments.
The Mental Health Gap Action Programme (mhGAP) was launched by the World Health Organization (WHO) in 2008 to scale up services for mental, neurological and substance use disorders for low- and lower-middle-income countries. Subsequently, an updated mhGAP intervention Guide (mhGAP-IG 2.0) was released in 2016. This study explores the use and effectiveness of mhGAP-IG 2.0 by mental health volunteers of two South Asian charities in the UK. Semi-structured interviews were carried out with eight volunteers. The core themes identified were mental health awareness, mental health education, empathy and care, social perception and bias within the South Asian community, and personal development. The study identified mhGAP as a tool with transformative potential. Although the WHO originally planned the mgGAP-IG as a tool for low- and middle-income countries with limited mental health resources, this study demonstrates its usefulness even in high-income countries, as a foundation to educate volunteers working in mental health.
Burnout is a common issue among healthcare professionals and can have a negative impact on both personal and professional well-being. This initiative follows a group of doctors working in Buckinghamshire, UK, who are at moderate to high risk of burnout, over 6 months to determine whether participation in a movie club, as a form of stress relief and social support, can have a positive impact on well-being. The aim of the project was to investigate the impact on doctors’ well-being by improving connectedness, reducing the feeling of isolation and encouraging face-to-face activities.
Cultural sensitivity, competence and curiosity are essential for clinicians. To promote these, we developed an elective module in cultural psychiatry for medical students, consisting of eight seminars. In seminar eight, we used film clips to teach mental state examination. We comment on the development and delivery of the module, and offer a selection of student feedback. Cultural psychiatry could be better integrated into core medical school curricula, and we call for research to explore this.
Higher specialist trainees (HSTs) in psychiatry in Ireland were recruited to complete a 21-item online questionnaire anonymously. Questions were designed to establish the research experience of HSTs in various years of training, identify perceived barriers to participation and generate potential strategies to overcome these barriers.
Results
Of 165 HSTs surveyed, 50 (30%) responded. Most respondents (58%) were in the second or third year of HST. Most (72%) were training in general adult psychiatry. Themes that emerged from analysis of the qualitative data were ‘collaborative research culture’, ‘guidance’, ‘choice’ and ‘access to resources’. Participants felt they needed more structured guidance and regular supervision, and expressed a desire for more networking and collaboration.
Clinical implications
The need for a supportive, collaborative research culture within psychiatry was predominant among responses. Structured research programmes and access to resources may facilitate a more positive research culture and should be considered as part of the training curriculum.
The past 5 years have seen numerous court judgments and changes to rules and procedures that relate to the work of expert psychiatric witnesses in the British Isles. This article outlines these changes, pointing out their implications for the expert witness, and highlights pertinent judgments in over 100 court and tribunal cases.
In 1978, William Alwyn Lishman's Organic Psychiatry: The Psychological Consequences of Cerebral Disorder was published, fostering the development of neuropsychiatry and leading to the recognition of Lishman as the father of neuropsychiatry. This article is a narrative account of his personal struggles, as well as conceptual dilemmas he dealt with while writing this book, and how through its four editions it has evolved to become an anchor for psychiatrists as they seek to develop understanding of the workings of the brain, and a beacon for them when they discuss clinical implications of diagnosis with patients and families.
While clozapine has risks, relative risk of fatality is overestimated. The UK pharmacovigilance programme is efficient, but comparisons with other drugs can mislead because of reporting variations. Clozapine actually lowers mortality, partly by reducing schizophrenia-related suicides, but preventable deaths still occur. Clozapine should be used earlier and more widely, but there should be better monitoring and better management of toxicity.
This year's BIALL Annual Conference, held in Leeds in June, was a great success, with excellent speakers, cutting edge tech on display and even a murder – which was quickly solved – during the big dinner on the Thursday night.
When admitting patients to hospital and treating them, psychiatrists and other health professionals may need to deprive them of their liberty. Where this occurs, professionals will need to work within a statutory framework to practice legally and protect their patients’ right to liberty under Article 5 of the European Convention on Human Rights. Within England and Wales, some clinical scenarios will require a choice to be made between the Mental Health Act 1983 (MHA) and the Mental Capacity Act 2005 (MCA) and its Deprivation of Liberty Safeguards (DoLS). This choice can be complex, is often overlooked and frequently misunderstood in clinical practice. Deciding between the two frameworks must be done on a case-specific basis. With the use of code of practice guidelines, case law and an unfolding clinical scenario we aim in this article to support clinicians in taking a clear-sighted approach to the dilemma and the factors to consider when deciding between the two regimes.
The history of the Grange Annual Conference is traced to its roots in the work of Sir William Norwood East, the Royal Medico-Psychological Association and Waddiloves Hospital in Bradford, UK.
The COVID-19 pandemic significantly impacted the mental health of adults with intellectual and developmental disabilities (IDD). During this period of uncertainty and need for up-to-date information, various virtual training programmes demonstrated the role of tele-mentoring programmes.
Aim
The aim of this paper is to describe the educational evaluation of the National Extension for Community Healthcare Outcomes – Adults with Intellectual and Developmental Disabilities (ECHO-AIDD), a programme for service providers working with adults with IDD during COVID-19.
Method
The programme consisted of six sessions, conducted weekly, over two cycles. Each session included didactic teaching by hub team members, COVID-19 news updates, wellness check-ins and a brief mindfulness activity, followed by a 30 to 45 min case-based discussion. The hub structure had an inter-professional approach to team expertise. Those with lived experience were an integral part of the content experts’ hub. Pre-, post- and follow-up evaluation data were collected.
Results
Care providers from health and social care sectors (n = 230) participated in the programme. High levels of engagement and satisfaction were reported. Self-efficacy ratings improved from pre- to post-, and were maintained at 8-week follow-up; improvement from pre- to post- was significant (P < 0.0001).
Conclusion
Exposure to National ECHO-AIDD educational intervention led to improvement in perceived competencies. This study also shows the valuable role of people with lived experience in fostering adaptive expertise in learners. The outreach and scalability support the feasibility of building a national virtual community of practice for IDD service providers. Future studies should focus on studying the impact of these programmes on the health outcomes of people with IDD.
We address the unconsciously biased perception of psychiatric disorders, highlighting a hierarchical perspective that favours certain diagnoses over others. We aim to uncover reasons for these inequities, emphasising the need for a shift toward pathophysiology-based nomenclature that can promote equal support for each disorder, enhance treatment adherence and encourage open discussions.
The use of feedback to address gaps and reinforce skills is a key component of successful competency-based mental health and psychosocial support intervention training approaches. Competency-based feedback during training and supervision for personnel delivering psychological interventions is vital for safe and effective care.
Aims
For non-specialists trained in low-resource settings, there is a lack of standardised feedback systems. This study explores perspectives on competency-based feedback, using structured role-plays that are featured on the Ensuring Quality in Psychosocial and Mental Health Care (EQUIP) platform developed by the World Health Organization and United Nations Children’s Fund.
Method
Qualitative data were collected from supervisors, trainers and trainees from multiple EQUIP training sites (Ethiopia, Kenya, Lebanon, Peru and Uganda), from 18 key informant interviews and five focus group discussions (N = 41 participants). Qualitative analysis was conducted in Dedoose, using a codebook with deductively and inductively developed themes.
Results
Four main themes demonstrated how a competency-based structure enhanced the feedback process: (a) competency-based feedback was personalised and goal-specific, (b) competency-based feedback supported a feedback loop, (c) competency-based feedback supported a comfortable and objective feedback environment, and (d) competency-based feedback created greater opportunities for flexibility in training and supervision.
Conclusions
A better understanding of the role of feedback supports the implementation of competency-based training that is systematic and effective for trainers and supervisors, which ultimately benefits the learning process for trainees.