The global mental health (GMH) field aims to equitably improve mental health and well-being everywhere. This article reviews persistent common challenges hindering sustained, high-quality delivery of mental health and psychosocial support (MHPSS). Our focus is on programming that is funded or implemented by external organizations, typically universities or international non-governmental organizations from high-income countries. It is a consensus statement of MHPSS practitioners, programmers and researchers working for these organizations and some who are locally based who observe these programs in action. We comment on progress to date, barriers and recommendations for change and the importance of promoting sustained integration of MHPSS into health and social service systems through a comprehensive, recovery-oriented system of care. We call for prioritizing often-neglected issues (e.g., stigma, severe mental health conditions and neurodevelopmental conditions), strengthening workforce training and supervision and monitoring and evaluation systems to ensure program quality. The continued dominance of the Global North in shaping GMH programming priorities remains a concern. We advocate for a greater involvement of local workers and communities in agenda-setting for programs, culturally grounded implementation and long-term capacity building. Evidence-based practices must be met with contextual relevance, and comprehensive guidelines for sustained support are needed for development settings. For persistent funding challenges, we recommend clearer funder objectives, investment in in-house mental health expertise and funder coordination with prioritization of complementary programming. These recommendations are essential to realizing equitable, comprehensive, evidence-based and contextually grounded GMH programming.

The recent conflict in the Middle East posed unprecedented threats, with hundreds of long-range ballistic missiles launched toward Israel, targeting military and civilian facilities including hospitals. Organizational and logistic actions were taken in Sheba Medical Center, both pre-emptively and during the conflict, preparing for a mass casualty incident while maintaining routine medical care to the population and maintaining safety of patients and staff. These included discharging patients and increasing home hospitalizations, ward evacuations, transferring patients to protected areas, and classifying patients by their vulnerability and status of protection, accelerated structural adaptation of underground spaces to house patients, and construction of a tented field hospital underground. An effective command and control system was in place to monitor protective status, and an ethical committee was convened to assist in decision-making. These measures enabled continued delivery of emergency and medical care under fire while ensuring the safety of patients and staff.

The weekly iron and folic acid supplementation (WIFAS) programme is a school-based initiative designed to reduce iron and folate deficiency anaemia among adolescent girls. In Ethiopia, donor-supported pilot programmes are implementing WIFAS in schools, but evaluations of its demand- and supply-side barriers and facilitators remain limited. This study aimed to explore these barriers and facilitators in the Sidama Region of Ethiopia. An exploratory qualitative study collected data from ten WIFAS-targeted schools using key informant interviews (KIIs) and focus group discussions (FGDs). Participants included purposively selected school directors, WIFAS-trained teachers, health centre heads, district health and education office nutrition focal points, and regional health and education bureau delegates. Ten FGDs were conducted with adolescent girls and their mothers. Thematic analysis was performed using Open Code software to identify emerging themes. This study identified low awareness of iron and folic acid (IFA) tablets, negative community perceptions, fear of side effects, supplementation interruptions due to school closures, and inadequate coverage as key barriers. Structural barriers included poor programme coordination, weak supply chain management, and water scarcity. Facilitators included free IFA tablet distribution, health extension workers’ involvement in awareness campaigns, positive testimonials, local leader support, training, and regular supervision. The WIFAS programme implemented in schools of the Sidama Region faces programmatic and structural barriers. However, facilitators like free IFA distribution, health extension worker involvement, and community support offer opportunities for improvement. These findings highlight the need for addressing barriers while leveraging existing facilitators for enhancing programme success.

Dunbar’s framework highlights the challenge of maintaining large, stable social networks given cognitive constraints. Expanding on this, I propose that fractal social networks function as lossy compression algorithms, efficiently reducing the complexity of social storage and retrieval. Rather than tracking all relationships explicitly, individuals rely on hierarchical abstractions and transitive inference, shifting storage complexity from $O\left( {{N^2}} \right)$ to $O\left( {N\log N} \right)$. This insight suggests broader implications for cognitive evolution, institutional organization, and artificial intelligence.

Implementation science plays a crucial role in effectively translating scientific knowledge into sustainable, evidence-based health practices. This perspective article focuses on some Latin American experiences, highlighting the limitations of applying methodologies developed in the Global North to settings marked by structural inequalities, economic constraints and cultural diversity. The included experiences examine a range of programs, such as the national Breastfeeding and Feeding Strategy, the evaluation of the Triple P-Positive Parenting Program in Chile and the community component of Mental Health Gap Action Programme in Colombia. Other contributions explore professional training initiatives and offer critical reflections on frameworks, such as the Consolidated Framework for Implementation Research and the Reach, Effectiveness, Adoption, Implementation and Maintenance. The reflections call for strengthening local capacities, fostering meaningful South–South and South–North collaborations, and advancing a context-sensitive, equity-oriented approach to implementation science that supports the development of more adaptive, effective and just health systems.

Youth who are lesbian, gay, bisexual, transgender, queer or questioning, and other diverse sexual and gender identities (LGBTQ+) experience disproportionately high rates of suicidal thoughts and behaviors compared to heterosexual and cisgender peers, yet many face barriers to care. Data came from a national online survey of 18,663 LGBTQ+ youth aged 13–24 years in the United States (September–December 2023). Analyses focused on participants who reported wanting mental health care in the past year and assessed access, barriers, service modalities and suicidal ideation/attempts. Half of LGBTQ+ youth who wanted mental health care did not receive it. The most common barrier was fear of talking about mental health concerns (42%). Among those who received care, one-on-one therapy was most common (69% in-person and 53% online). Suicidal ideation was lower among youth in therapy (46% in-person and 40% online) compared to those using crisis lines (75%). After adjusting for demographics, hotline use remained strongly associated with elevated risk: adjusted odds ratio (aOR) = 3.77 (95% confidence interval [CI]: 3.11–4.56) for suicidal ideation; aOR = 3.21 (95% CI: 2.62–3.94) for attempts. Despite strong willingness to seek care, structural and identity-related barriers leave many needs unmet. Expanding culturally competent services is essential to reducing suicide risk.

Meta-cognition enhances the social bonding hypothesis for musicality, integrating imagination, episodic simulation, causal inference, and inhibition. Music fosters group cohesion by engaging the endogenous opioid system, supporting intergroup understanding through vivid mental imagery, and facilitating socio-affective fiction. Additionally, causal inference enables contextual interpretation of music, while inhibition refines musical coordination and executive function, reinforcing cognitive flexibility for cooperative social behavior.

The menopausal period in women is characterized by neuroendocrine alterations, which is in part mediated by the reduction in circulating estrogen. During this transition, many perimenopausal and menopausal women experience sleep disturbances and increased susceptibility to sleep-related disorders. Sleep disruptions are partially attributed to nighttime vasomotor symptoms (VMS), which exacerbates the insomnia risk in the menopausal woman. Converging data implicate the orexin system in the pathophysiology of insomnia and VMS, particularly through regulation of arousal, thermoregulation, and sympathetic outputs. Estrogen decline due to menopause is postulated to modulate orexin signaling, thereby heightening sympathetic drive and thermoregulatory instability. Given this potential mechanistic framework, orexin receptor antagonists, notably dual orexin receptor antagonists (DORAs), have been proposed as alternative menopausal therapeutics. Herein, we aim to examine preclinical, translation, and clinical literature assessing the therapeutic potentials of DORAs as a nonhormonal intervention for the mitigation of insomnia and VMS in midlife women.

While grooming and other forms of physical bonding are crucial for stress management, social play and laughter deserve equal recognition as tools for both stress relief and the reinforcement of social relationships. They play a pivotal role in the development of motor and social skills and serves as a foundational behavior in species that rely on cooperation and alliance-building.

To explain human social sophistication, and proximal phylogenetic steps leading to it, Dunbar claims that mentalising expands to increasingly high levels of recursion. However, the evidential basis for this claim is weak, exposing both a limitation in Dunbar’s account and in the field’s current understanding of social sophistication.

Facial expression has evolved as a solution to the primate group living problem. A growing body of empirical evidence suggests that the evolution of facial expression has been driven by the need to bond. Dunbar’s theories of group cohesion are therefore key to understanding primate (including human) facial expression.