Cognitive impairment in the ICU can have long-term, life-altering impacts well beyond the ICU and hospital stay. Cognitive impairment can be hard to identify in the complex medical setting of the ICU, but the systematic use of standardized screens and assessments can alert the write as healthcare team to cognitive impairment. Patients with disorders of consciousness benefit from cognitive stimulation interventions. For patients awake and alert, cognitive intervention strategies include cognitive training (e.g., word search, memory match) and cognitive rehabilitation (e.g., ADL and IADL performance). Early engagement in activity in the ICU can help improve overall performance. One component of rehabilitation is functional cognition, defined as the process of utilizing and integrating thinking and processing skills to accomplish everyday activities. Assistive technology is another tool that can help patients with tasks from communication to complex problem solving and executive functioning. Cognitive stimulation, training, and rehabilitation all work toward decreasing the impact of cognitive impairments and improving overall function and quality of life. Examining patients’ performance through real-life functional tasks help to generalize these skills.

This chapter provides insights on physical rehabilitation in the intensive care unit (ICU) and on the general wards, covering the current evidence based on landmark randomized controlled trials and systematic reviews of the field. Progressive mobilization and the use of assistive technology devices provide opportunities for physical rehabilitation in the ICU and across the hospitalization, including strategies such as stepwise mobility, active exercises, passive mobilization, cycling, and neuromuscular electrical stimulation. Physical rehabilitation of patients in the ICU comes with inherent risks, and the identification of safety criteria is critical to mitigate the occurrence of adverse events related to mobilization. The use of physical functioning instruments as a component of rehabilitation is important to screen patients at risk of poor physical outcomes, monitor rehabilitation efficacy, and predict recovery trajectories.

From a panel of leading experts in the late 1980s to modern day international consortiums, ICU follow-up clinics have experienced significant growth and have been a catalyst for much of the research that continues to drive this field forward. This chapter details the origins of the first ICU follow-up clinics through to conteomporary global collaborations of clinics designed to enhance clinical care, patient and provider education, and research.

Suicide is not simply a typology of violence. All forms of violence are interrelated, and preventative action should tackle the common antecedents to all. Understanding what these are, and how they differ between regions and cultures, is key to developing effective violence prevention strategies that extend beyond suicide. In this chapter we discuss the relationship between suicide and other forms of violence including analysis of data from the World Health Organization. We then consider factors influencing volume and direction of violence including gender, poverty, drug and alcohol misuse, adverse childhood experiences, war, and natural disasters. Before finally moving on to preventative action that considers all forms of violence under the same framework. Throughout the chapter real-world examples will be given for important concepts with particular reference to self-immolation in South Asia and the Eastern Mediterranean Region as it is the authors’ area of research expertise.

This chapter serves to identify barriers and solutions for PICS clinic formation and success. Systematic identification of patients with PICS risk factors and their stakeholders in care can facilitate education about the pathophysiology of PICS during hospitalization. Early clinic team contact with the patient and their care stakeholders increases clinic recruitment and reduces attrition through clarifying the need and purpose of the clinic. Secondary to the patient’s medical complexity and progression through hospitalization, rehabilitation, and home, there are inherent risks for gaps in care. These gaps can be bridged with an interdisciplinary screening process and transition of care plan.

Survivors of critical illness are at increased risk for the development of functional impairments, including difficulties performing activities of daily living and instrumental activities of daily living. This chapter explores the role of occupational therapy (OT) in the rehabilitation of patients impacted by post intensive care syndrome (PICS). Specific evaluation tools used by occupational therapists that can be assess PICS patients to identify their impairments in the key areas of physical, cognitive, and mental health are described. Thereafter, interventions used by occupational therapists to remediate identified impairments and maximize independence are described, derived from a combination of evidence-informed practice in similar patient populations and current empirical evidence for PICS rehabilitation.

This chapter describes the Mental Health Gap Action Programme (mhGAP) and the mhGAP-Intervention Guide (mhGAP-IG) developed by the World Health Organization (WHO), aimed at scaling up suicide prevention and management services to bridge unmet need.The mhGAP-IG is an evidence-based tool for mental disorders with structured and operationalised guidelines for clinical decision-making targeting non-specialist community and primary care workers in low and middle-income countries (LMICs).

The aim of this book is to provide evidence to inform the development and implementation of suicide prevention globally. It covers a range of topics that are relevant from local to national levels. It has an unapologetic emphasis on social determinants of suicide and a global perspective, with utility across the world as a primary resource by practitioners and policymakers. It aims at accessibility, with an emphasis on what can be achieved given the current knowledge base.

A central message of this book is the importance of using rigorous evidence to guide suicide prevention, whilst recognising that the best evidence is always partial. Key research is cited in the text and readers are, in places, directed to public-domain digital resources. The book aims to have relevance in low- and middle-income countries, as well as in high-income countries. It is not a country-by-country international overview.

Age-Friendly Health Systems include hospitals, clinics, and long-term care facilities that provide state-of-the art care to older adults. They organize care around 5 core principles known as the 5Ms: Mobility, Mentation, Medications, Multicomplexity, and What Matters Most. The 5Ms have not been applied previously to care delivery for older adults with post-intensive care syndrome (PICS); thus, this chapter offers a novel, interprofessional 5Ms approach to evidence-based care delivery for older adults with PICS. The first section provides essential background on interpreting evidence about PICS through the lenses of ageism (bias related to age) and ableism (bias related to disability status). Each of the next five sections explains one of the 5Ms constructs and summarizes relevant evidence related to PICS. The final section summarizes offers a vision linking Age-Friendly Healthcare, Age-Friendly Communities, and Age-Friendly Public Health after critical illness.

Before examining how the regulation of bioethical matters impacts the equal right to live in the world for people with impairments, Chapter 1 elaborates on key concepts relevant for the book’s later chapters: disability, eugenics, ableism, and neoliberalism. It begins with a critical discussion of the medical and social models of disability, the two dominant approaches to understanding disability in disability studies. The chapter also highlights the troubled recent history of eugenics, the concept of ableism and the persistence of ableist policies and practices, as well as the importance and shortcomings of disability rights laws in furthering disability justice and equality.