Multiple epidemiological studies have shown an increased prevalence of adverse mental health outcomes in refugee populations and have highlighted children and adolescents to be particularly at risk. This commentary considers a Cochrane Review examining the efficacy of community-based interventions at improving the mental health of refugee children and adolescents in high-income countries. The review concludes that community-based interventions are ineffective at improving mental health in such populations. Notably, the data are limited by significant risk of bias and a small sample size. This article aims to critically appraise this systematic review, extrapolate implications for current practice and identify avenues for further research.

Teenagers often present in crisis with risk issues, mainly risk to self but sometimes risk to others. Adolescent violence is commonplace and is not just the remit of adolescent forensic psychiatry. Clinicians may lack confidence assessing risk of violence and can neglect vital areas that are essential to reduce risk. Use of structured violence risk assessments enables the multi-agency professional network to formulate a young person's presentation and their violence in a holistic way and consequently develop targeted risk management plans addressing areas such as supervision, interventions and case management to reduce the risk of future violence. Of the several validated tools developed for young people, the Structured Assessment of Violence Risk – Youth (SAVRY™) is that most used by UK-based forensic adolescent clinicians. This article outlines the epidemiology, causes and purposes of violence among adolescents; discusses types of risk assessment tool; explores and deconstructs the SAVRY; and presents a fictitious risk formulation.

The COVID-19 pandemic significantly increased the challenges faced by families affected by dementia, leading to an immediate increase in both the number of calls received by Dementia UK's Admiral Nurse Dementia Helpline and the levels of distress and complexity of the calls. Consequently, Admiral nurses experienced feelings of helplessness, echoed in the experiences of other health professionals. One of the approaches that enabled Admiral nurses to cope during this time was ‘hope’, and this article explores the use of hope-based approaches as tools for working therapeutically with families during the pandemic. Although written from the perspective of Admiral nurses, the approaches described are transferable to others working across health and social care. The article provides an overview of one of the main models of hope in the healthcare literature, Snyder's hope model, and explores the literature on hope more widely. Fictitious case vignettes, drawn from clinical practice during the pandemic, are used to illustrate how hope-based approaches can be applied to practice.

The nature of culpability and agency in patients with a variety of psychiatric diagnoses is complex. In this article, a psychiatry resident (specialty trainee in psychiatry) reflects on a clinical encounter in medical school to demonstrate some of the benefits (including the removal of stigma) and dangers (including the threat to patients’ agency) of using the medical model to conceptualise psychiatric illness.

This brief commentary on Greenberg's article ‘When the illness speaks’ addresses the problem of agency in mental disorder. Complementing the perspective of the article, it advocates an approach that does not see the causal mechanism of disorder-related behaviour in terms of an exclusive disjunction between the effects of the individual patient's own agency or manifestations of the illness. When reduced agency becomes part of the person's self-conception, passivity no longer means behaviour that is alien to their ‘genuine self’. Relatedly, the requirement that the patient's self-conception be validated raises some questions regarding its therapeutic constraints.

This is the first of two articles reviewing consent in those under the age of 18 (also referred to as ‘minors’ in UK law). This can be a complex issue in clinical practice because the law endows competent/capacitated minors with the absolute right to accept treatment, but a limited right to refuse. This first article summarises recent cases of refusal of treatment in minors. It uses them to ask two central questions: how do we, as clinicians, think about autonomous self-determination in minors and to what extent does the rights agenda support minors’ autonomous self-determination? Autonomy as one of the principles of biomedical ethics is explored. How the minors’ rights agenda supports the development of autonomy is considered. The amount of weight given in the domestic courts to the rights of minors with reference to the Human Rights Act 1998 and the United Nations Convention on the Rights of the Child is described. These considerations demonstrate the way that the courts are giving the views of the minor greater weight in decision-making in keeping with age and maturity. This article introduces the second article, which comprehensively reviews decision-making in minors, explores competence and capacity in minors and examines the differential treatment of acceptance and refusal.

This is the second of a pair of articles reviewing the topic of consent in minors. Both articles have a particular emphasis, drawing on theory and case law, on the differential treatment of acceptance and refusal in minors. This article considers the concept of capacity in young people (aged 16 and over) and competence in children (under the age of 16) by reviewing underpinning statute and case law with particular reference to England and Wales. This provides a platform for consideration of the reach of capacity in minors with regard to acceptance and refusal of treatment. In doing so the article explores the key, but still elusive, ingredient of maturity, which has significance to the process. Fictitious vignettes allow consideration of the application of the concepts of maturity and autonomy in clinical practice. The article also considers the potential for the UK's Parliament to make changes to current statute regarding consent in minors.

This commentary reflects on two articles on consent in those under 18 years of age, known in law as ‘minors’. I consider why the language and landscape of the law in relation to consent in this age group can be alienating to psychiatrists, interrogate the legal complexities regarding consent in children and adolescents, refer to key aspects of relevant case law and end with practical suggestions that might improve clinical practice with cases that have the potential for legal complexity.

The Expression of the Emotions in Man and Animals has been considered Charles Darwin's forgotten masterpiece and is his only book on psychology. It is also the first ever systematic application of Darwinian theory to the expression of emotions and has been considered by some to be the foundational text of evolutionary psychology. This article explores some key concepts in the book and gives reasons why both psychiatry and psychology can benefit greatly from becoming better acquainted with this work.

Email is a major means of communication in healthcare and it facilitates the fast delivery of messages and information. But email's ubiquity has brought challenges. It has changed the way we get things done, and working days can be dictated by the receipt and reply of multiple email messages, which drown out other priorities. This article examines email's advantages and disadvantages and, with a focus on healthcare professionals, examines what individuals and organisations can do to ensure email works for us, rather than – as can seem the case – the other way around.