Dual disorder, comprising of substance use and mental health disorders, requires a comprehensive treatment approach. The most effective is integrated dual disorder treatment, which involves addressing both conditions concurrently by the same specialists and in the same setting. This study examines characteristics of integrated dual disorder care offered by treatment services across European countries.

In 2022, representatives of 14 integrated care for dual disorder providers in 10 European countries were asked to respond to a survey about their treatment process, outcomes, barriers and facilitators when implementing dual disorder treatment in respective countries. Thematic qualitative analysis was used to explore closed- and open-ended responses, focusing on commonalities and differences between surveyed services.

Integrated care services varied in treatment settings and structure, but all offered comprehensive support for dual disorder. Among 14 services, half addressed tobacco addiction or provided suicide prevention, three treated cannabis use, and none accepted patients in opioid agonist therapy. Few services reported evaluating treatment outcomes in standardised way. Services supported patients with social security, employment, housing and education, but also noted difficulties in coordinating post-treatment care due to divergent views on dual disorder among specialists from different services.

Integrated care services provide comprehensive and tailored support for people with dual disorder but remain distinct within the healthcare options available to this patient group across Europe. Existing and future integrated care services would benefit from addressing tobacco and cannabis use, measuring treatment outcomes and improving continuity of care.

The introduction of the Assisted Decision Making (Capacity) Act in Ireland and developments in capacity law elsewhere prompt further consideration of our understanding of capacity and how we assess it.

This is a perspective piece on the role of emotion in the decision-making process, and how this impacts on our understanding of capacity. Both normal and pathological emotional states are reviewed in terms of their influence on decision-making. Capacity assessments are then considered, and whether sufficient account is taken of emotions here.

The paper considers whether we need to change the legal test for capacity to take sufficient account of emotions, based on the foregoing discussion.

Finally the paper makes recommendations for supporting capacity in light of our knowledge of the impact of emptions on decision-making.

Suicidal ideation, plans and attempts, is a leading public health issues among adolescents worldwide, including in Pakistan. This study examines the effectiveness of a culturally adapted didactic strategy (CADS) in targeting suicidal ideation and associated symptomatology (ClinicalTrials.gov: NCT05324670).

Adolescents (n = 70, male) expressing suicidal ideation who recently engaged in self-harm (previous 6 months), were assigned to 6 sessions (weekly) of CADS or a control intervention (psycho-education material) and assessed pre- and post-intervention utilising the Beck Scale for Suicidal Ideation (BSS), the Depression, Anxiety and Stress Scale-21 (DASS-21) and Barratt Impulsiveness Schedule-II (BIS-II).

Participants in the CADS cohort demonstrated a significant reduction in suicidal ideation compared to controls at treatment end (F = 266.7, p < 0.001, ηp2 = 0.80), and six-weeks post intervention. Individuals receiving CADS demonstrated a modest reduction in attentional (F = 32.5, p < 0.001, ηp2 = 0.33), motoric (F = 45.9, p < 0.001, ηp2 = 0.41) and non-planning impulsivity (F = 21.9, p < 0.001, ηp2 = 0.25), in depressive (F = 142.2, p < 0.001, ηp2 = 0.68), and anxiety symptoms (F = 43.9, p < 0.001, ηp2 = 0.40) and stress levels (F = 96.4, p < 0.001, ηp2 = 0.59). These findings were maintained at six-week follow-up.

CADS was an effective short-term intervention in reducing suicidal ideation, impulsivity, depressive and anxiety symptoms in a high school adolescent male population. Future studies including an active comparator and greater participant diversity would further elucidate the potential efficacy of this intervention.

To audit data on clinical outcomes and suicidal ideation, as part of a service evaluation, in individuals presenting with low mood at an Irish frontline, community-based, rural psychology service, to determine whether the intervention provided was effective in reducing suicidal ideation and low mood.

Clinical outcome data from 428 service users who scored in the clinical range for depression and who completed an intervention with the service were audited to determine if scores on suicidal and self-harm ideation – as measured by PHQ9 Q9 – changed between assessment and discharge.

91% of service users who scored in the clinical range for depression and expressed suicidal or self-harm ideation at assessment reported an improvement post-intervention. At discharge, 85% of these individuals no longer reported any suicidal or self-harm ideation. A majority (68.5%) of those who reported ideation at assessment, and a majority of those who did not report ideation (78%), achieved reliable change (i.e. an improvement of ≥5pts) in their final PHQ-9 scores. Clinical recovery was achieved by discharge in 69% of those without and 47% of those with ideation at assessment. Not reporting suicidal or self-harm ideation at assessment was statistically more likely to result in reliable change at discharge than reporting such ideation.

Results from this clinical service evaluation suggest swift access to psychological intervention, by this rural, frontline primary care psychology service, was associated with reductions in levels of suicidal and self-harm ideation in those suffering from depressive symptoms in the clinical range.

Psychiatric advance directives (PADs) and joint crisis plans (JCPs) are documents that allow users of mental health services to state their preferences for treatment for a future situation in which they are unable to give consent. In Germany, both PADs and JCPs are legally binding in the context of mental healthcare.

The objective of this study was to examine mental health professionals’ views on PADs and JCPs, identify challenges in their application in clinical practice, and derive recommendations for their implementation.

We conducted semi-structured interviews with 14 mental health professionals with experience in JCPs in Germany. We analyzed the interviews following qualitative content analysis.

Participants identified several opportunities associated with JCPs, including strengthening the therapeutic relationship and building trust, promoting self-determination and participation, fostering therapeutic progress, reducing coercion, and enhancing the attitudes of mental health professionals. They also recognized a number of challenges, such as limited resources, insufficient knowledge and interest among service users, uncertainty and skepticism among mental health professionals, and the infrequent updating of JCPs. In addition, participants offered suggestions for improving the implementation of JCPs at both organizational and practical levels.

Mental health professionals describe a variety of opportunities and challenges of JCPs in clinical practice. To address these challenges and enhance the implementation of JCPs, further research and targeted training for mental health professionals are needed, alongside the development of institution-specific policies.

The intersection between the Assisted Decision-making (Capacity) Act 2022 (ADMCA) and the Mental Health Act, 2001 (MHA) has prompted considerable debate. Although not alone in its differential treatment of mental health and physical health advance healthcare directives (AHDs), Ireland is unique in affording legally binding status to mental health AHDs for some but not all inpatient service users detained under mental health legislation. As such, in this study we aim to compare groups of service users for which AHDs would be binding or not at point of detention and to track changes in binding status over the course of admission.

This is a retrospective observational study examining involuntary admissions to a 36 bedded acute psychiatric unit in Dublin from 2021 to 2023. Admissions were grouped into those initially detained on grounds of risk or on the treatment criterion alone, as this would determine binding status of a mental health AHD. We also examined changes to binding status over the course of admission to calculate median bed days when a service user would be entitled to a binding AHD. Descriptive statistics and inferential testing (Chi-squared and Mann–Whitney U) were used to analyse the data.

Of 287 admissions of 212 service users, 73.9% admissions were under the treatment criterion alone and would therefore qualify for a binding AHD. We found that diagnosis, mode of detention, and service division were significantly associated with AHD binding status. Service users would qualify for binding AHDs on 83.6% of involuntary bed days and, of those admissions affirmed by the first tribunal, 89.9% would qualify for binding AHDs in the days afterward.

Most involuntary service users would qualify for a legally binding AHD under the ADMCA for at least part of their admission. Should AHDs become common practice, binding AHDs will play a significant role in inpatient psychiatric care.

A clinic to assess and treat mental health (MH) within a community substance use disorder (SUD) service has been implemented with the aim to facilitate engagement, progress, and completion of substance use treatment.

This study was completed to assess the effectiveness of such an integrated service. The records of individuals seen within the clinic during 2022 and 2023 were assessed for the reason for referral, diagnosis, and treatment offered, and outcome of MH and SUD.

A total of 118 individuals were assessed. The majority (58%) were referred due to a lack of progress in treatment. The most frequent MH diagnosis was bipolar disorder (57%), followed by smaller numbers of diagnoses of psychosis, PTSD, anxiety and depression. Seventy-four (63%) individuals improved in MH, and eighty (68%) in SUD.

Despite the limitations due to the naturalistic methodology, this early work suggests that an integrated type of provision of MH treatment within a SUD service might have a beneficial complementary role within the existed parallel treatment model implemented in England.

Screening tools for attention-deficit/hyperactivity disorder (ADHD) help to identify individuals likely to have ADHD. Several screening scales are used for identifying adults with ADHD, based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The ADHD symptoms described in the DSM were originally developed to describe the behaviours of children, not adults, and focus on the triad of symptoms of inattention, hyperactivity, and impulsivity. Clinical research and experience, however, have revealed additional dimensions of adult ADHD, such as hyperfocus, racing thoughts, emotional lability, impaired sleep, and differences in time perception. Commensurate with the conditions’ growing recognition, the adult ADHD presentation requires rethinking.

To understand better the ADHD symptomatology experienced by adults, qualitative interviews were conducted with 11 diagnosed adults.

Using thematic analysis, nine themes of adult ADHD symptoms were identified. The first three themes map to the original triad of symptoms – attentional difficulties, hyperactivity, and impulsivity. A further three themes identified are briefly mentioned in the DSM – disorganisation, forgetfulness, and reduced activation. The final three themes are covered to some degree in the current rating scales but are absent from the DSM 5 – emotional lability, sleep difficulties, and time perception difficulties.

This study highlights nine themes relevant to adult ADHD, six of which are absent from the DSM 5’s triad. This research highlights gaps in current assessment tools and suggests symptoms that are more reflective of the adult experience of having ADHD.

Understanding service users’ knowledge of and attitudes towards the rapidly progressing field of mental health technology (MHT) is an important endeavour in clinical psychiatry.

To evaluate the current use of and attitudes towards MHT (mobile apps, online therapy and counselling, telehealth, web-based programmes, chatbots, social media), a 5-point Likert-scale survey was designed based on previous studies and distributed to attendees of an adult community mental health service in Ireland. Chi-square tests were used and corrected for multiple comparisons.

107 mental health service users completed the survey (58% female, aged 18–80). 86% of respondents owned a smartphone. 27.1% reported using a mental health application, while 33.6% expressed interest in using one in the future. 61.7% reported they had not used and were not interested in using AI for their mental health, and 51.4% indicated they would not feel comfortable using it. 46.8% were not comfortable with psychiatrists utilising AI in their care. The majority (86.9%) preferred face-to-face appointments, while 52.6% would consider using MHT while on a waiting list. Younger participants reported significantly greater comfort using mental health apps and higher self-rated knowledge of AI.

There were low levels of knowledge about and comfort using MHT, accompanied by concerns about confidentiality and privacy. Younger service users tended to be more comfortable with and knowledgeable about MHT. Despite the growing interest in digital approaches, there remains a clear preference for face-to-face appointments, underscoring the importance of addressing privacy and safety concerns, together with training and education.

This study evaluated the efficacy and acceptability of Ireland’s National Clinical Programme for ADHD in Adults (NCPAA), providing public assessment and supports for adults with ADHD.

Overall, 249 adults (51% women, 42% men, 4% non-binary, 1% other gender) were recruited from three NCPAA services using consecutive sampling. Participants completed the Adult Self-Report Scale (ASRS) and the Weiss Functional Impairment Rating Scale (WFIRS-S) at baseline, 6, and 12 months; service satisfaction was measured with the Service Satisfaction Scale (SSS). Reflexive thematic analysis explored responses to two open-ended questions.

Service users presented with high baseline symptomatology and life challenges. Significant improvements were observed in ASRS and WFIRS-S (except education) in the first six months. Improvements were retained at 12 months in ASRS and WFIRS-S domains of work, life skills, self-concept and social. but not family, risk or education. Service satisfaction was high, particularly among those diagnosed with ADHD. Thematic analysis identified three positive themes: feeling affirmed, benefits of supports, and person-centred care; and three improvement areas: access barriers, resource gaps, and need for ongoing support.

Engagement with NCPAA services is associated with improvements in ADHD symptoms and life challenges and is acceptable to adults with ADHD in the short term. Service limitations, particularly staffing constraints, warrant attention. Recommendations include strengthening resources, improving communication and appointment systems, and enhancing links to external supports. Given the absence of a control group, findings should be considered preliminary.