This study addresses the mental health needs of refugees and migrants in the Netherlands, highlighting the urgent public health challenges they face. Unique psychosocial hurdles, exacerbated by cultural dislocation, language barriers and systemic inequalities, hinder their access to quality mental healthcare. This study explores how coloniality intersects with mental healthcare access, using a decolonial framework to challenge stereotypes and assumptions that marginalize migrant voices. Through semi-structured interviews with migrants and language service providers, this research reveals the complexities of navigating the mental healthcare system. Findings reveal that temporality, professionalism and language barriers are key issues in migrants’ mental healthcare journeys. We advocate for systemic changes that prioritize migrant perspectives. Ultimately, this study aims to inform policy and practice to enhance mental health services for migrant populations in the Netherlands and contribute to the broader dialogue on decolonization in mental health.

The 2007 adoption of the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) marked a critical juncture in the area of Indigenous rights. As a nonbinding agreement, its adoption is at the discretion of each state, resulting in significant state-level variation. Importantly, within-state variations remain underexplored. These differences are potentially significant in federal, decentralized countries such as Canada. This article examines why some provinces and territories lead in implementing the key principles embedded in UNDRIP, whereas others have dragged their feet. We collected 230 Canadian regulations introduced at the subnational level between 2007 and 2023, and assessed the impact of three key variables (i.e. political ideology, resource politics and issue voting). We found that none of these variables explained within-state variations on their own. To further explore the role of these variables, we subsequently compared two provinces at different stages of the UNDRIP implementation spectrum (Québec and British Columbia).

Obtaining high-resolution, autonomous and continuous measurements of internal and interfacial convection at the ice–ocean interface is important to understand sea-ice desalination, compare the effects of gravity drainage and salt segregation, and give insight into the behaviour of the sublayer beneath the ice. We present the first digital image processing method that can be applied to Schlieren images from a quasi-2D Hele-Shaw cell to provide continuous high-frequency measurements of fingers and streamers, which are linked to interfacial and internal convection, respectively. Previous studies lack the ability to provide a temporal evolution of this dynamic system at a high enough resolution to investigate these interactions. The improved algorithm confirms previous results, while providing a more detailed and statistically acceptable description of the processes during artificial sea-ice growth. We demonstrate that internal convection exhibits a highly variable behaviour that changes in time. As the ice growth rate decreases to its minimum value, internal convection becomes periodically inactive while interfacial convection remains active throughout the experiments. This temporal change suggests a dominant, shorter time-period for gravity drainage to occur and a longer time-period over which salt segregation occurs, while the oscillation in expulsion behaviour suggests that the sublayer is more turbulent than diffusive.

Determining the factors that impact the risk for infection with SARS-CoV-2 is a priority as the virus continues to infect people worldwide. The objective was to determine the effectiveness of vaccines and other factors associated with infection among Canadian healthcare workers (HCWs) followed from 15 June 2020 to 1 December 2023. We also investigate the association between antibodies to SARS-CoV-2 and subsequent infections with SARS-CoV-2. Of the 2474 eligible participants, 2133 (86%) were female, 33% were nurses, the median age was 41 years, and 99.3% had received at least two doses of COVID-19 vaccine by 31 December 2021. The incidence of SARS-CoV-2 was 0.91 per 1000 person-days. Prior to the circulation of the Omicron variants, vaccine effectiveness (VE) was estimated at 85% (95% CI 1, 98) for participants who received the primary series of vaccine. During the Omicron period, relative adjusted VE was 43% (95% CI 29, 54), 56% (95% CI 42, 67), and 46% (95% CI 24, 62) for 3, 4, and ≥ 5 doses compared with those who received primary series after adjusting for previous infection and other covariates. Exposure to infected household members, coworkers, or friends in the previous 14 days were risk factor for infection, while contact with an infected patient was not statistically significant. Participants with higher levels of immunoglobulin G (IgG) anti-receptor binding domain (RBD) antibodies had lower rates of infection than those with the lowest levels. COVID-19 vaccines remained effective throughout the follow-up of this cohort of highly vaccinated HCWs. IgG anti-RBD antibody levels may be useful as correlates of protection for issues such as vaccine development and testing. There remains a need to increase the awareness among HCWs about the risk of contracting SARS-CoV-2 from contacts at a variety of venues.

Aims: People under mental health (MH) services’ care are at increased risk of suicide. We aimed to identify opportunities for suicide prevention and underpinning data enhancement in people with recent contact with MH services.

Methods: A population-based study of all who died by suicide in the year following an MH services contact in Wales, 2001–2015 (cases), paired with similar patients, with the same mental health diagnoses, who did not die by suicide (controls). We linked the National Confidential Inquiry into Suicide and Safety in Mental Health and the Suicide Information Database – Cymru with primary and secondary healthcare records. We present odds ratios and 95% confidence intervals (OR [95% CI]) of conditional logistic regression.

Results: We matched 1,031 cases with 5,155 controls. In the year before their death, 98.3% of cases were in contact with healthcare services, and 28.5% presented with self-harm.

A high proportion (98.3%) of cases were in contact with primary and secondary healthcare services in the year before their death. Compared with controls, cases were more likely to attend emergency departments (OR 2.4 [2.1–2.7]) and have emergency hospital admissions (OR 1.5 [1.4–1.7]); but less likely to have primary care contacts (OR 0.7 [0.6–0.9]), out-patient attendances (OR 0.2 [0.2–0.3]) and missed/cancelled out-patient appointments (OR 0.9 [0.8–1.0]).

A high proportion of cases presented to primary and secondary healthcare services with accidents, injury and poisoning, and especially self-harm – more so than controls (for self-harm, 28.5% of cases compared with 8.5% of controls; OR 3.6 [2.8–4.5]). This was particularly true for female patients admitted to hospital with injury and poisoning (OR 3.3 [2.5–4.5] in females compared with 2.6 [2.1–3.1] in males).

Conclusion: We may be missing existing opportunities to intervene across all settings, particularly when people present to emergency departments and hospitals, especially with self-harm. Intent underlying injury and poisoning events may be undisclosed, or recorded as undetermined or without specifying intent when they may in fact be self-harm, particularly in females. Efforts should be made to appropriately identify those who are self-harming, including by direct and non-judgmental questioning on presentation underpinned by staff training and awareness. Prevention efforts should focus on strengthening non-urgent and routine contacts (primary care and outpatients), responding to emergency contacts, and better self-harm care. This study also highlights the benefits of enhancing clinical audit systems with routinely collected data for data completeness, breadth, and depth.