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Chapter 4 continues the theme of the preceding chapter in chronological order and seeks to expose the contrast between two coexisting theoretical frameworks: the clinical tradition, which still argued for the somatic basis of mental illnesses, and the emerging field of psychotherapy. The second part of the chapter examines the figuration of the ‘nervous child’, which recognised the importance of the environment in mental health.
Situated between the history of pain, history of childhood and history of emotions, this innovative work explores cultural understandings of children's pain, from the 1870s to the end of the Second World War. Focusing on British medical discourse, Leticia Fernández-Fontecha examines the relationship between the experience of pain and its social and medical perception, looking at how pain is felt, seen and performed in contexts such as the hospital, the war nursery and the asylum. By means of a comparative study of views in different disciplines – physiology, paediatrics, psychiatry, psychology and psychoanalysis – this work demonstrates the various ways in which the child in pain came to be perceived. This context is vital to understanding current practices and beliefs surrounding childhood pain, and the role that children play in the construction of adult worlds.
To explore current and potential upcoming legal provisions concerning advance healthcare directives in psychiatry in Ireland, with particular focus on clinical challenges and ethical issues (e.g., self-harm, suicide).
Methods:
Review and analysis of selected relevant sections of the Assisted Decision-Making (Capacity) Act 2015, Assisted Decision-Making (Capacity) (Amendment) Act 2022, Mental Health Act 2001, Mental Health Bill 2024, and Criminal Law (Suicide) Act 1993, and relevant publications from Ireland’s Medical Council and Decision Support Service.
Results:
The Assisted Decision-Making (Capacity) Act 2015 outlined new procedures for advance healthcare directives. The Assisted Decision-Making (Capacity) (Amendment) Act 2022 specified that advance healthcare directives relating to mental health are binding for involuntary patients unless involuntary status is based on Section 3(1)(a) of the Mental Health Act 2001 (i.e., the ‘risk’ criteria). The Mental Health Bill 2024 proposes making advance healthcare directives binding for all involuntary patients. In relation to suicide and self-harm, the Criminal Law (Suicide) Act 1993 states that ‘a person who aids, abets, counsels or procures the suicide of another, or an attempt by another to commit suicide, shall be guilty of an offence’, and the Decision Support Service advises that healthcare professionals are exempted from criminal liability if complying with a valid and applicable advance healthcare directive that refuses life-sustaining treatment, even where the directive-maker has attempted suicide.
Conclusions:
Considerable public and professional education are needed if advance healthcare directives are to be widely used. The ethical dimensions of certain advance directives require additional thought and, ideally, professional ethical guidance.
Mental illness continues to be a leading cause of illness in Australia and Aotearoa New Zealand. The effects of reduced mental health have significant consequences for individuals, families and the community. Prevention and early intervention are crucial to improve health outcomes. Much of the support and care for individuals and families experiencing mental health illness occurs within the community, and nurses are major providers of that care. This chapter focuses on the role of community mental health nurses in providing recovery-orientated care for individuals living with mental illness and their families.
Traditional faith healers (TFHs) are often consulted for serious mental illness (SMIs) in low- and middle-income countries (LMICs). Involvement of TFHs in mental healthcare could provide an opportunity for early identification and intervention to reduce the mental health treatment gap in LMICs. The aim of this study was to identify models of collaboration between TFHs and biomedical professionals, determine the outcomes of these collaborative models and identify any mechanisms (i.e., explanatory processes) or contextual moderators (i.e., barriers and facilitators) of these outcomes. A systematic scoping review of five electronic databases was performed from inception to March 2023 guided by consultation with local experts in Nigeria and Bangladesh. Data were extracted using a predefined data charting form and synthesised narratively. Six independent studies (eight articles) satisfied the inclusion criteria. Study locations included Ghana (n = 1), Nigeria (n = 1), Nigeria and Ghana (n = 1), India (n = 1), Hong Kong (n = 1) and South Africa (n = 1). We identified two main intervention typologies: (1) Western-based educational interventions for TFHs and (2) shared collaborative models between TFHs and biomedical professionals. Converging evidence from both typologies indicated that education for TFHs can help reduce harmful practices. Shared collaborative models led to significant improvements in psychiatric symptoms (in comparison to care as usual) and increases in referrals to biomedical care from TFHs. Proposed mechanisms underpinning outcomes included trust building and empowering TFHs by increasing awareness and knowledge of mental illness and human rights. Barriers to implementation were observed at the individual (e.g., suspicions of TFHs), relationship (e.g., reluctance of biomedical practitioners to equalise their status with TFHs) and service (e.g., lack of formal referral systems) levels. Research on collaborative models for mental healthcare is in its infancy. Preliminary findings are encouraging. To ensure effective collaboration, future programmes should incorporate active participation from community stakeholders (e.g., patients, caregivers, faith healers) and target barriers to implementation on multiple levels.
This study presents a comprehensive analysis of recent mental illness research by utilizing an advanced bibliographic method capable of analyzing up to 12,965 papers indexed in the Web of Science database, overcoming the limitations of traditional tools like VOSviewer, which typically analyze fewer than 1,000 papers. By examining a vast dataset, this study identifies key trends, significant keywords, and prominent contributors, including leading researchers, universities, and countries/regions, in the field of mental illness research. Additionally, the study highlights eight major contributors to mental health problems, offering critical insights into the field’s current state. The findings underscore the importance of advanced bibliographic methods in providing a more detailed and accurate overview of mental illness research. This analysis not only enhances the understanding of young scholars entering the field but also uncovers significant trends and identifies notable gaps in the literature. The study advocates for continued innovation and interdisciplinary collaboration to deepen understanding and address unresolved challenges in mental health research.
For several years stigma researchers in India have relied on Western instruments or semi-structured stigma scales in their studies. However, these scales have not been rigorously translated and adapted to the local cultural framework. In the current study, we describe the cultural adaptation of six stigma scales with the purpose of using it in the native language (Kannada) based on translation steps of forward translation, expert review and synthesis, cultural equivalence, back translation and cognitive interview processes.
Several items were modified in the target language at each stage of the cultural adaptation process as mentioned in the above steps across all scales. Cultural explanations for the same have been provided. Concepts such as “community forest” and “baby sitting" was replaced with equivalent native synonyms. We introduced native cultural and family values such as “joint family system” and modified the item of housing concept in one of the tools. The concept of “privacy” in the Indian rural context was observed to be familial than individual-based and modification of corresponding items according to the native context of “privacy”. Finally, items from each scale were modified but retained without affecting the meaning and the core construct.
Burnout is a common issue among healthcare professionals and can have a negative impact on both personal and professional well-being. This initiative follows a group of doctors working in Buckinghamshire, UK, who are at moderate to high risk of burnout, over 6 months to determine whether participation in a movie club, as a form of stress relief and social support, can have a positive impact on well-being. The aim of the project was to investigate the impact on doctors’ well-being by improving connectedness, reducing the feeling of isolation and encouraging face-to-face activities.
The story of Mary and Martha is a “text of terror” for women and the mentally disabled, elevating Martha as emblematic of the spiritual failure of the anxious woman. While scholarship has focused upon the precise nature of Martha’s work, this article argues that whether Martha was in the kitchen or doing ministry, she was doing servile labor and incurring the “slavish” worry associated with such work. Attention to the socio-economic context of Martha’s worry recenters the labor dispute that is at the heart of this short passage. Rather than naturalizing ancient norms about worry or continuing to use the disabled body as something to “think with,” this article contextualizes Martha’s “worry and distraction,” demonstrating the ties between the female body, worry, anxiety, and enslaved labor in antiquity. Martha’s worry is a disability that is manufactured by unjust labor structures that purposefully assign worry to some bodies and not others.
Mounting evidence suggests that the Mediterranean diet has a beneficial effect on mental health. It has been hypothesised that this effect is mediated by a variety of foods, nutrients and constituents; however, there is a need for research elucidating which of these components contribute to the therapeutic effect. This scoping review sought to systematically search for and synthesise the research on olive oil and its constituents and their impact on mental health, including the presence or absence of a mental illness or the severity or progression of symptoms. PubMed and OVID MEDLINE databases were searched. The following article types were eligible for inclusion: human experimental and observational studies, animal and preclinical studies. Abstracts were screened in duplicate, and data were extracted using a piloted template. Data were analysed qualitatively to assess trends and gaps for further study. The PubMed and OVID MEDLINE search yielded 544 and 152 results, respectively. After full-text screening, forty-nine studies were eligible for inclusion, including seventeen human experimental, eighteen observational and fourteen animal studies. Of these, thirteen human and four animal studies used olive oil as a comparator. Observational studies reported inconsistent results, specifically five reporting higher rates of mental illness, eight reporting lower and five reporting no association with higher olive oil intake. All human experimental studies and nine of ten animal studies that assess olive oil as an intervention reported an improvement of anxiety or depression symptoms. Olive oil may benefit mental health outcomes. However, more experimental research is needed.
To outline the life and work of Greek physician Asclepiades of Bithynia (124–40 BC), especially his contributions to thinking about mental illness.
Methods:
Review and discussion of relevant fragments of Asclepiades’ work that survive and review of secondary literature, supplemented by relevant systematic literature searches (e.g. PubMed).
Results:
Asclepiades challenged the long-standing Hippocratic doctrine of the four humours and developed an approach to physical and mental illness that was humane, reasoned, and a forerunner of later developments in psychiatry. Asclepiades argued that the human body, like everything in the universe, comprised tiny, imperceptible particles, which he called önkoi, seamless masses in perpetual motion. In consequence, Yapijakis describes Asclepiades as ‘the father of molecular medicine’. Asclepiades held that good health was maintained by free, balanced motion of önkoi through theoretical pores, while disease resulted from blockage or impaction of önkoi passing through pores in various body parts (e.g. brain). Based on this idea, Asclepiades recommended releasing people with apparent mental illness from confinement and using judicious combinations of diet, exercise, massage, bathing, and music to treat ‘phrenitis’ (delirium) and melancholia. He suggested that the physician act ‘safely, swiftly and pleasantly’ (‘cito, tutu, jucunde’) for both physical and mental illness.
Conclusions:
Asclepiades belongs to the historical tradition of progressive medical approaches to mental illness, not least because he applied his principles for the treatment of physical illness to mental illness. His ideas about psychiatry set the scene for further evolution of attitudes to mental illness and its treatment over subsequent centuries.
College students disproportionately live with increased risk and burden of mental illness and suicide, yet most students do not access formal campus mental health services. One part of the solution to this problem has been the Bandana Project (BP), a peer-led mental health awareness and suicide prevention program. The program leverages the members’ vested interest in peer support, mental health promotion, and suicide prevention efforts to foster connectedness and offer alternative support to those who may be struggling. Education offered through the program orients members to relevant, evidence-based suicide prevention strategies and to various mental health resources. The program may contribute to reducing the burden of suicide and mental illness on campuses and help make college communities more supportive of students’ mental health. Further development, applications, and limitations of this program on the college campus setting – and beyond – are discussed.
In the context of climate change, the impacts of extreme weather events are increasingly recognised as a significant threat to mental health in the UK. As clinicians and researchers with an interest in mental health, we have a collective responsibility to help understand and mitigate these impacts. To achieve this, however, it is vital to have an appreciation of the relevant policy and regulatory frameworks. In this feature article, a collaboration amongst mental health and policy experts, we provide an overview of the integration of mental health within current climate policies and regulations in the UK, including gaps and opportunities. We argue that current policy and regulatory frameworks are lacking in coverage, ambition, detail and implementation, as increases in weather extremes and their negative impacts on mental health outpace action. For example, across current national and local climate policies, there is almost no reference to the impacts of extreme weather events on mental health. Whilst alarming, this provides scope for future research to fill evidence gaps and inform policy and regulatory change. We call for mental health and policy experts to work together to improve our understanding of underlying mechanisms and develop practical interventions, helping to bring mental health within climate policy and regulatory frameworks.
An introduction and overview of the mental health conditions relevant to people with intellectual disability. The chapter focuses on the evidence base to support or refute whether they suffer greater rates of mental health problems, Psychiatric classification and prescribing; Comparison tables of international classification of diseases (ICD) versions 10 and 11; and the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) 4 and 5 and DC-LD.
Autism Spectrum Disorders (ASDs) are a group of severe developmental and neuropsychiatric disorders usually apparent by the age of three. Autism, referred to as autism spectrum disorder in the 11th revision of the International Classification of Diseases (ICD-11), is a neurodevelopmental condition characterised by persistent deficits in social interaction and social communication, as well as a range of restricted, repetitive behaviours (World Health Organization 2018). The onset of autism is in the developmental period (0–18 years of age), though for some autistic persons the symptoms may manifest later in life, at a time of increased social demands (World Health Organization 2018). In addition to the aforementioned core autistic features, many autistic people have associated symptoms, including hypo- or hypersensitivities to sensory stimuli, difficulties describing their emotional state (alexithymia), and problems with gross motor co-ordination The chapter will discuss the interface between autism spectrum disorder and intellectual disability and the potential management of the disorder. It will also cover the gender variations in presentation.
Moderate-to-vigorous physical activity (MVPA) is beneficial for health, and reducing sedentary behavior (SB) is recommended in international guidelines. People with mental illnesses are at higher risk of preventable diseases than the general population, partly attributable to lower MVPA and higher SB. Self-determination theory provides a framework for understanding how motivation regulates behavior. This study aimed to evaluate the contribution of different forms of motivation for physical activity (amotivation, controlled, autonomous) to MVPA and SB in people with mental illnesses.
Methods
Cross-sectional self-reported and accelerometer-derived MVPA and SB in people with a range of mental illnesses across four countries were pooled for analysis (Australia, Belgium, England, Uganda). Motivation for physical activity was measured using the Behavioural Regulation in Exercise Questionnaire (BREQ). Regression analyses were used to investigate the association of MVPA and SB with amotivation, controlled, autonomous motivations, controlling for mental health and demographic variables.
Results
Autonomous motivation was associated with 31% higher self-reported MVPA, and amotivation and controlled motivation were associated with 18% and 11% lower self-reported MVPA, respectively (n = 654). In contrast, controlled motivation was positively associated with SB (n = 189). Having physical comorbidities or an alcohol use disorder was associated with lower MVPA (n = 318). Sub-analyses with accelerometer-derived MVPA and SB (n = 139 and n = 145) did not reveal any associations with motivational forms.
Conclusions
Findings with an international sample support the universal relevance of motivation in promoting health-related behavior. Strategies for facilitating autonomous motivation should be utilized by health professionals seeking to support people with mental illnesses to become physically active.
Objective: The study aims to build a comprehensive network structure of psychopathology based on patient narratives by combining the merits of both qualitative and quantitative research methodologies. Research methods: The study web-scraped data from 10,933 people who disclosed a prior DSM/ICD11 diagnosed mental illness when discussing their lived experiences of mental ill health. The study then used Python 3 and its associated libraries to run network analyses and generate a network graph. Key findings: The results of the study revealed 672 unique experiences or symptoms that generated 30023 links or connections. The study also identified that of all 672 reported experiences/symptoms, five were deemed the most influential; “anxiety,” “fear,” “auditory hallucinations,” “sadness,” and “depressed mood and loss of interest.” Additionally, the study uncovered some unusual connections between the reported experiences/symptoms. Discussion and recommendations: The study demonstrates that applying a quantitative analytical framework to qualitative data at scale is a useful approach for understanding the nuances of psychopathological experiences that may be missed in studies relying solely on either a qualitative or a quantitative survey-based approach. The study discusses the clinical implications of its results and makes recommendations for potential future directions.
People living with mental illness report a broad spectrum of nutrition risks, beyond malnutrition, but appropriate and adequately validated nutrition risk screening tools for mental health settings are lacking. This study aimed to develop a nutrition-risk screening tool, the NutriMental Screener, and to perform preliminary feasibility and validity testing. In an international, stakeholder engaging approach, a multifaceted nutrition-risk screening tool for mental health services was developed by means of workshops with international stakeholders and two online surveys. Feasibility of the NutriMental screener was tested as part of a research study in Switzerland with 196 participants, evenly distributed across the three study groups (sixty-seven outpatients and sixty-five inpatients with psychotic or depressive disorders as well as sixty-four controls without mental illness). The NutriMental screener consists of ten items covering different nutritional issues that indicate the need for referral to a dietitian or clinical nutritionist. Almost all patients (94·7 %) reported at least one nutrition risk by means of the NutriMental screener. Prevalence for nutrition risks via NutriMental screener was higher in patients than in controls. Almost every second patient expressed a desire for nutritional support (44·7 %). After further validity testing is completed, there is the potential for the NutriMental Screener to replace malnutrition screening tools as routine screening in various mental health settings aiming to organise nutritional therapy prescriptions in a more targeted and efficient manner.
Prospective university students experience substantial academic stressors and psychological vulnerabilities, yet their mental health literacy (MHL) remains inadequately explored. This study investigates four dimensions of MHL – help-seeking behaviors, stigma, knowledge about mental health and understanding of mental illnesses. Besides, Geographic Information System (GIS) techniques are employed to analyze spatial disparities in MHL, which is the first in the context of MHL research. A total of 1,485 students were assessed for sociodemographic characteristics, admission-related variables, health behaviors and family histories of mental health issues. Data were analyzed using SPSS and ArcGIS software. Multivariable linear regression analyses unveiled predictors of the MHL dimensions, with gender, family income, admission test performance, smoking, alcohol and drug use, physical and mental health history, current depression or anxiety and family history of mental health and suicide incidents emerging as common predictors. GIS analysis unraveled notable regional disparities in MHL, particularly in knowledge of mental health and mental illness, with northern and some southern districts displaying higher literacy levels. In conclusion, these findings accentuate significant gender and sociodemographic inequalities in MHL among prospective university students, highlighting the imperative for targeted interventions to enhance MHL and foster mental well-being in this cohort.