IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE最新文献

Objectives: Youth self-harm (SH) is viewed as a public health concern and one of the main reasons for urgent psychiatry assessment. This systematic review sought to establish prevalence of SH among youth in Ireland.

Methods: A systematic review using pre-defined search terms was conducted (Jan 1980-March 2024).

Results: From a total of 204 papers identified, 18 were included. Significant variation in rates of SH was found. Limiting data to adolescent years (15-18), best estimates for overall lifetime rates of SH ranged from 1.5% (when rates of SH were reported based on a two-stage study design), to 23% (where SH was limited to non-suicidal SH). SH was typically higher in females, impulsive in nature, and occurred in the home setting. Whilst almost half of youth sought help before (43.7%) or after (49.8%) the SH episode, this was most often to a friend or family member. Overall rates of professional help seeking were low.

Conclusions: Robust studies using clear definitions of terms, separately capturing SH with and without suicidal intent, and distinguishing SH in the context of a mental illness, are required to inform service developments. Given the frequent occurrence of SH among youth accompanied by predominance of help seeking via friends and family, it is imperative that psychoeducation is delivered to families and peers. Out of hours community and specialist mental health services are essential to address this important issue.

Objectives: Understanding variations in knowledge and attitudes of psychiatrists to psilocybin therapy is important for the collective discourse about the potential impact on clinical practice and public health in Ireland.

Methods: A 28-item questionnaire was designed based on previous studies and distributed to psychiatrists in Ireland via online mailing lists and at in-person academic events.

Results: 151 psychiatrists completed the questionnaire (73.3% were under 40 years of age, 76.0% were trainees, and 49.0% were female). In the total sample, 81.5% agreed that psilocybin therapy shows promise in the treatment of psychiatric disorders and 86.8% supported funding research, 86.8% would be willing to refer a patient if it was licensed and indicated, and 78.1% would consider the treatment for themselves, if indicated. Conversely, 6.6% agreed that psilocybin therapy was unsafe even under medical supervision, and 21.9% thought it was potentially addictive. 15.9% of the total sample reported at least one concern including, lack of robust evidence, long-term effectiveness, superiority to current interventions, potential harmful effects, cost and accessibility, and impartiality. Less than half of respondents felt knowledgeable (40.0%) and 9.9% felt adequately prepared to participate in psilocybin therapy. Consultant psychiatrists trended towards less optimism for a potential role in bipolar depression and emotionally unstable personality disorder compared to trainee psychiatrists.

Conclusion: Overall psychiatrists in Ireland held positive attitudes towards psilocybin therapy. However, there was a lack of knowledge evident. Addressing the knowledge gap and aligning with the best available evidence will be key if psychedelic therapy is to prevail in a clinical setting.

This article explores the shift in mental health recovery from mere symptom management to a holistic approach via the CHIME framework. It delves into the author's experience, beginning with the loss of his father, a war veteran with mental health struggles, at 16, thrusting him into the role of primary caregiver for his mother, who also battled mental health issues and eventually took her own life. These events spotlight the shortcomings of traditional mental health care and the urgent need for empathetic, multifaceted services. Advocating for co-creation in mental health services, the article outlines a transition towards a system that integrates recovery principles through stages from co-ideation to co-evaluation, emphasising holistic, person-centred care. It calls for a reimagined mental healthcare system that respects individual journeys and is rooted in co-creation, signalling a critical move towards systemic change.

Objectives: Legislation is a powerful tool for facilitating mental healthcare. Gender is an important social determinant of physical and mental health. Many jurisdictions are in the process of revising their mental health law, to align with human rights commitments. Consideration of gender in these revisions could enhance the mental healthcare received by women, transgender and non-binary individuals.

Aim: This paper examines gender-based provisions in mental health law published in English.

Methods: Countries that use English as an official language were identified. Jurisdictions in these countries with stand-alone mental health laws were included. Legislation was reviewed for gender-specific provisions.

Results: Seventy-five countries were evaluated; 71 jurisdictions were included. Thirty-eight jurisdictions had 88 gender-specific provisions. These addressed ten key areas, including: general gender-based protections, female representation on boards and review panels, protections during searching and restraint, gender separated facilities, protections in relation to parenting, fertility, sterilisation and termination. Fiji, Ghana, India, and the Australian jurisdictions had the highest number of gender-specific laws. However, gender-specific provisions are highly heterogeneous and are drafted from a cisnormative perspective and fail to adequately address the specific needs of individuals outside of that framework.

Conclusion: Gender-specific provisions can enhance the protections afforded by mental health law. However, as legislation can be a blunt instrument, careful consideration must be given to potential unintended consequences. During revisions of mental health law consideration should be given to gender-specific provisions and legislation must be inclusive of individuals identifying as transgender, non-binary and other genders.

Objectives: The aim of this study is to assess General Practitioner (GP) trainees' training experience, and confidence in assessing and managing children and adolescents with common mental health conditions in primary care in Ireland.

Methods: An online anonymous questionnaire was distributed to third and fourth year GP registrars enrolled in the Irish College of General Practitioners training schemes. The online questionnaire evaluated participants' training experiences and confidence levels in key areas of child and adolescent mental health in primary care.

Results: Sixty participants completed the survey out of 406, yielding a response rate of 14.8%. The majority (88%) reported no formal training or experience working in Child and Adolescent Mental Healthcare Services (CAMHS) during their GP training scheme. Responses indicated that many participants rated their competency, skills, and knowledge in essential areas of Child and Adolescent Mental Health as needing improvement. Similarly, their awareness of referral pathways and specialty services was below expectations, with poor perceived access to services. A large proportion (91.7%) expressed a definite need for further training in child and adolescent mental health disorders.

Conclusion: The results highlight the need for enhanced training and support for GP trainees in the field of Child and Adolescent Mental Health, ensuring their ability to effectively and confidently address these common issues in primary care.

Objective: To evaluate the rates of use of restrictive practices (RPs), such as seclusion and physical restraint, in approved mental health centres (ACs) in Ireland.

Methods: Examination of data reported to the regulator of mental health in Ireland, the Mental Health Commission (MHC), and the Health Research Board (HRB).

Results: There has been a substantial reduction in RP use in Irish ACs between 2018 and 2022.

Conclusions: The MHC welcomes this reduction in RP use and considers several possible reasons for this data.

Background: The rights of mental health service users are a subject of profound debate. In this article, we aim to examine mental health professionals' perspectives, opinions, and attitudes on the state of service users' rights.

Methods: We conducted a thematic analysis of eleven focus groups involving mental health professionals.

Results: Through this process, we identified two main meta-themes that shed light on the challenges faced by mental health service users: 'Transforming the therapeutic relationship' and 'Societal determinants of service users' rights'. Within the former meta-theme, we identified the following themes: 'Diversifying mental health knowledge', 'Risk-protection tensions', and 'Being (ir)responsible'. Within the latter meta-theme we identified 'Determinants inside the clinics' and 'Determinants outside the clinics.'

Conclusions: Reflecting on these themes could potentially encourage new strategies to support professionals in overcoming the subjective barriers that prevent their adherence to rights-based mental health care models.