IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE最新文献

Objectives: To assess levels of restrictive practice in approved centres in Ireland following the introduction of revised rules and codes of practice and the implementation by the Mental Health Commission (MHC)) as regulator of a near real-time reporting mechanism.

Methods: We examined data reported to the MHC via its computerised system from 65 approved centres during a two-year period from 2024 to 2025.

Results: The data indicate an accelerated decline in restrictive practice in approved centres in Ireland.

Discussion: Restrictive practice (Restraint and Seclusion) has been declining in approved centres in Ireland. This progress accelerated following the implementation of revised, human rights-based Rules governing the use seclusion and a Code of Practice on the use of physical restraint which were developed by the MHC after consultation with stakeholders and came into effect on 1 January 2023. Many factors contributed to this progress including steps taken by the regulator and by approved centres to enhance this welcome trend.

The position paper 'The development of services for treatment of personality disorder in Adult Mental Health Services' was published by the College of Psychiatrists of Ireland Personality Disorder Special Interest Group (PDSIG) in 2021. Following this, we are advocating for the development of a national treatment strategy for personality disorders in Ireland. As part of this process, we have examined international evidence and best practice guidelines for establishing personality disorder services. Key recommendations from the literature include access to services, continuity of care, a multidisciplinary approach, tiered models of care, collaboration with service users, staff training and supervision, and delivery of evidence-based interventions. These recommendations should form the backbone of a national personality disorder strategy for Ireland.

Objectives: Interest in psilocybin as a treatment for depression has risen over the past decade, fuelled by promising clinical trials and a rapidly evolving regulatory landscape. Media coverage plays a critical role in shaping public perceptions, yet little is known about how psilocybin is portrayed in global anglophone online news for the treatment of depression.

Methods: This study examines the comprehensiveness and sentiment of English-language online news articles (n = 125) discussing psilocybin as a treatment for depression from January 2000 to May 2024. Articles were sourced from the top 30 global anglophone news outlets, assessed using a 13-item instrument for comprehensiveness, and analysed for sentiment across five thematic categories. A separate sub-analysis was completed for Irish media.

Results: Findings indicate a significant increase in coverage over time, with 43.2% of articles published between 2022 and 2024, predominantly from the USA (68%). While 90.4% of articles cited researchers, fewer addressed risks (47.2%), long-term evidence (46.4%), or patient perspectives (25%). Sentiment analysis revealed a very positive sentiment across articles which was 2.27 on a scale from -5 (most negative) to + 5 (most positive) (SD 1.33), with no significant changes over the time period. Reporting on psilocybin's onset and duration of effects increased significantly, reflecting growing clinical evidence. However, coverage remains concentrated in prominent outlets, with limited attention to patient experiences and long-term safety.

Conclusions: These findings highlight the media's role in shaping discourse on emerging treatments and suggest a need for more balanced reporting to align public understanding with scientific evidence. This study provides a foundation for future research on media portrayals of psilocybin and implications for public perception and policy.

Consultation-liaison psychiatry (CLP) refers to the subspecialty of psychiatry and the specialist clinical services that deliver care at the intersection of mental and physical healthcare. CLP services provide specialist medical and multidisciplinary expertise for managing conditions in these areas of mental and physical healthcare overlap, and comorbidity. The Model of Care for CLP was identified as a key priority in Sharing the Vision, the 2020 national mental health policy in Ireland. Following four years of work by a writing group initiated by the Faculty of Liaison Psychiatry at the College of Psychiatrists of Ireland, the Model of Care for CLP in Ireland was launched in May 2025 (Cpsychi H (2025). Consultation-Liaison Psychiatry: A Model of Care for Ireland. Dublin: HSE.).). Consultation-Liaison Psychiatry: A Model of Care for Ireland. Dublin: HSE.). This reflects the collaborative efforts between the Liaison Faculty and the Irish Health Service Executive (HSE). This Model of Care, developed in collaboration with clinicians and patients, the College of Psychiatrists of Ireland, and the HSE, provides a potential template for future collaborations in the development and implementation of National Mental Health policy.

Background: The concept partnership has developed since Sherry Arnstein first created the ladder of citizen participation. Within mental health discourse, this was first acknowledged by "A Vision for Change" (2006) and later, through adopting co-production (2017). In 2011, the College of Psychiatrists of Ireland, created a collective called Recovery Experience Forum of Carers and Users of Services (REFOCUS) which became a leading example of partnership between stakeholders in the organisation. However, REFOCUS's impact on stakeholders needs to be examined.

Methods: A qualitative investigation using an autoethnography methodology is proposed. The approach allows for the interweaving of personal experiences with culture to create new knowledge. A focus group was conducted, and transcripts were subject to reflexive thematic analysis.

Results: Seven out of fourteen participants, representing all three stakeholders, were available at time of interview. From the process of reflexive thematic analysis, five themes were constructed. Each with a number of sub-themes attached, which in turn represented stakeholder perspectives regarding REFOCUS.

Discussion: This paper highlights several issues that need addressing in future research on REFOCUS. The paper demonstrates the continuous presence of stigma within Irish mental health services. However, it also highlights a number of beneficial aspects to REFOCUS including informal peer support, service users, and family member involvement in college activities as well as increasing meaning and purpose in one's life along with a renewed identity different to that of the service user or family member.

Background: Cardiovascular disease (CVD) is the leading cause of death worldwide. Research suggests people with Mental Health Disorders (MHDs) have increased CVD risk. However, knowledge gaps exist regarding CVD risk management for general practice patients with MHD, and interventions that might improve CVD prevention. This study examined the perspectives of general practice professionals in Ireland on cardiovascular risk assessment for patients already diagnosed with MHD and to describe current approaches to identifying this population using the Mental Health Finder (MHF) tool.

Methods: An embedded mixed-methods design was adopted, guided by constructivist grounded theory and the Social Ecological Model. Aggregated anonymised data, including availability and use of the MHF tool, were collected from five practices and analysed in SPSS. In-depth semi-structured interviews were conducted with 12 general practitioners and three practice nurses. Qualitative data were analysed using Braun and Clarke's Reflexive Thematic Analysis.

Results: Of the five practices, two had access to the MHF tool. These reported combined prevalence of 18.7% for MHD compared with 0.5-11.5% in practices without the tool, highlighting the importance of systematic identification. Qualitative analysis generated four themes: (1) prevalence of MHD in general practice, (2) association between MHD and CVD risk, (3) CVD risk management in patients with MHD, and (4) holistic care.

Conclusion: CVD risk assessment for patients with MHD in general practice is largely opportunistic and unstructured. Participants highlighted the need for structured frameworks, protocols, and enhanced supports to enable systematic cardiovascular assessment and management in this population.

The recovery model of mental health care is distinct from the biomedical model of mental health care. To promote one runs the risk of marginalising the other. Both approaches have merit. Values of hope and optimism, social inclusion, collaborative decision-making, retaining a personal identity beyond an identity simply defined by a diagnosis of mental illness, are all central to the recovery model. A reorientation of mental health services is required, a change in culture which embodies the principles of a recovery model within which, the perspectives of patients and families are heard together with the perspectives of mental health professionals who have knowledge and expertise to offer. In Meath Community Mental Health Services we have implemented such a recovery model, the model of open dialogue where principles of dialogue, social inclusion, immediate help and collaborative decision-making are paramount. We began this service in 2019 and carried out an audit of the first 6 months of our implementation. The audit illustrated overwhelming satisfaction from service users and their families with the new approach. On foot of our successful pilot project we have extended the model of open dialogue to other teams in Meath and Louth, including the in-patient unit in Drogheda. Our open dialogue project illustrates how a recovery model of mental health care can be successfully implemented in a public mental health system.

Objectives: To characterise hospital-treated multimorbidity patterns in people who subsequently died a drug-related death in Scotland, and to identify clinically meaningful associations among conditions and decedent to inform prevention and care.

Methods: A register-based retrospective cohort study using nationally linked hospital admission (1996-2019) and mortality (2008-2019) records for 5,749 decedents. We identified hospital admissions for Elixhauser comorbidities using ICD-10 codes. Correlation analysis, network analysis, and Bayesian clustering were used to describe co-occurring conditions and identify patient clusters with distinct comorbidity profiles.

Results: Over half (50.9%) of decedents had at least one admission for an Elixhauser comorbidity. The most frequent were related to alcohol use (38.2%), drug use (29.1%), other neurological disorders (18.0%, mainly epilepsy/seizures/anoxic brain injury), depression (15.2%), and psychoses (12.5%). Network analysis highlighted drug use, alcohol use, psychoses, depression, and neurological disorders as central conditions. Bayesian clustering identified seven distinct patient clusters, including groups characterised by: high psychiatric and drug-use admissions; extensive physical comorbidities; alcohol and liver disease; dominant neurological issues and depression.

Conclusions: Individuals experiencing drug-related deaths exhibit substantial multimorbidity with distinct patterns often dominated by substance use and mental ill-health but also including significant physical health clusters. These distinct profiles underscore the need for integrated, tailored care strategies addressing substance use, psychiatric, and physical health needs to mitigate mortality risk.