International Review of Psychiatry最新文献

Mental health policies are increasingly informed by international guidelines and evidence. However, translating these frameworks into sustained system-level change often proves difficult. This paper presents a policy learning case study examining how large-scale, deinstitutionalization-focused mental health reform was initiated and subsequently evolved in Czechia. Building on prior descriptive analyses of ESIF-supported reform, and drawing on administrative data, project documentation, evaluation reports, and qualitative feedback from 23 people with lived experience (PWLE), we analyse mental health reform as a system-level process. The analysis focuses on mechanisms shaping reform trajectories, including financing arrangements, intersectoral coordination, selected system-level outcomes, and political continuity. High-level political support and ESIF resources enabled coordinated investments in infrastructure, workforce development, service innovation, and national monitoring and analytical capacity, including the establishment of community mental health centres. Early progress included expansion of community-based services, reductions in long-term hospitalisation, improved service accessibility, increased involvement of PWLE in service design and governance, and declining population stigma. However, subsequent political changes slowed reform momentum and exposed vulnerabilities where innovations lacked stable institutional embedding and sustainable cross-sectoral support. This study shows that evidence-based mental health innovations remain vulnerable unless embedded in clinical practice, service structures, and institutional arrangements resilient to political change.

This article introduces a novel approach within the autoethnographic landscape, 'developmental autoethnography' (DAE), presently aimed as a complementary tool in therapy using ThePosAE. While ThePosAE has its purpose towards the future, DAE is intended as an archaeological method, which goes backwards, layer by layer, in order to examine why certain senses and feelings are still present in later life, although they may have their origin in childhood. The practical part of DAE is borrowed from narrative autoethnography (AE), i.e. writing one's story, either alone or together with a therapist or a teacher. The theoretical part rests on psychology and neurophysiology and emphasizes the importance of incorporating developmental factors in AE. In order to visualise how the practical part of DAE can be used, I have started the article by writing a short story about my own feelings as an adult and then speculated on their possible connections to my early life. Thereafter, I have presented a theoretical framework intended to give foremost therapists a deeper understanding of the importance of psychological- and neurodevelopmental factors when guiding me or another client forward towards a positive future.

Traumatic experiences can have profound and lasting effects on children and adolescents, particularly when mass violence disrupts environments traditionally perceived as safe. In May 2023, Serbia experienced two unprecedented mass shootings within 48 h, resulting in 19 fatalities, all involving children and young people. These events underscored the urgent need for rapid, accessible, and developmentally appropriate psychosocial responses beyond existing institutional frameworks. This paper presents the development and implementation of CEZAM (Centar za Mlade-Centre for Youth), a novel community-based model of psychosocial support for young people in Serbia. CEZAM was established as a non-stigmatizing, freely accessible service for children, adolescents, and young adults aged 10-30, as well as their families. The CEZAM model integrates three interconnected components: time-limited psychosocial counselling, preventive educational and wellness programmes, and structured youth engagement through volunteering and outreach activities. Between April 2024 and December 2025, CEZAM provided services to 3342 users, indicating unmet needs for accessible community-based support. The findings demonstrate the feasibility and relevance of an integrated, multi-sectoral psychosocial service model in post-trauma contexts and highlight the importance of early, accessible interventions in supporting recovery, resilience, and long-term mental well-being among young people.

This article is an enquiry between two educators, one from social science and the other from counselling psychology, exploring how Positive Autoethnography can be applied in both teaching and therapeutic contexts. An exploration by co-founders of #Love@ECU, a research initiative at Edith Cowan University (ECU) in Western Australia, the piece investigates the intersection of emotional learning and educational practice through the emerging framework of Heart Skills, an original format currently used in teaching interpersonal skills at ECU. It integrates personal narrative, embodied experience and emotional insight to consider how student growth and resilience can be cultivated. Central to this exploration is the concept of the heart as a bridge between body and mind, offering a holistic perspective that connects cognitive and somatic awareness. As part of ongoing work, we present here a series of reflective writing exercises, such as composing 'love letters to the dear heart', designed to foster self-love, emotional insight and healing through narrative. These exercises are intended to be shaped into autoethnographic artefacts that trace the development of the 10 core Heart Skills, that include empathy, assertiveness, compassion and leadership. Our aim is to create practical applications of Positive Autoethnography (PosAE) that support both pedagogical and therapeutic outcomes. This exploration lays the groundwork for future empirical research using Positive Autoethnography. By expanding the Heart Skills model through experiential, creative and reflective practices into a Heart Skills PosAE Toolkit, we hope to offer a transformative framework for heartful learning and emotional development across disciplines.

The relationship between humans and dogs is specifically influenced by human personality and sociocultural background. It is affected by conscious and unconscious dynamics in private and public spaces and varies based on own identity, (racial) background and how it is and has been perceived and dealt with historically and in contemporary society. Methodologically, this article uses a collaborative intercultural positive autoethnography approach (IcPosAE) to describe the experiences of the authors - a mother and her son - with dogs. Childhood experiences with pets, discourses regarding getting a dog and attachment to their dog are described, and the authors' understandings of experiences with dogs in public spaces in Germany, Australia and South Africa are discussed. Findings show that the authors' attachment to dogs, based on their lived experiences at individual and collective levels, is strongly influenced by belonging to specific sociocultural and racial groups in South Africa, which define to a large extent how humans and pets interact with each other in public. The authors demonstrate how the interpretations of behaviour are shaped through racialised individual experiences and racial bias in interactions between humans and dogs in public. Conclusions are drawn and recommendations are provided regarding ways in which human-pet relationships can support the reconstruction of sociocultural interactions for members of different racial groups constructively mediated through human-canine interaction.

We explored how dialogical autoethnography can illuminate the transformative potential of leadership struggles during COVID-19. Focusing on experiences of the first author-a Japanese woman leader serving as a higher-education institution dean from 2020-2023-we examined how initially negative challenges gradually evolved into growth opportunities. COVID-19 forced institutions to undergo rapid digital transformation in a context where Japan lagged behind other countries, requiring training in new technologies, coping with canceled in-person orientation programs, and addressing rising student isolation and mental health concerns. Students faced suspended study-abroad opportunities and prolonged uncertainty until the emergence of vaccine. The first author shared her experiences through dialogues with the second author, who acted as a dialogical collaborator. We combined emic (insider) and etic (outsider) perspectives through iterative cycles of conversation, transcription, and reflective memo writing, enabling both researchers to trace how overwhelming emotions-e.g., anxiety, frustration, and shame-were gradually reinterpreted as sources of resilience, pride, and professional growth. Dialogical autoethnography uncovers hidden learning in crisis leadership and shows how collaborative reflection helped the first author understand her transformation of vulnerability into strength. We contribute to leadership and higher-education research by offering insights into women's crisis leadership and demonstrating dialogical autoethnography's methodological value.

In the last decades mental health services experienced dramatic changes with a sharp decrease of psychiatric hospital beds and the integration of psychiatric inpatient care into medical care. In addition, psychiatric outpatient services have been developed and expanded. While some experts suggest to treat even very acute patients as outpatients, others recommend inpatient treatment for them. While numerous disadvantages of psychiatric hospital treatment have been eliminated, others continue to burden mentally ill persons. We assume that most of these disadvantages can be eliminated resulting in a better balance between in- and outpatient care. Despite the integration of psychiatric inpatient services into general hospitals high proportions of mentally ill persons suffer from comorbid physical diseases resulting in increased mortality. Better collaboration between specialists in medicine and psychiatrist is needed. New collaborative models based on scientific evidence can support this. All health professionals need a comprehensive education of this somatic-psychiatric comorbidity. Recent studies have shown that lifestyle interventions can prevent some somatic comorbid illness. Until now implementation of these preventive measures is rare, requiring a massive extended implementation in the next years. Overall, this will need sophisticated research, new health care strategies and adequate resources.

Artificial intelligence (AI) is rapidly transforming health care, offering novel opportunities for diagnosis, treatment, monitoring, and workflow optimization. These technologies now encompass digital therapeutics, chatbots, and advanced machine learning tools. On the surface, AI has the capability to enhance mental health treatment with personalized interventions, extending access to care, and streamlining administrative tasks. But there are significant ethical concerns raised by the use of AI in mental health care. Given the potential benefits, the future of psychiatry will likely involve hybrid models combining human expertise with AI capabilities. However, to realize this future, it is critical to address questions about safe and ethical integration, and implementation of AI in clinical care. Thoughtful integration can help improve treatment outcomes, expand access, and transform mental health care delivery while prioritizing safe and ethical patient-centered care. It is thus essential for clinicians to develop AI literacy and participate in shaping responsible and ethical implementation of AI in psychiatric care. Clinicians must also navigate concerns about privacy, data security, algorithmic and other biases, and the risk of AI-assisted deception. Effective deployment warrants critical oversight to ensure that AI complements human-led care.

Armed conflict remains a major determinant of global mental ill-health, particularly in low- and middle-income countries. Recent international resolutions have expressed deep concern about the growing but unmet mental health and psychosocial support needs of populations affected by armed conflict and other humanitarian crises, emphasizing the urgency of strengthening prevention, protection, and care through evidence-based and rights-based approaches. Although progress has been made in closing historic gaps-such as the inclusion of mental health indicators in global humanitarian health systems-significant disparities persist between global commitments and the delivery of effective, contextually relevant interventions. Despite increasing policy recognition, mental health services in conflict-affected settings often lack sustainable integration, cultural adaptation, and coordination across humanitarian and health sectors. This paper critically examines contemporary approaches to the treatment of mental health conditions in conflict zones, with a particular focus on conflicts in the Middle East, Sub-Saharan Africa and Eastern Europe. Drawing on recent empirical and policy developments from these regions, it proposes a conflict-sensitive mental health systems framework that bridges humanitarian, clinical and public health perspectives to inform scalable and contextually grounded strategies for improving mental health outcomes among populations affected by armed conflict.