Subodh Dave

The recent proposal by NHS England to establish specialist mental health crisis centres has prompted considerable discussion. This editorial examines the initiative, which aims to reduce accident and emergency pressure and provide tailored care. However, it raises significant questions about the potential to exacerbate systemic fragmentation. Concerns highlight inadequate funding, the risk of resegregation of mental health from physical care and increased stigma if not properly integrated. This article argues that true holistic care requires seamless integration, advocating strongly for co-located mental health and medical emergency departments, which have shown improved outcomes. Ultimately, the success of these centres depends on addressing wider NHS issues, robust evaluation and a comprehensive vision prioritising the entire mental health pathway, from prevention to long-term recovery, to genuinely transform patient lives.

We conducted a cross-sectional survey to examine how undergraduate psychiatry is taught and assessed across medical schools in the UK that have at least one cohort of graduated students. In total, 27 medical schools completed the survey. Curriculum coverage of common mental disorders, assessment skills and mental health law was broadly consistent, although exposure to psychiatric subspecialties varied. Significant variation existed regarding the duration of psychiatry placements and availability of enrichment activities. Small-group teaching, lectures and e-learning were the most frequent teaching modalities and various professionals and lived experience educators (patient and/or carers) contributed to teaching. Objective structured clinical examinations and multiple-choice questions dominated assessments. Medical schools should consider increasing students' exposure to different psychiatric subspecialties and integrating physical and mental health training to address comorbidity and promote holistic care. Future research should explore whether specific undergraduate experiences promote greater career interest and skills in psychiatry.

Objectives. Patient involvement in mental health professional education is required by policy but lacks a robust evidence base. The impact of involvement in education on patients with mental health conditions may differ from that of patients with other conditions. This study aims to review the impact of involvement in mental health professional education on the patients with mental health conditions involved.
Setting. Electronic databases MEDLINE, PubMed, AMED, EMBASE, PsycINFO, Emcare, BNI, HMIC and CINAHL were systematically searched to find articles reporting on health professional teaching interventions involving patients with mental health conditions and the psychological, social or physical impact of involvement. The search took place in August 2023.
Results. Findings from 20 articles were amalgamated into four synthesised findings: (1) Impact of general involvement (2) impact of making a difference through teaching, (3) impact of new relationships and (4) impact of talking about experiences.
Conclusions. Patient involvement in mental health professional education can be beneficial for patients with mental health conditions when their experiences are respected and valued as expertise by students and academic staff. The experiences of patient educators in the mental health field are unique in that teaching activities interact with their mental health. Future research should evaluate patient involvement in the mental health field separately and report research findings according to reporting guidelines.

‘Digital’ is an omnipresent yet often vague, misunderstood or feared topic in health services. There are many current and potential gains for individual patients and local populations, clinicians and organisations through optimisation of digital technologies. We argue that understanding the various aspects of digital psychiatry is an essential contemporary need. This is the first of two articles on the subject, exploring the gains and challenges of virtual/online assessments, including ethical considerations and the use of virtual reality and electronic prescribing.

Purpose of reviewForced displacement, from wars, terrorism, internal disputes and environmental disasters, has been witnessed throughout human history. Forcibly displaced people face unimaginable difficulties and atrocities in their attempts to survive. Provision of support often focuses on basic needs, such as food, shelter and essential health demands. We present here a narrative review informed by syndemic theory to understand the existing literature on the associations between substance use disorders and experiences of forced displacement.Recent findingsThe risk factors associated with SUDs are similar to or overlap with those experienced by forcibly displaced people, yet there is substantial heterogeneity in patterns and prevalence of substance use across the different forcibly displaced people. Despite recognition that SUDs among forcibly displaced people are concerning, there are large gaps in knowledge. These include questions around whether forced displacement is directly and consistently linked with SUDs prevalence, what the patterns of risk and resilience look like across different cultures experiencing different causes of displacement over varying durations, and what constitutes effective interventions for these groups. These gaps are at least partly due to research having been disproportionately conducted in developed countries rather than in low- and middle-income countries.Specifically, we categorise syndemic risks of both forced displacement and substance use disorders into four areas: trauma and violence, loss and instability, transit and resettlement and acculturation. We use causal loop diagramming to illustrate important synergistic interactions. We propose a research and intervention policy agenda informed by a broad and varied stakeholder base, accounting for generational and life-course effects and context specific cultural, structural and economic priorities and values.

AD is the commonest mental disorder with a lifetime prevalence rate of 21.1% in Europe, 31.0% in the United States2,3, a point prevalence of 5%, and a greater preponderance amongst women4. Living with ADs can be a long-term challenge. In many cases, it occurs along with other mood disorders5,6. In most cases, AD improves with psychological therapies and medication. Making lifestyle changes, learning coping skills and using relaxation techniques also can help. However, failure to treat AD and its consequences can be economically and socially costly. Therefore, early recognition of the disorder is imperative as that improves the scope for treatment and the prognosis. This guide describes critical aspects of the various subtypes of AD and how to manage them.  

An unintended consequence of the COVID-19 pandemic has been the exponential growth of telemedicine, with automation of healthcare becoming more common. Face-to-face meetings and training events have been replaced relatively seamlessly with online versions, taking clinical or academic expertise to distant parts of the world and making them more accessible and affordable. The wide reach of digital platforms offering remote healthcare offers the opportunity of democratising access to high-quality healthcare, However, certain challenges remain: (a) clinical guidance developed in one geographical area may need adaptation for use in others; (b) regulatory mechanisms from one jurisdiction need to offer patient safety across other jurisdictions; (c) barriers created by disparity in technology infrastructure and the variation in pay for services across different economies, leading to brain drain and an inequitable workforce. The World Health Organization's Global Code of Practice on the International Recruitment of Health Personnel could offer the preliminary framework on which solutions to these challenges could be built.

BACKGROUND: During the COVID-19 pandemic as much as 40% of the global population reported deterioration in depressive mood, whereas 26% experienced increased need for emotional support. At the same time, the availability of on-site psychiatric care declined drastically because of the COVID-19 preventive social restriction measures. To address this shortfall, telepsychiatry assumes a greater role in mental health care services. Among various on-line treatment modalities, immersive virtual reality (VR) environments provide an important resource for adjusting the emotional state in people living with depression. Therefore, we reviewed the literature on VR-based interventions for depression treatment during the COVID-19 pandemic. SUBJECTS AND METHODSWe searched the PubMed and Scopus databases, as well as the Internet, for full-length articles published during the period of 2020-2022 citing a set of following key words: "virtual reality", "depression", "COVID-19", as well as their terminological synonyms and word combinations. The inclusion criteria were: 1) the primary or secondary study objectives included the treatment of depressive states or symptoms; 2) the immersive VR intervention used a head-mounted display (HMD); 3) the article presented clinical study results and/or case reports 4) the study was urged by or took place during the COVID-19-associated lockdown period. RESULTSOverall, 904 records were retrieved using the search strategy. Remarkably, only three studies and one case report satisfied all the inclusion criteria elaborated for the review. These studies included 155 participants: representatives of healthy population (n=40), a case report of a patient with major depressive disorder (n=1), patients with cognitive impairments (n=25), and COVID-19 patients who had survived from ICU treatment (n=89). The described interventions used immersive VR scenarios, in combination with other treatment techniques, and targeted depression. The most robust effect, which the VR-based approach had demonstrated, was an immediate post-intervention improvement in mood and the reduction of depressive symptoms in healthy population. However, studies showed no significant findings in relation to both short-term effectiveness in treatment of depression and primary prevention of depressive symptoms. Also, safety issues were identified, such as: three participants developed mild adverse events (e.g., headache, "giddiness", and VR misuse behavior), and three cases of discomfort related to wearing a VR device were registered. CONCLUSIONSThere has been a lack of appropriately designed clinical trials of the VR-based interventions for depression since the onset of the COVID-19 pandemic. Moreover, all these studies had substantial limitations due to the imprecise study design, small sample size, and minor safety issues, that did not allow us making meaningful judgments and conclude regarding the efficacy of VR in the treatment of depression, taking into account those investigations we have retrieved upon the inclusion criteria of our particularistic review design. This may call for randomized, prospective studies of the short-term and long-lasting effect of VR modalities in managing negative affectivity (sadness, anxiety, anhedonia, self-guilt, ignorance) and inducing positive affectivity (feeling of happiness, joy, motivation, self-confidence, viability) in patients suffering from clinical depression.