Work stress is widely thought to be a significant problem in the health and community services sector. We reviewed evidence from a range of different data sources that confirms this belief. High levels of psychosocial risk factors, psychological health problems and workers compensation claims for stress are found in the sector. We propose a multilevel theoretical model of work stress to account for the results. Psychosocial safety climate (PSC) refers to a climate for psychological health and safety. It reflects the balance of concern by management about psychological health v. productivity. By extending the health erosion and motivational paths of the Job Demands-Resources model, we propose that PSC within work organisations predicts work conditions and in turn psychological health and engagement. Over and above this, however, we expect that the external environment of the sector particularly government policies, driven by economic rationalist ideology, is increasing work pressure and exhaustion. These conditions are likely to lead to a reduced quality of service, errors and mistakes.

Policymaking and the care of people with schizophrenia are still recovering from the shock of the arrival of a more objective way of appraising the best available evidence. It is still early days. There are several directions that practice and policy could go and there are indications that the rebuilding is not the same as what has gone before. After the earthquake we should be able to build more wisely.

The first episode of psychosis frequently occurs during adolescence and early adulthood, and is associated with high levels of trauma, affective disturbance and suicide. The social networks of service users often decrease significantly following the first onset, although many will remain in close contact with some family members particularly during the early phases. However, the negative impact of psychosis on families and their relationship with the identified service user are well documented. Family intervention is a recommended and evidence-based treatment in later psychosis. In this paper, we review the literature on family interventions in early psychosis in the context of new evidence for its efficacy and its routine incorporation in early intervention services for psychosis.

Routinely collected and reported indicators for health service utilization have traditionally been event/episode related and hospital centered. This is also the case for service utilization by persons with mental disorders, for whom national and international databases usually report rates of hospital discharges, mean length of stay for hospital episode and the like. Such event/episode-related indicators are of limited use for planning and improving services for persons with mental disorders. It is argued that new reporting systems are needed that allow the monitoring of the pathways of persons with mental disorders through the service system. It is shown how – owing to recent developments in techniques of ‘pseudonymization’ and the ever-increasing computer power for dealing with large volumes of patient data – such a system can be established and how it can contribute to analyzing empirically such mental health-care issues as ‘heavy utilizers’, ‘revolving door psychiatry’, ‘continuity of care’, ‘de-institutionalization’ and the like. Results of a record linkage study for the total population of a federal state of Austria monitoring both psychiatric and non-psychiatric health service utilization are reported. Some unexpected findings include the high utilization of non-psychiatric services by patients discharged from a psychiatric hospital bed, results which could not have been found by psychiatric case registers which usually only monitor utilization of psychiatric services.

This contribution reviewed the experience of the Cochrane Drugs and Alcohol Group (CDAG) in terms of production of evidence to guide policy and practice. By December 2010, the group had published 55 reviews, with 299 authors involved and 744 primary studies included out of 2114 studies considered for inclusion. 90% of the studies included were randomized controlled trials (RCTs). Considering the ‘Implication for practice’ section of each review, 31% interventions were classified as to do, 11% as do not do it, 52% to do only in research and for 6% a final judgment was impossible because the reviews included no studies or only one study. These proportions varied according to the type of substance of abuse studied; interventions judged as to do were 42% for alcohol, 32% for opioids, 12% for psychostimulants, 33% for poly drugs, and for prevention. The reviews produced by the CDAG provide evidence on effectiveness of several interventions, and identify areas of uncertainty, where more primary research is needed.

All good quality trials of psychological interventions need to check formally that therapists have used the techniques prescribed in the published therapy manuals, and that the therapy has been carried out competently. This paper reviews methods of assessing adherence and competence used in recent large-scale trials of Cognitive Behaviour Therapy (CBT) for psychosis in the UK carried out by our research groups. A combination of the Cognitive Therapy Rating Scale and specific versions of the Cognitive Therapy for Psychosis Adherence Scales provides an optimal assessment of adherence and competence. Careful assessment of the competence and adherence can help identify the procedures actually carried out with individuals within trials. The basic use of such assessments is to provide an external check on treatment fidelity on a sample of sessions. Such assessment can also provide the first step towards moving research towards making sense of CBT for psychosis as a complex intervention and identifying which techniques work for which problems of people with psychosis, at which stages of disorder?

Medicine in most parts of the world is becoming a stressful profession. Psychiatrists represent a high-risk group among doctors for experiencing burnout, alcohol and drug use, posing suicide risk and other forms of work-related stress. There are reports that entrants in the profession of psychiatrists are decreasing globally. Conceptual issues related to burnout are explored and factors contributing to burnout in psychiatrists are reviewed. Methodologically sound studies are needed to help us understand positive aspects of psychiatry as a profession and the environment psychiatrists work in. Effective treatment programmes for burnout are also needed not only to reduce suffering but also to retain psychiatrists in the profession.

There is now growing evidence to suggest that the experience of psychosis may be so traumatic for some that it can lead to Post Traumatic Stress Disorder (PTSD)-type symptoms or post-psychotic trauma symptoms (PPTS). There is, however, less knowledge about what psychological interventions may be helpful in reducing these symptoms. Evidence from the literature, to date, suggests that of the seven studies that have addressed this issue only four were randomized controlled trials (RCTs). However, all these studies included less than 100 patients with the vast majority reporting positive results. Overall, it seems that although cognitive-behavioural treatment (CBT)-based psychological interventions appear to be efficacious in the treatment of PPTS, the studies are too small to draw any firm conclusions and should be subjected to larger good-quality RCTs. Further research will also need to establish the role of mediating variables such as shame and depression in the treatment of PPTS.

When developing accessible, affordable and effective mental health systems, exchange of data between countries is an important moving force towards better mental health care. Unfortunately, health information systems in most countries are weak in the field of mental health, and comparability of data is low.

Special international data collection exercises, such as the World Health Organization (WHO) Atlas Project and the WHO Baseline Project have provided valuable insights in the state of mental health systems in countries, but such single-standing data collections are not sustainable solutions. Improvements in routine data collection are urgently needed. The European Commission has initiated major improvements to ensure harmonized and comprehensive health data collection, by introducing the European Community Health Indicators set and the European Health Interview Survey. However, both of these initiatives lack strength in the field of mental health. The neglect of the need for relevant and valid comparable data on mental health systems is in conflict with the importance of mental health for European countries and the objectives of the ‘Europe 2020’ strategy.

The need for valid and comparable mental health services data is today addressed only by single initiatives, such as the Organisation for Economic Co-operation and Development work to establish quality indicators for mental health care. Real leadership in developing harmonized mental health data across Europe is lacking. A European Mental Health Observatory is urgently needed to lead development and implementation of monitoring of mental health and mental health service provision in Europe.

The Cochrane Collaboration represents a quite successful example of a grass roots international effort aimed at contributing the growing demand for valid and reliable information on the effects of health care intervention, eagerly sought by consumers, patients, doctors and policy makers worldwide. The Cochrane Collaboration is fully aware that part of its success is due to the originality of its founding principles and that the challenge ahead is to maintain its ‘Cochrane Collaboration brand’ while understanding how a mature organisation can cope with the expectations of the relevant stakeholders with whom it seeks to collaborate. In this editorial reference is made to the strategic reflections emerged from the internal review that the organisation has recently completed to guide its years ahead.

This paper discusses an integrated approach to mental health studies on Financing of Illness (FoI) and health accounting, Cost of Illness (CoI) and Burden of Disease (BoD). In order to expand the mental health policies, the following are suggested: (a) an international consensus on the standard scope, methods to collect and to analyse mental health data, as well as to report comparative information; (b) mathematical models are also to be validated and tested in an integrated approach, (c) a better knowledge transfer between clinicians and knowledge engineers, and between researchers and policy makers to translate economic analysis into practice and health planning.

It is known that studies with statistically significant results have a higher probability to be published (publication bias). Therefore, studies with no statistically significant differences (or not favoring the investigational drug) may not be found in commonly accessed databases and remain unpublished. Moreover, unpublished data may also refer to information that are not included in study reports published in scientific journals but that may be important to estimate study outcomes. Retrieving unpublished evidence represents a compelling challenge for researchers, and in the present paper we explore how to do it.

Although randomised controlled trials are the reference methodology to assess the effects of therapeutic interventions, for interventions that naturally occur in groups of individuals random allocation of participants may be inappropriate. In these cases, the unit of random allocation may be the group or cluster, rather than the individual. Clinical trials that randomly allocate groups or clusters of individuals are called cluster randomised trials. This article briefly presents the main implications of cluster randomisation with respect to the following methodological aspects: generalisability, concealment of allocation, comparability at baseline, blindness, loss of clusters and intra-class correlation.

Systematic reviews carried out by Cochrane Collaboration (an international network of researchers belonging to this independent, not-for-profit organization) are recognized worldwide as the highest standard in evidence-based healthcare. The main reason is that Cochrane reviews follow a common and specific methodology to limit bias and random error. In this issue, we highlight the most important methodological features of Cochrane reviews, also reporting details on the editorial process to publish the review in the Cochrane Library.