Patient safety problems stemming from healthcare represent a significant cause of morbidity and mortality globally. The evidence base on safety in mental healthcare, particularly regarding community-based mental health services, has long fallen behind that of physical healthcare, with fewer research publications, developed primarily in isolation from the wider improvement science discipline. This disconnect both yields, and stems from, conceptual and practical challenges which must be surmounted in order to advance the science and improvement of safety in mental healthcare.

The objectives of this research were to conduct a narrative review to provide an overview of conceptual issues in this area, their origins, and implications for patient safety science and clinical care. We also sought to identify approaches to overcoming these issues.

We examined theoretical and empirical evidence from the fields of patient safety, mental health, and improvement science to address this knowledge gap.

We identified challenges with defining safety in the context of community mental healthcare, ascertaining what constitutes a ‘preventable’ safety problem requiring intervention, and in finding relevant research evidence. The research indicated that risk management has taken precedence over proactive safety promotion in mental healthcare. This positions service users as the origin of safety risks, with iatrogenic harm and latent system hazards associated with mental healthcare widely overlooked.

We propose a broader conceptualisation of safety to advance the field and outline potential next steps for the integration and uptake of different sources of ‘safety intelligence’ within community mental health services.

NS is the director of London Safety and Training Solutions Ltd, which offers training in patient safety, implementation solutions and human factors to healthcare organisations and the pharmaceutical industry. The other authors have no competing interests.

Intensive home-treatment (IHT) for people experiencing a mental health crisis has been progressively established in many European countries as an alternative to in-ward treatment. However, the management of acute episodes at home can cause burden in the caregivers of these patients.

To create a brief group intervention (BGI) to reduce burden in the caregivers of the patients admitted to an IHT unit.

A preliminary version of the BGI (BGI 1.0) was designed based on literature’s review. It consisted of 4 sessions of 90 minutes (one per week), on-line (COVID-19), focused on caregivers burden, stress and self-care, communication skills, and self-compassion. All the caregivers of the patients admitted for IHT from 10/01/2020 to 06/01/2021 were offered the BGI 1.0. At the end of the intervention, participants (caregivers and therapists) were asked about their opinion on its contents and usefulness.

A total of 31 caregivers received the BGI 1.0. Most of them felt satisfied with the intervention. Opinions varied as to which contents should be expanded or included. The therapists thought that the number of sessions should be increased to take a closer look at some contents or to include new ones. They also believed that the on-line format hindered the adherence and the interaction between the participants.

The BGI 1.0 seems to be a good starting point to design the final version of the intervention. However, an exhaustive assessment of the construct of burden in a larger sample of caregivers should be performed prior to its design.

No significant relationships.

Resilience has been described as an individual’s ability to adjust or adapt to significant adverse or traumatic circumstances.

The aims of this study were to assess the resilience of caregivers of patients with mental disorders and to identify its associated factors.

We conducted a descriptive and analytical cross-sectional study among caregivers of patients followed in the outpatient psychiatry department at the university hospital of Sfax(Tunisia), during septembre 2021. Resilience was assessed using Connor–Davidson Resilience Scale(CD‑RISC).The total scores range from zero to 100. The cut-off scores for this questionnaire is 50, with higher score indicating higher resilience.

Our sample included 34 family caregivers. The mean age was 47.47 years (SD=12.4 years)and the sex ratio (M/F) was 1.42. They were the parents of patients in 35.3% of cases. The mean duration of providing care to patients was 8.62 years. The mean resilience score of caregivers was 42.85 and 26.5% of them were resilients. The Caregivers with low socioeconomic level (p=0.004), a history of chronic illness (p=0.0001), a long duration of providing care (p=0.001), a stressful events (0.002) and those victims of agressive behaviors committed by patients (p=0.0001) were more likely to have a low resilience score.

Our results stated that three out four cargivers have low level of resilience. Interventions targeting stress related to social events and burden of care, and violence committed by patients in their family environment should be integrated to increase the caregivers’resilience.

No significant relationships.

Over the past decades, a growing body of evidence has demonstrated the impact of the psychosocial work environment on workers’ health, safety and wellbeing. These factors may also affect employees ’job satisfaction.

To explore psychosocial determinants of job satisfaction among workers in a Tunisian electricity and gas company.

A cross-sectional survey was conducted among male workers in a Tunisian electricity and gas company. The Copenhagen Psychosocial Questionnaire (COPSOQ), the Job Content Questionnaire and the general health questionnaire (GHQ12) were used to assess psychosocial risk factors at work. A principal component analysis (PCA) was used to assess correlations between instruments ’scores. Multiple linear regression analysis was applied to explore the specific factors associated with job satisfaction. Data were analysed using R software.

A total of 83 workers participated in the survey (the age range: 21-60 years). Job satisfaction score varied from 0 to 100% with a mean of 73.09 %. In the PCA, job satisfaction had a positive correlation with high social support and a negative one with work-family conflicts, a high psychological demand, stress, burnout and quantitative demands. In multivariate analysis, factors negatively associated with job satisfaction were: age, stress and low social support. In contrast, seniority was positively associated with job satisfaction.

Job satisfaction is deeply influenced by the psychosocial work environment. Therefore, it is necessary to provide supervision, communication, and social support for these workers to increase or maintain a high level of job satisfaction.

No significant relationships.

About 3% of the general population suffers from Severe Mental Illness (SMI), including schizophrenia spectrum, bipolar and major depressive disorders. In this group, the rates of cardiovascular disease, diabetes mellitus and metabolic syndrome are approximately twice as high as the general population and the life expectancy is 13-30 years inferior compared to age and sex matched controls, greatly due to medical comorbidities. Low levels of physical activity (PA) and low fitness are likely to play a role.

To review the evidence about the effects of PA on physical health markers and psychiatric clinical symptoms of SMI patients.

We performed a literature review on the impact of exercise programs in physical and mental health of SMI patients using the PubMed and Google Scholar databases.

Several studies demonstrate that PA improves a variety of physical health markers in SMI patients, such as body weight, body mass index, waist circumference, body fat percentage, cardiorespiratory fitness, systolic blood pressure and HDL cholesterol. In parallel, there is evidence to support the benefit of PA in mental health, especially due to its effect on mood. Furthermore, PA promotes cognitive functioning, sleep quality, quality of life, self-esteem and fosters social interaction. Moreover, in patients with schizophrenia, exercise seems to decrease negative symptoms.

Implementation of regular physical activities in psychiatric wards should be considered whenever possible, due to its positive effects on physical and mental health. The adoption of structured exercise programs in psychiatric wards is feasible, safe, and well-received by patients.

No significant relationships.

There has been obvious in university education the importance of mental health and psychological well-being of students along with academic achievements (Lambert et al., 2019). M. Seligman, one of the founders of positive psychology, characterizes positive education as education aimed at acquiring happiness along with knowledge and skills (Seligman et al., 2009).

The current study aims to overview the positive education impact on mental health and psychological well-being.

Systematic analysis of research publications concerning positive education and its role for maintenance of mental health and psychological well-being.

While university administration collects student’s feedback on various aspects of the educational process, it almost never asks students for their opinion on what can be done for their psychological well-being. The promotion of psychological well-being among young people is becoming an increasingly popular topic, and positive education is increasingly emerging within education. Positive education can be seen as a general sphere of positive psychology and advanced practice in education that aims the development of students for both academic achievement and psychological well-being. Special attention in positive education is paid to the use of empirically proven methods and programs aimed at improving well-being, engagement in educational activities, optimism, positive emotions, life satisfaction and other positive experience.

A particularly promising direction for the development of positive education can be the use of information and communication technologies to improve mental health and psychological well-being. The reported study was funded by the Russian Foundation for Basic Research, project number 18-29-22049.

No significant relationships.

There is limited existing research about patient safety issues in mental healthcare. A lack of evidence is particularly pronounced in relation to safety in community-based mental health services, where the majority of care is provided. To date, reviews of mental health patient safety literature have focused primarily on inpatient care settings.

This systematic scoping review will aim to identify and synthesise literature about the types of patient safety problems in adult community-based mental health settings, the causes of these problems, and evaluated safety interventions in this care context.

A systematic search was conducted on 19th June 2020 and refreshed on 23rd October 2021, across five databases: Medline, Embase, PsycINFO, Health Management Information Consortium, and Cumulative Index to Nursing and Allied Health Literature. The search strategy focused on three key elements: ‘mental health’, ‘patient safety’ and ‘community-based mental health services’. Retrieved articles were screened at title, abstract and subject heading level, followed by full-text screen of longlisted articles.

In this presentation, the findings of this systematic scoping review will be described, based on synthesised literature about safety incidents, broader care delivery problems, their causes, and evaluated patient safety interventions to address these issues.

This study will offer learning opportunities about the safety problems, contributory factors, and safety interventions in adult community-based mental health services, as described in the evidence base. Review findings will also help to ascertain gaps in existing research, which should be addressed in future studies.

NS is the director of London Safety and Training Solutions Ltd, which offers training in patient safety, implementation solutions and human factors to healthcare organisations and the pharmaceutical industry. The other authors have no competing interests.

Despite improvement of mental health outcomes over the last years in Tunisia, there are still striking rural-urban mental health inequalities.

The aim of this study is to evaluate the rural-urban differences in accessing mental health care among patients with psychiatric disorders

A cross sectional and descriptive survey was conducted between March and April 2021 in the department of psychiatry D of Razi Hospital including 70 patients admitted or treated as outpatients. The sex ratio was 1.

The participants were aged between 17 and 68. About 11.42% came from rural areas. In these areas, 75% percent had low income versus 30.64% in urban areas. (p=0.047) The percentage of celibacy in urban areas was 68.85% versus 37.5% in rural areas (p=0.042) No significant difference was observed between the level of education and living in rural or urban areas. There was no association between rural or urban origin and number of admissions or treatment adherence or use of cannabis. The mean time between symptoms onset and consulting was 8.51 years in rural areas versus 2 years in urban areas. Moreover, time between symptoms onset and admission was significantly associated with rural or urban origin (p=0.045). The mean duration was 13,33 years (±10) in rural areas versus 3.12 years (±4.13).

Families living in urban areas had better income and would come to psychiatric hospital earlier. Therefore, we should help patients in rural areas access to mental health facilities for a better medical care.

No significant relationships.

Decision Support Systems (DSS) are appropriate tools for guiding policymaking processes in Mental Health (MH) management, especially where a balanced and integrated care provision is required.

To assess the performance of a MH ecosystem for identifying benchmark and target-for-improvement catchment areas according to the Balanced Care model.

The MH provision, distinguishing inpatient, day and outpatient main types of care, has been assessed in the Mental Health Network of Gipuzkoa (Basque Country, Spain) using a DSS, integrating Data Envelopment Analysis, Monte-Carlo Simulation and Artificial Intelligence. 13 catchment areas, defined by a reference MH centre, are the units (universe) for the analysis. The indicators for MH ecosystem performance were: relative technical efficiency, stability and entropy, for identifying both benchmarking and target-for-improvement areas. The analysis of the differences between the two groups can be used to design organizational interventions.

The Mental Health Network of Gipuzkoa showed high global efficiency scores, but it can be considered statistically unstable (small changes in variable values can have relevant impacts on its performance). For a global performance improvement, it is recommended to reduce admissions and readmissions in inpatient care, increase workforce capacity and utilization of day care services and, finally, increase the availability of outpatient care services.

This research offers a guide for evidence-informed policy-making to improve MH care provision in the main types of care and provide aftercare. The characteristics of the area to be improved are critical to design interventions and assess their potential impact on the MH ecosystem.

No significant relationships.

As mental health and emotional wellbeing while serving a sentences contribute a lot to the successful resocialization of juvenile convicts, it is necessary to study the factors that influence them.

To consider the relationship between the subjective frequency of social support from various sources and indicators of mental health and well-being of juvenile convicts.

The study used DASS (Lovibond, Lovibond, 1995), WEMWBS (Tennant et al., 2007), PANAS (Watson, Clark, Tellegen, 1988), SPANE (Diener et al., 2010), and a question to measure the subjective frequency of seeking for support from different sources (parents, close relatives, friends, mentors, psychologists, other convicts etc.), as measured on a 4-point scale from 1 (never) to 4 (constantly). 657 juvenile convicts aged 15 to 18 (M=17.0; SD=0.8) took part in the study.

Regression models (R>0.5) were obtained by means of regression analysis (frequencies of seeking for support from different sources were taken as independent variables). The declared frequency of seeking for support from mentors served as a predictor of psychological well-being (Beta 0.148, t=2.271; p=0.024), the level of depression (Beta=-0.193, t=-2.917; p=0.004), anxiety (Beta=-0.157, t=-2.365; p=0.018) and stress (Beta=-0.142, t=-2.136; p=0.033), as well as of negative experience (Beta=-0.202, t=-3.025; p=0.003). The declared frequency of seeking suppotr from psychologists predicted the level of positive experience (Beta=0.128, t=2.052; p=0.041) and of positive affects (Beta=0.145, t=2.259; p=0.024).

Mental health, well-being and emotional state of juvenile convicts are directly related to the perception of the frequency of seeking support from the employees of the correctional camps (mentors and psychologists).

No significant relationships.

Mental Health is an invisible part of public health, and a determinant of it by affecting the human, social and economic capital of countries. Is one of the main causes of disability worldwide and, when left untreated, they can lead to increased costs and premature mortality. In 2019 they represented 22% of the disability burden in DALY in the European Union. Regarding the effects of economic recessions studies suggest that they have detrimental effects on mental health. And can became a reality in the current pandemic scenario.

To reflect on the studies carried out that debate the effects of previous economic crises on mental health, particularly the 2008-2013 crisis. It aims to list not only the possible intervention strategies in the area as well as the barriers to their implementation.

Classic review of the topic through the international literature and the state of the art on available platforms. Establish a proxy between the unemployment rate and the number of packages (antidepressants and anxiolytics consumed) in homologous periods as a representative capacity of the impact of the crisis on mental health.

The number of packages of antidepressants and anxiolytics behave differently. the antidepressants have greater consumption when unemployment decreases.

Several studies describe that the increase in the unemployment rate, indebtedness and social exclusion are empirically proven as consequences of the economic crises and predisposing factors for mental pathology. However, this does not translate into a proxy for the consumption of antidepressant packages with the increase in the unemployment rate. It may be due to the non-prioritization of mental health.

No significant relationships.

Mental illness is the single largest cause of disability in the UK, with one in four individuals suffering from a mental health problem. Despite this, only 13% of the NHS budget goes towards treatment of mental illness. It is thus unsurprising that addressing the parity of esteem of mental health has been highlighted as a major priority for the healthcare system, with the NHS Five Year Forward plan aiming to achieve this by 2020.

To explore the barriers to achieving parity of esteem of mental healthcare in the UK and develop recommendations for implementation.

Narrative review of literature and synthesis of findings

Three key barriers to achieving parity of esteem of mental health were identified: the current mental health investment standard (MHIS), medical sub-specialisation, and access to acute day units (ADU). The following recommendations were thus synthesised: to increase the time-period to measure MHIS increments, integrating mental health teaching into specialty training programmes, and increasing the availbility of ADUs to crisis referral teams.

Addressing the disparity between mental and physical health is a major priority for the NHS. This research provides an overview of current barriers and suggests recommendations for improvement. By prioritizing improvement in the MHIS, integrating mental health teaching into specialty training, and increasing access to ADUs, the NHS formulates an excellent founding to achieving the ultimate goal, parity of esteem of mental health.

No significant relationships.

Low parental income during childhood is associated with increased risk of mental disorders at later ages. However, despite a disproportionate share of migrant children growing up in persistent poverty, as compared to their majority counterparts, the research on whether the association varies by migrant background is limited.

Is there an association between parental income during early childhood and the risk of mental disorder, defined by use of outpatient mental healthcare services (OPMH), in adolescence and early adulthood? Does the strength of the association vary by migrant background?

Information from five national registers were combined to study a population of 577,072 individuals. We applied discrete-time logistic regression, with an interaction term between parental income and migrant background to study differences in the association by migrant background.

Low parental income during early childhood was associated with twice the odds of OPMH use in adolescence and early adulthood compared to individuals with higher parental income. Even after adjusting for a range of covariates the association remained significant, yet, weaker. The association was, however, in the opposite direction for migrants. Those in the higher income group had higher probability of OPMH use. The relative differences within groups were small, but significant for migrants from Middle East and North Africa, South Asia and Western countries.

Social inequalities in mental health may have an onset already in childhood, Therefore, future interventions should focus on reducing social inequalities in childhood in order to improve the mental health in young people.

No significant relationships.

We live in a global world, where immigration is no longer just an escape, but also a demand and a desire. Globalization imposes the challenge of recognizing psychiatric illness in the most diverse of patients.

To review the literature about the documentation of ethnic differences and the psychotic symptoms presentation.

We performed a MEDLINE search using the key words: ethnic differences and psychotic symptoms. We only included studies with full text published in English.

Since the 1970s, some studies have shown that there are differences in the manifestation of psychiatric illness in ethnic minorities. Most recent studies confirm this statement, mainly with an increase in immigration in the 20th century, with the receiving countries having an increase in the number of cases of psychosis (affective and non-affective). Belonging to an ethnic minority increases the risk of psychotic symptoms and experiences, witch is related to the patients perception of discrimination, social differences, family separation and the stress associated with immigration. On the other hand, these groups also have less access to health care.

Currently, professionals are more aware of the global world and what this implies in the manifestations of psychiatric illnesses. However, more studies will be needed to identify these natural differences. In this way, we will be able to help our patients anywhere and support their families.

No significant relationships.

Currently, there is scientific evidence supporting the relationship between socio-environmental factors and the onset of a first episode of psychosis (FEP). In this context, the phenomenon of migration, seen as a negative life experience, may become an important risk factor in developing a psychotic disorder (PD). In Europe, the impact of this phenomenon is growing and, therefore, it’s necessary to provide a proper answer to these individual’s mental health problems.

Identify which phases of this migration process are most important in the development of a FEP and what are the more significant socio-environmental factors in each phase.

Bibliographic research in Pubmed database using the terms “Migration” and “First Episode Psychosis”.

Research confirms that migrants have a 2 to 3-fold increased risk of developing a PD. This risk will be even higher in the refugee population. Pre- and post-migration factors demonstrated to be more important than factors related with the migration process itself. In the pre-migration phase highlight factors like the lower parental social class and a previous trauma. In the post-migration phase highlight factors like discrimination, social disadvantage and a mismatch between expectations and reality.

Literature is unanimous in considering migrant status as an independent risk factor for the development of FEP, possibly due to the outsider’s role in society. Thus, despite the growing interest in Biological Psychiatry, this work demonstrates that socio-environmental factors are very preponderant in the development of these disorders and because of that further investigation is still necessary.

No significant relationships.

The shortage of doctors has become a worrying problem in Tunisia. It is influenced by the phenomenon of immigration which remains poorly studied despite its magnitude.

To describe the migration intentions of Tunisian young doctors and to identify the associated factors that influence their decisions.

This is a cross-sectional, analytical survey conducted between January and June 2019. It included all young doctors practicing in academic hospitals of Sousse (Tunisia). Data collection was based on a standardized self-administered questionnaire.

A total of 182 valid questionnaires were collected. The median age was 26.9±2.5 years and the sex-ratio was 0.47. Immigration projects were reported by 38.5% of participants. The main destination was France (36.3%%). The main contributing factors were marital status (p<10-3), resident status (p=0.002), surgical specialty (p<10-3), personal dissatisfaction (p=0.003), underpayment (p<10-3), workload and difficult work conditions (p<10-3), lack of appropriate training (p<10-3), financial crisis and economic instability (p<10-3), lack of a clear strategy for the healthcare system (p=0.005) and the impression by the model of other doctors who left Tunisia (p=0.01).

The rate of migration intentions expressed in this study highlights the emergent need of interventions emanating from the Tunisian health-care system’s problems in order to stop the flow of young doctors towards developed countries in quest of better conditions.

No significant relationships.

Research on the prevalence of and risk factors for insomnia among refugee populations is limited and tends to focus on pre-migratory trauma. Yet, post migratory stressors are just as important for mental health and may also relate to insomnia.

Objective: To determine the association between different post-migration stressors and insomnia among Syrian refugees living in Norway.

We used data from the REUFGE study, a cross-sectional survey with 902 Syrian refugees who arrived in Norway between 2015 and 2017. Insomnia was measured with the Bergen Insomnia Scale and post-migrant stress with the Refugee Post-Migration Stress Scale (RPMS). We applied logistic regression analyses to investigate the association between seven different postmigration stressors and insomnia after controlling for demographics, traumatic experiences and post traumatic stress symptoms.

Of the 873 participants who completed questions on insomnia, 515 (41%) reported insomnia. There was no significant difference between men and women. The most commonly reported postmigration stressors were Competency Strain [SML1], Family and Home Concerns, and Loss of Home Country. After controlling for demographics, traumatic experiences and post-traumatic stress symptoms, Financial Strain, Loss of Home Country, Family and Home Concerns and Social Strain were still associated with higher odds of insomnia.

Resettlement difficulties are related to poorer sleep among refugees. Measures to improve the social conditions and financial concerns of refugees in receiving countries could potentially reduce insomnia among refugees which in turn, may benefit mental and physical health.

No significant relationships.

Migratory flows are increasing more and more, especially regarding the refugee crisis during the last years. There are around 86,7 million migrants in Europe. Migrants share similar experiences that may affect their physical and mental health, such as loss of a social network, lack of economical support or high levels of stress and discrimination.

To analyze the obstacles that migrants must face to obtain a mental health assistance and the importance of an intercultural approach.

A narrative review of the existing literature on the subject.

Although there exists evidence that shows that migrants tend to have more health needs, they usually seek less medical advice and receive a poor-quality attention, fulfilling the inverse-care law. This is due to several reasons. Many migrants are excluded of the health care system due to bureaucratic impediments. Also, the language has a determining role, since a higher quality of communication could lead to a better understanding of the symptoms, reducing the risk of erroneous evaluations. Besides, different background and culture between the patient and the doctor can result in lack of communication, mistrust, mistreatment, poor adherence, and worse prognosis.

Despite the exponential growth of migration in the last decade and the continue progression, migrants still face many barriers to receive healthcare. It is necessary to do more research on the mental health of migrants and ethnic minorities to ensure quality care to different cultures.

No significant relationships.

Cultural syndromes are pathologies that cannot be understood outside the cultural or subcultural context of the person who suffers from it, since both their etiology and symptoms are symbolized by the patient and by the environment in fields of significance inherent to their culture. The globalization process in which we are involved affects the presentation, understanding, diagnosis and treatment of cultural syndromes as they were traditionally understood.

The objective of this work is to review the current state of cultural syndromes, the evolution of incidence and prevalence in recent years, as well as whether the globalization process has affected their understanding.

A bibliographic review has been carried out on cultural syndromes and case reports in both endemic and foreign populations. Likewise, a reflection is made on the possible evolution of these syndromes.

Globalization has been understood as a natural process of integration of nations and their cultures, incorporating the diversity and specificity of the other without forgetting their own and traditional characteristics. Within the globalization process, positive advances in the health area are recognized, specifically in the fields of communication and biotechnology. However, the negative impact of globalization on the daily life and health of people worldwide is undeniable. Those that are economically most disadvantaged are particularly affected. The cases of cultural syndromes in distant countries, the misunderstanding of the symptoms as well as the difficulties of integration of migrant patients with mental suffering must be the object of debate and study.

Globalization affects the care and understanding of mental health

No significant relationships.

European researchers have observed that psychosis is 3 times more frequent in immigrants than in native-born subjects.

our study aims to determine the sociodemographic characteristics of immigrants hospitalized for first episode of psychosis (FEP)

it’s is a descriptive retrospective study. 21 files were recruited from the psychiatry department archive. Only files of immigrant patients hospitalized, during the period between 2016 to 2021, for FEP and with neither personal nor family medical history of psychosis were included in our study.

A total number of 11 patients was included in our study. The analyse of sociodemographic characteristics revealed that; 62.5% of patients were female. The average age was 31 years. About half of them were dark skinned (particularly African), 25% were divorced, and 75% having university level. The majority of cases, have had a clandestine access to Tunisia, and were either unemployed or doing cleaning tasks with a low economic level and frequent conflicts in their workplaces. The average period between entering Tunisia and the onset of symptoms was 11.375 months.

A comparative study on a larger sample would be beneficial in order to determine the risk factors for psychosis in immigrants and, consequently, leads to effective preventive measures.

No significant relationships.