Leadership in Mental Healthcare: Emerging National and Global Challenges

This edition of the journal considers the important need for leadership among the medical community in delivering mental healthcare agendas both nationally and on the international stage. Several emerging challenges facing mental health services are highlighted in this issue including the increasing prevalence of novel psychoactive substance use, and the need for integration of care across mental health services. Global challenges such as a further examination of mental health issues related to the COVID-19 pandemic, and the impact of war and conflict on mental health in children are also examined.

The Mindspace Mayo service, an Irish community-based brief intervention service for young people with mental health problems, is evaluated by Corley and colleagues (pp.). They found that clinical outcomes were improved following a brief intervention of therapeutic support, although a limitation was the lack of a control group within the service evaluation. In another paper relevant to youth mental health Boonstra and colleagues (pp.) evaluate the patient experience of turning 18 while attending mental health services. The authors present a thematic analysis of semi-structured interviews conducted among people aged 18-24 years. Deficiencies in preparation for transition to a new service and a lack of communication between services are reported as key themes. The authors suggest potential pathways to integrate psychiatric services for this important transition point in the life cycle.

Keeping with the theme of mental health services in young people, the paper by Bond and colleagues (pp.) on sleep problems in a specialist child and adolescent ADHD service found that 84% of participants scored above the clinical threshold for a sleep disorder. Greater sleep problems were associated with increased ADHD severity, but sleep problems were not significantly associated with other co-morbid mental health problems or stimulant use. The findings highlight the need for effective ADHD treatment to improve sleep problems in this population, as well as the importance of addressing sleep problems to improve ADHD symptoms.

Synthetic and semisynthetic cannabinoids are posing novel challenges for psychiatric services with limited testing available and only an evolving understanding of their psychiatric consequences. A case series by O’Mahony and colleagues (pp.) details two instances of psychosis possibly induced by the novel semisynthetic compound Hexahydrocannabinol (also known as HHC), which has been recently available legally in Ireland.

A systematic review by Jacinto et al., (pp.) reports the most comprehensive review of the incidence of psychotic disorders in Ireland to date. Data spanning 40 years indicates that the incidence of psychosis in Ireland is relatively consistent with international literature in other countries. The pooled incidence of schizophrenia was 20 per 100,000 person-years (95% CI: 10.6-37.5), while the incidence of all psychotic disorders based on 4 previous studies varied from 22 per 100,000 person-years (95% CI: 17.3-28) in Dublin to 34.1 per 100,000 person-years (95% CI: 31-37.5) in Cavan and Monaghan. The higher incidence in more deprived and fragmented social environments is a reminder of the need for resourcing in certain demographic areas. Of interest, there was no clear difference between urban and rural environments, although it is notable that psychosis incidence studies have not been conducted widely throughout Ireland.

Crisis resolution home treatment teams (CRHTT) are a developing component of psychiatric services for patients presenting in crisis. Although limitations in the study by Crowley and colleagues (pp.) were acknowledged, the research found that inpatient admissions were reduced by 38.5% following the introduction of CRHTT, highlighting the potential benefits to delivering care with this type of service.

Another type of service that has been developed in parts of Ireland, dialectical behaviour therapy (DBT), is recognised as an effective but resource intensive therapy which can restrict its availability. The perspective piece by Joyce and colleagues (pp.) looks at the long-term sustainability of DBT programmes. They suggest that systemic issues in DBT programmes such as staffing and limited availability of training are associated with decreased sustainability over time. Programmes were also noted to frequently fail in the early years, while those lasting five years were likely to be more sustainable in the long run.

The theme of COVID-19 papers is continued in this edition, particularly how individuals with certain mental illnesses may have been more severely impacted by the pandemic. The paper by O’Gorman and colleagues (pp.) demonstrates the substantial impact of COVID-19 on individuals with emotionally unstable personality disorder. Qualitative data in this paper suggests that there were challenges related to the reduction in mental health services during the pandemic, while the discontinuation of COVID-19-mandated restrictions had a positive impact for some.

An interesting survey by Khan and colleagues (pp.) highlights the negative effect which COVID-19 had on individuals with eating disorders. A further interesting article by Mannix and colleagues (pp.) analysing the prevalence of probable suicide for two years pre- and post-COVID-19 found no change in rates of or methods employed by individuals who died by probable suicide in a region in the west of Ireland.

The editorial for this edition by Twohig and colleagues (pp.) considers the increasingly relevant issue of war and its impact on the mental health of children. The authors consider this from the perspective of John Bowlby’s attachment theory, arguing for the importance of policymakers to consider the influence of global political events on disruption to attachment in children. This editorial and this issue in general emphasise the need for medical leadership in highlighting important issues both nationally and on the global stage.