WHO declared that mental health care should be considered one essential health service to be maintained during the coronavirus disease 2019 (COVID-19) pandemic. This study aims to describe the effect of lockdown and restrictions due to the COVID-19 pandemic in Italy on mental health services’ utilisation, by considering psychiatric diagnoses and type of mental health contacts.

The study was conducted in the Verona catchment area, located in the Veneto region (northeastern Italy). For each patient, mental health contacts were grouped into: (1) outpatient care, (2) social and supportive interventions, (3) rehabilitation interventions, (4) multi-professional assessments, (5) day care. A ‘difference in differences’ approach was used: difference in the number of contacts between 2019 and 2020 on the weeks of lockdown and intermediate restrictions was compared with the same difference in weeks of no or reduced restrictions, and such difference was interpreted as the effect of restrictions. Both a global regression on all contacts and separate regressions for each type of service were performed and Incidence Rate Ratios (IRRs) were calculated.

In 2020, a significant reduction in the number of patients who had mental health contacts was found, both overall and for most of the patients’ characteristics considered (except for people aged 18–24 years for foreign-born population and for those with a diagnosis of schizophrenia. Moreover, in 2020 mental health contacts had a reduction of 57 096 (−33.9%) with respect to 2019; such difference remained significant across the various type of contacts considered, with rehabilitation interventions and day care showing the greatest reduction. Negative Binomial regressions displayed a statistically significant effect of lockdown, but not of intermediate restrictions, in terms of reduction in the number of contacts. The lockdown period was responsible of a 32.7% reduction (IRR 0.673; p-value <0.001) in the overall number of contacts. All type of mental health contacts showed a reduction ascribable to the lockdown, except social and supportive interventions.

Despite the access to community mental health care during the pandemic was overall reduced, the mental health system in the Verona catchment area was able to maintain support for more vulnerable and severely ill patients, by providing continuity of care and day-by-day support through social and supportive interventions.

Care needs represent an essential paradigm in planning residential facility (RF) interventions. However, possible disagreements between users and staff are critical issues in service delivery. The Experience Sampling Method (ESM) tracks experiences in the real world and real time. This study aimed to evaluate the care needs of patients with schizophrenia spectrum disorder (SSD) in RFs and its association with daily activities and mood monitored using the ESM.

As part of the DIAPASON project, 313 residents with SSD were recruited from 99 Italian RFs. Sociodemographic and clinical characteristics were recorded. Care needs, the severity of symptomatology and negative symptoms were assessed. Fifty-six residents were also assessed for 7 consecutive days using the mobile ESM. Descriptive, agreement, predictor and moderator analyses were conducted.

The staff rated a higher number of total and met needs than service users (p < 0.001). Only a slight agreement between users and staff on unmet needs was found in self-care (k = 0.106) and information (k = 0.100) needs, while a moderate agreement was found in accommodation (k = 0.484), food (k = 0.406), childcare (k = 0.530), physical health (k = 0.470), telephone (k = 0.458) and transport (k = 0.425) needs. Older age (−0.15; p < 0.01), longer SSD diagnosis (−0.16; p < 0.01), higher collaboration (−0.16; p < 0.01) and lower symptomatology (−0.16; p < 0.01) decreased the number of unmet needs, while being a female (0.27; p < 0.05) and a shorter length of stay in an RF (0.54; p < 0.001) increased the number of unmet needs. A higher number of unmet needs was associated with a lower amount of time spent in leisure activities or reporting a positive mood: on the contrary, more unmet needs were associated with a greater amount of time spent in religious or non-productive activities. The associations between unmet needs rated by staff and users and momentary mood as assessed using the ESM were not moderated by the severity of symptomatology.

Although care needs are fundamental in planning residential activities aimed at recovery-oriented rehabilitation, RF interventions did not fully meet users' needs, and some disagreements on unmet needs between users and staff were reported. Further efforts are necessary to overcome Italian RF limits in delivering rehabilitative interventions defined by real users' needs to facilitate users' productivity and progress towards personal recovery.

To summarize reports describing implementation and evaluation of Web-based psychosocial interventions for disaster-related distress with suggestions for future intervention and research, and to determine whether a systematic literature review on the topic is warranted.

Systematic searches of Embase, PsycINFO, and MEDLINE were conducted. Duplicate entries were removed. Two rounds of inclusion/exclusion were conducted (abstract and full-text review). Relevant data were systematically charted by 2 reviewers.

The initial search identified 112 reports. Six reports, describing and evaluating 5 interventions, were included in a data analysis. Four of the 5 interventions were asynchronous and self-guided modular programs, with interactive components. The fifth was a short-term, online supportive group intervention. Studies utilized a variety of evaluation methods, and only 1 of 14 outcome measures used across the studies was utilized in more than 1 project.

Several Web-based psychosocial interventions have been developed to target disaster-related distress, but few programs have been formally evaluated. A systematic review of the topic would not be recommended at this time due to heterogeneity in reported studies. Further research on factors impacting participation, generalizability, and methods of program delivery with consistent outcome measures is needed.

The aim of this paper is to present a novel case for the formation, operation and evaluation of a community advisory aboard comprised of Muslims residing in the San Francisco Bay Area, California that utilised a community based participatory approach to address local Muslim mental health needs. The CAB was recruited in partnership with the Muslim Community Association (MCA), one of the largest Islamic centres in the San Franscisco Bay Area. In addition to describing the development of the CAB, the authors present the findings of the evaluation and synthesis of best processes based on CAB members' feedback.

To evaluate the perceived community advisory board members' perceptions of their roles and elicit feedback on how to enhance the relationship between the university team and the CAB, an evaluation was conducted by an independent team who was not part of the research process. Data was collected using anonymous individual surveys and small group open discussions that were conducted over three evaluation meetings. The evaluation utilised mixed method data collection strategies using questions from Schulz et al. (2003, Evaluation and Program Planning 26, 249–262), an instrument for evaluating dimensions of group dynamics within CBPR partnerships.

Results of the evaluation within the sphere of CAB operation indicated that CAB members found the greatest satisfaction from their contributions through direct participation in the research activities that were conducted by the university-CAB team. The collective responses indicated that most CAB members were satisfied with trust built between the university-CAB team and the diversity represented in the members of the board. However, given that the Bay Area is home to a very diverse Muslim community, challenges in recruiting representatives that account for all possible self-identifying groups was reported by the CAB with recommendations to recruit religious leaders. Recommendations also included eliciting funds for potential financial compensation for CAB members.

The Stanford-San Francisco Bay Area CAB demonstrated that empowering community members through direct participation, creating channels and safe spaces for feedback help create community rooted research that carry the true voices of marginalised communities and reflects their evolving needs

Not only is nature essential for human existence, but many of its functions and contributions are irreplaceable. Studying the impact of these changes on individuals and communities, researchers and public health officials have largely focused on physical health. Our aim is to better understand how climate change also exacerbates many social and environmental risk factors for mental health and psychosocial problems, and can lead to emotional distress, the development of new mental health conditions and a worsening situation for people already living with these conditions.

We considered all possible direct and indirect pathways by which climate change can affect mental health. We built a framework which includes climate change-related hazards, climate change-related global environmental threats, social and environmental exposure pathways, and vulnerability factors and inequalities to derive possible mental health and psychosocial outcomes.

We identified five approaches to address the mental health and psychosocial impacts of climate change which we suggest should be implemented with urgency: (1) integrate climate change considerations into policies and programmes for mental health, to better prepare for and respond to the climate crisis; (2) integrate mental health and psychosocial support within policies and programmes dealing with climate change and health; (3) build upon global commitments including the Sustainable Development Goals, the Paris Agreement and the Sendai Framework for Disaster Risk Reduction; (4) implement multisectoral and community-based approaches to reduce vulnerabilities and address the mental health and psychosocial impacts of climate change; and (5) address the large gaps that exist in funding both for mental health and for responding to the health impacts of climate change.

There is growing evidence of the various mechanisms by which climate change is affecting mental health. Given the human impacts of climate change, mental health and psychosocial well-being need to be one of the main focuses of climate action. Therefore, countries need to dramatically accelerate their responses to climate change, including efforts to address its impacts on mental health and psychosocial well-being.

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.

People diagnosed with a severe mental illness (SMI) are at elevated risk of dying prematurely compared to the general population. We aimed to understand the additional risk among people with SMI after discharge from inpatient psychiatric care, when many patients experience an acute phase of their illness.

In the Clinical Practice Research Datalink (CPRD) GOLD and Aurum datasets, adults aged 18 years and older who were discharged from psychiatric inpatient care in England between 2001 and 2018 with primary diagnoses of SMI (schizophrenia, bipolar disorder, other psychoses) were matched by age and gender with up to five individuals with SMI and without recent hospital stays. Using survival analysis approaches, cumulative incidence and adjusted hazard ratios were estimated for all-cause mortality, external and natural causes of death, and suicide. All analyses were stratified by younger, middle and older ages and also by gender.

In the year after their discharge, the risk of dying by all causes examined was higher than among individuals with SMI who had not received inpatient psychiatric care recently. Suicide risk was 11.6 times (95% CI 6.4–20.9) higher in the first 3 months and remained greater at 2–5 years after discharge (HR 2.3, 1.7–3.2). This risk elevation remained after adjustment for self-harm in the 6 months prior to the discharge date. The relative risk of dying by natural causes was raised in the first 3 months (HR 1.6, 1.3–1.9), with no evidence of elevation during the second year following discharge.

There is an additional risk of death by suicide and natural causes for people with SMI who have been recently discharged from inpatient care over and above the general risk among people with the same diagnosis who have not recently been treated as an inpatient. This mortality gap shows the importance of continued focus, following discharge, on individuals who require inpatient care.

An early and prolonged lockdown was adopted in Argentina during the first wave of COVID-19. Early reports evidenced elevated psychological symptoms.

To explore if the prolonged lockdown was associated with elevated anxiety and depressive symptoms; if mental fatigue was associated with lockdown adherence (a phenomenon called ‘behavioural fatigue’); and if financial concerns were associated with lockdown adherence and emotional symptoms.

The survey included standardised questionnaires to assess depressive (PHQ-9) and anxious (GAD-7) symptoms, mental fatigue, risk perception, lockdown adherence, financial concerns, daily stress, loneliness, intolerance to uncertainty, negative repetitive thinking and cognitive problems. LASSO regression analyses were carried out to predict depression, anxiety and lockdown adherence

The survey reached 3617 adults (85.2% female) from all provinces of Argentina after 72 days of lockdown. Data were collected between 21 May 2020 and 4 June 2020. In that period, Argentina had an Oxford stringency index of 85/100. Of those surveyed, 45.6% and 27% met the cut-offs for depression and anxiety, respectively. Mental fatigue, cognitive failures and financial concerns were correlated with psychological symptoms, but not with adherence to lockdown. In regression models, mental fatigue, cognitive failures and loneliness were the most important variables to predict depression, intolerance to uncertainty and lockdown difficulty were the most important for anxiety, and perceived threat was the most important for predicting lockdown adherence.

During the extended lockdown, psychological symptoms increased, being enhanced by mental fatigue, cognitive difficulties and financial concerns. We found no evidence of behavioural fatigue. Thus, feeling mentally fatigued is not the same as being behaviourally fatigued.

Lebanon is a medium-income country in the Eastern Mediterranean which has seen a surge in interest in mental health following years of stagnation. The mental health needs of the country for severe psychiatric disorders are underserved.

The aim of our study is to describe community mental healthcare services in Lebanon and to address local opportunities and challenges.

A review of the literature using local resources along with expert opinion was undertaken to synthesize the evidence.

Political instability, chronic underfunding and widespread stigma have contributed to maintaining a traditional model of private clinics affiliated with inpatient and long-stay psychiatric units. A number of initiatives have been launched to cater for patients with psychotic disorders and to offer partial hospitalization for others with mood-related conditions. In parallel, the Ministry of Public Health, with international funding, has been instrumental in efforts to standardize care at a national level, particularly for early detection and treatment in primary care. The priorities of the national mental health programme are consistent with the global trend in shifting services to the community. Hurdles remain, in line with those facing countries with similar socio-demographics and resources. These include limited third-party coverage of mental health, absence of training opportunities in multidisciplinary community settings and some clinicians’ reluctance to update their ways of working.

Development of a local workforce dedicated to providing a patient-centred approach in the least restrictive settings, is essential for consolidating community care in Lebanon. This would be reinforced by (overdue) legislation and implementation of a mental health law.

Psychosocial rehabilitation is a challenge in a society with demands unsuitable for those with severe mental illness (SMI). The Mental Health Department of Matosinhos Local Health Unity (MHD-MLHU) has developed a solidarity project aiming to evaluate and elaborate individualized rehabilitative responses with people with SMI, including people from the community motivated for solidarity initiatives.

To describe a psychosocial rehabilitation project focused on community integration of people with SMI, considering needs and resources of the population, and to present the individualized rehabilitation plans carried out for people with SMI.

In January 2019, we began the home evaluation of people with SMI monitored in the MHD-MLHU. To develop solidary based play-occupational groups, we interviewed people from the community and from the common mental pathology outpatient clinic willing to participate.

We present the description and evaluation of the psychosocial responses developed by the project. These responses include recreational-occupational groups, tailored to interests of each person with SMI, and using the community support group built for the purpose. These responses promote face-to-face activities, and enhance the destigmatization of SMI. The constraints resulting from the COVID-19 pandemic led to the creation of digital responses aimed at people with SMI and the community in general.

This experience has revealed the great potential of rehabilitating the community context of people with SMI, rather than just contemplating pre-existing structured responses. The pandemic created specific challenges but made the initiative even more relevant for SMI people and for promoting the mental health of the general population.

On August 4th 2020, a massive port explosion shook Beirut, killing at least 200, injuring more than 6,000 people and leaving more than a quarter of a million living in unfit homes. Various factors can participate in the severity of mental health outcomes of a disaster including the number of injuries, the degree of property destruction, unexpectedness of the occurrence of the event, and the type of the disaster.

The main aim of this study is to assess the prevalence of post-traumatic stress disorder (acute stress disorder) and major depression at 1 and 6 months following the Beirut explosion. The secondary aim is to determine predictors of PTSD incidence among civilians and relief workers affected by the disaster.

This is a cross-sectional study with data collected via an online survey through convenience sampling. People will be recruited via social media platforms. To achieve a power of 80% and a two-sided significance of 5% and because gender differences will be explored, assuming a design effect (deff) of 2.5, a minimum sample of 960 participants would be needed. The survey will include sociodemographic data, questions about exposure levels to trauma and a psychiatric symptom inventory. Pearson’s Chi Square test will be used to examine the association between categorical variables and regression models will be run to examine the associations while controlling for confounders, including age, gender and others.

The results from both rounds of data collection (months 1 and 6) will be available in late March 2021.

to follow based on results

No significant relationships.

For the first time in N. Macedonia we had the experience to include peer workers as an equal members in the newly formed community mental health teams. For the purpose of the RECOVER-e project we engaged 2 patients to be the new peer workers.

To evaluate the initial period of peer worker involvement in the community mental health teams and to identify the next steps for them.

Conducting interviews with the peer workers.

One important aspect that is worth mentioning is their motivation to continue their work in the community mental health teams and continue to improve. Another finding is their will to establish a user led organisation. A user led organisation in the field of mental health in our country is rare to be find, with only a couple of them functioning in N. Macedonia. So if our peer workers can make it, it would be a great step in the right direction.

Overall, taking into consideration all that the peer workers have achieved in the last period, including the ups and downs of being the first official peer workers in N. Macedonia, they are looking forward to improve their knowledge and continue building their practical experience. A great plus of it all is that they have a financial stability for this troubled pandemic period.

No significant relationships.

The National Mental Health Survey of India 2015-16 (Gururaj et al., 2016) indicated a large treatment gap of 70-92% for mental disorders and a paucity of mental health specialists in the country. In order to address this treatment gap and develop human resources, the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India, with impetus from the Ministry of Health and Family Welfare, Govt. of India, launched the online course of Diploma in Community Mental Health for Psychologists.

The course was designed with the objective of training individuals with a Master’s Degree in Psychology, in providing first-level psychological care in the community.

The course is a 3-month online programme comprising of approximately 25 hours of self-paced e-learning and 11 hours of live real-time interactive discussion via video conference. The course comprises of 6 modules, with an assessment at the completion of each module. Pre- and Post-Assessment is conducted to evaluate competencies achieved.

On successful completion of the course, trainees are expected to have achieved competencies to: Screen for and identify mental health problems in adults and children, and understand factors influencing them; Understand management options; Conduct interview-based functional developmental assessment for intellectual deficits; Conduct first-level brief psychosocial interventions; Make appropriate referrals to Mental Health Professionals and other health professionals.

This digitally-driven online course is a viable option for development of human resources on a large scale, in a resource-scarce (i.e. of mental health specialists) country such as India.

No significant relationships.

Social isolation in people living with schizophrenia is associated with poor quality of life and increased symptom severity. Volunteer befriending interventions are a potential strategy for addressing social isolation, but evidence of their effectiveness is limited, particularly in low- and middle-income countries. We assessed the experiences of volunteer befriending and tested its effectiveness for improving the quality of life of patients with schizophrenia in Bosnia and Herzegovina.

Between March 2018 and July 2020, we conducted a parallel-group, randomised controlled trial in adults with schizophrenia and poor quality of life at an outpatient clinic in Sarajevo. Patients were randomised to either the intervention, in which they were matched with a volunteer befriender with whom they met fortnightly over the 6-month intervention period, or treatment as usual. The primary outcome was quality of life measured on the Manchester Short Assessment and secondary outcomes were psychiatric symptoms and objective social outcomes. Outcome measurement was conducted by blinded researchers at 6- and 12-months.

In total, 65 patients were randomised into the intervention (n = 33) and control arms (n = 32) and 55 (85%) completed follow-up assessments at 6 months. Patients in the intervention showed a significantly more favourable quality of life at 6 months (primary outcome; mean difference: 0.7, 95% CI [0.3–1.1], p = 0.003) and 12 months (mean difference: 1.7, 95% CI [1.1–2.3], p < 0.001). They also had significantly lower symptom levels at both follow-ups, and a significantly more favourable objective social situation after 12 months. Participants reported largely positive experiences.

The exploratory trial conducted at one site found sustained improvements in quality of life and reductions in psychiatric symptoms. This suggests that volunteer befriending may be a feasible and effective treatment for patients with schizophrenia in resource-limited contexts, such as Bosnia and Herzegovina.