Autistic people have a high likelihood of developing mental health difficulties but a low chance of receiving effective mental healthcare. Therefore, there is a need to identify and examine strategies to improve mental healthcare for autistic people.

To identify strategies that have been implemented to improve access, experiences of care and mental health outcomes for autistic adults, and to examine evidence on their acceptability, feasibility and effectiveness.

A co-produced systematic review was conducted. MEDLINE, PsycINFO, CINHAL, medRxiv and PsyArXiv were searched. We included all study designs reporting acceptability or feasibility outcomes and empirical quantitative study designs reporting effectiveness outcomes. Data were synthesised using a narrative approach.

A total of 30 articles were identified. These included 16 studies of adapted mental health interventions, eight studies of service improvements and six studies of bespoke mental health interventions developed for autistic people. There was no conclusive evidence on effectiveness. However, most bespoke and adapted approaches appeared to be feasible and acceptable. Identified adaptations appeared to be acceptable and feasible, including increasing knowledge and detection of autism, providing environmental adjustments and communication accommodations, accommodating individual differences and modifying the structure and content of interventions.

Many identified strategies are feasible and acceptable, and can be readily implemented in services with the potential to make mental healthcare more suitable for autistic people, but important research gaps remain. Future research should address these and investigate a co-produced package of service improvement measures.

Stakeholders worldwide increasingly acknowledge the need to address coercive practices in mental healthcare. Options have been described and evaluated in several countries, as noted recently in major policy documents from the World Health Organization (WHO) and World Psychiatric Association (WPA). The WHO's QualityRights initiative promotes human rights and quality of care for persons with mental health conditions and psychosocial disabilities. A position statement from the WPA calls for implementation of alternatives to coercion in mental healthcare.

We describe the engagement of both the WHO and WPA in this work. We discuss their mutual aim to support countries in improving human rights and quality of care, as well as the differences between these two organisations in their stated goals related to coercion in mental healthcare: the WHO's approach to eliminate coercion and the WPA's goal to implement alternatives to coercion.

We outline and critically analyse the common ground between the two organisations, which endorse a similar range of rights-based approaches to promoting non-coercive practices in service provision, including early intervention in prevention and care and other policy and practice changes.

Advocacy and action based on an agreed need to find practical solutions and advances in this area have the power to build consensus and unify key actors.

We conclude that persons with lived experience, families, mental health professionals and policy makers are now coming together in several parts of the world to work toward the common goals of improving quality, promoting human rights and addressing coercion in mental health services.

individual attitudes and structural inadequacies act as major barriers towards non-utilization of cancer screening and treatment offers in many high-income countries with subsidized public healthcare.

Our interdisciplinary research group at Heidelberg University is studying the underlying individual perceptions, attitudes and experiences of age- and gender-specific barriers against cancer-related medical and psychosocial offers available in Germany.

We designed a mixed-methods, sequential explanatory study using two quantitative instruments to determine the most important age- and gender-specific barriers for non-patients and cancer patients and survivors. In the second phase, semi-structured interviews will be conducted via selective sampling to record participant opinions, experiences and expectations of using cancer-related health services.

We expect to identify and explain important personal barriers and facilitators related to the use of cancer screening and treatment offers. Further interviews with stakeholders in cancer healthcare, such as physicians, nurses and self-help groups will be conducted to complement data from the service-providers’ point of view. The results will be analyzed with behavioral and sociocultural theories to gain a deeper understanding of perceived and experienced barriers in accessing cancer care in Germany and to formulate recommendations for prospective targeted approaches and interventions.

Our findings will be useful for facilitating knowledge transfer and policy dissemination to increase public awareness about cancer offers and improve participation rates. The results will be also used to develop an interprofessional teaching module in the medical curriculum as well as prepare and implement advanced training courses for medical professionals certified by the State Medical Association.

This study is funded by Strube Stiftung Stuttgart.

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.

The COVID-19 pandemic has shown how quickly and drastically everyday life can change in extreme situations.

To investigate how external factors can affect human health – mentally and physically – and what indicators herald the proximity to a critical upheaval.

Using theories from theoretical physics and psychology, researchers from Heidelberg University and Karlsruhe Institute of Technology will observe emotional reaction via an ‘infinitesimal stimulus’ (f) to an image that gives the ‘infinitesimal displacement’ (d). While both the stimulus and the reaction are chosen to be small – and hence keep a person well within their emotional stability – the ratio (d/f) provides us a quantitative measure of the individual’s susceptibility i.e. reaction sensitivity. Over a six-month phase, we hope to correlate the individual susceptibility with the person’s general emotional state and to define a threshold reaction to indicate a person’s proximity to an emotional instability. Semi-structured interviews of extreme cases give us further insight into correlations between emotional states and susceptibility.

If an increased susceptibility in an individual actually precedes a long-term change in mood, then regular susceptibility measurements can be used, for instance, to detect depression at an early stage. We are particularly curious to observe the extent to which models from physics can be applied to society and the individual.

The final output is to integrate practical implementation aspects into the medical curricula in a transdisciplinary manner. If possible, a formula for understanding health stability should be formulated that would be highly innovative for the medical field.

This study is funded by the Heidelberg Academy for Sciences and Humanities.

Psychiatric care following self-harm treatment is pivotal in patients´ life both in short- and long-terms.

To examine follow-up psychiatric care received by patients treated for deliberate self-harm (DSH), and to assess the influence of psychiatric referral and treatment attendance on risk for subsequent mortality.

Nationwide registries were interlinked to follow all DSH patients for data on personal socioeconomic status, clinical features of DSH, psychiatric treatment and cause of death. Data were analyzed with Logistic regression and cause-specific survival analysis.

The study identified 43153 patients involving 69569 DSH episodes. Of these patients 15.7% were referred or transferred to psychiatric services and 51.0% attended psychiatric treatment within subsequent 3 months. Evidently, prior psychiatric history and psychiatric comorbidities had strong influence on both referral and attendance to psychiatric healthcare, personal socioeconomic status also deviated the likelihoods. During the follow-up, 7041 patients died from suicide (n=911) or other causes (n=6130). While suicide risk was highly associated with male gender, middle age, and particularly, prior and coexisting psychopathologies, other cause mortality was strongly associated with old age and socioeconomic disadvantages. Meanwhile, a referral to psychiatric services was associated with suicide risk, and the risk was particularly high for patients who received the referral but did not attend psychiatric treatment. The observed effect was more pronounced during the early years, and in patients of young or middle age and those with a clear intent of self-harm.

The insightful findings highlight the importance of patients´ attendance and engagement in follow-up psychiatric care on risk for subsequent mortality.

No significant relationships.

One critical barrier to the uptake of mental health programmes is the so-called physical healthcare gap, a concern raised by the unattended physical comorbidity and early mortality of persons with severe mental illness.

To evaluate the extension of physical healthcare gap among persons with severe mental illness under chronic drug therapies.

A population-based cohort study was carried out, using Lombardy healthcare utilisation databases. Prevalent patients treated with blood pressure-, lipid- or glucose-lowering agents were identified in January 2017. Among these, those who were receiving care for depression, schizophrenia, bipolar disorder or personality disorder formed the study cohort. A reference cohort was randomly selected from prevalent patients treated with chronic therapies without signs of severe mental disorders, to be matched with study cohort members for gender, age and number of previous contacts with the National Health System. One-year adherence to healthcare was measured through the proportion of days covered (drug adherence), and exposure to selected recommendations (clinical control adherence).

The 55 162 patients with severe mental illness were less likely to have high adherence to blood pressure-lowering, lipid-lowering or antidiabetic agents than the reference cohort by −24% (95% CI −26 to −22%), −10% (95% CI −14 to −6%) and −25% (95% CI −29 to −21%), respectively. The 9250 patients with diabetes and severe mental illness had −18% (95% CI −22% to −13%) reduced likelihood to meet recommendations for the clinical management of diabetes, compared with the reference cohort.

Adherence to chronic drug therapies was sensibly worse among patients living with mental illness than those without signs of mental disorders.

Caregiver support groups provide an avenue for interactions among the caregivers of the mentally ill, where they share their fears, hopes and uncertainties about their ill relatives. They are a means to be “heard” by care providers, a platform for psychoeducation as well as an avenue for participation in clinical decision making and formulation of patients’ care plans. In most parts of Africa, such support groups do not exist and where they do, they are poorly structured and poorly funded.

This review was aimed at examining the concept of caregiver support groups for the mentally ill globally as revealed in the currently avaliable body of knowledge, as well as raise awareness for the need for such groups in Africa

A review of related literature was done using appropriate key words and search engines.

This review revealed the presence of well- structured support groups for the caregivers of the mentally ill in many parts of the world. The advantages of such groups and their contributions to the holistic care of these patients in those regions were also discussed, while suggesting a possible structure for their creation, sustainability and focus in Africa.

The support of caregivers for the mentally ill must be given keen attention by both care providers and policy makers, with prime importance given to the creation and funding of more caregiver support groups in the continent in order to achieve quality and holisitic care for the mentally ill.

Characterised by its population density, cultural and ethnic diversity, familial fragmentation and high levels of HIV/AIDS, crime and homelessness, Paris poses specific problems with regard to mental healthcare.

Epidemiological studies show high rates of generalised anxiety and drug and alcohol abuse and dependence, greater use ofpsychoactive medication and, at the same time, apprehension about looking after mentally ill family members at home.

Although the Greater Paris area has a much higher density of GPs and specialists than the national mean, there are considerable variations within the region itself, with the central area having up to four times as many GPs or psychiatrists as the outer suburbs. On the other hand, although the number of mental health medical acts and the number of people receiving mental health care have been rising dramatically over the last 15 years, Paris has considerably less adult psychiatry beds and day care places per head of population than the rest of France.

Current planning targets include a more equitable distribution of mental health care service provision for the rapidly evolving urban population, early prevention of psycho-affective disorders, suicide and drug and alcohol misuse and the creation of low threshold services for adolescents in difficulty.

To advance the quality of mental healthcare in Europe by developing guidance on implementing quality assurance.

We performed a systematic literature search on quality assurance in mental healthcare and the 522 retrieved documents were evaluated by two independent reviewers (B.J. and J.Z.). Based on these evaluations, evidence tables were generated. As it was found that these did not cover all areas of mental healthcare, supplementary hand searches were performed for selected additional areas. Based on these findings, fifteen graded recommendations were developed and consented by the authors. Review by the EPA Guidance Committee and EPA Board led to two additional recommendations (on immigrant mental healthcare and parity of mental and physical healthcare funding).

Although quality assurance (measures to keep a certain degree of quality), quality control and monitoring (applying quality indicators to the current degree of quality), and quality management (coordinated measures and activities with regard to quality) are conceptually distinct, in practice they are frequently used as if identical and hardly separable. There is a dearth of controlled trials addressing ways to optimize quality assurance in mental healthcare. Altogether, seventeen recommendations were developed addressing a range of aspects of quality assurance in mental healthcare, which appear usable across Europe. These were divided into recommendations about structures, processes and outcomes. Each recommendation was assigned to a hierarchical level of analysis (macro-, meso- and micro-level).

There was a lack of evidence retrievable by a systematic literature search about quality assurance of mental healthcare. Therefore, only after further topics and search had been added it was possible to develop recommendations with mostly medium evidence levels.

Evidence-based graded recommendations for quality assurance in mental healthcare were developed which should next be implemented and evaluated for feasibility and validity in some European countries. Due to the small evidence base identified corresponding to the practical obscurity of the concept and methods, a European research initiative is called for by the stakeholders represented in this Guidance to improve the educational, methodological and empirical basis for a future broad implementation of measures for quality assurance in European mental healthcare.