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.

There is now compelling evidence that migrant groups in several countries have an elevated risk of developing psychotic disorders.

To identify risk factors for psychosis in immigrant population.

case report and Computerised literature search of MEDLINE and PUBMED and PsycINFO databases was performed using the keywords: immigration, psychosis, schizophrenia.

Mrs AM is 22 years old, Ivorian, without any personal or family psychiatric history, married and mother of an 11 months old baby.

Because of the poor socio-economic conditions, she immigrated illegally to tunisia 3 months ago, accompanied by her husband, leaving her child in her native country. since then, she has been working in cleaning jobs with very low salaries and several conflicts in the workplace, which pushed AMto leave the job. One month before her admission, according to her husband, she became isolated, distrustful, she often watches herself in the mirror, refuses to take a shower, with some bizarre behaviors and persecutory words, then she became aggressive with her husband andneighbors, hence her admission.

The interview revealed a dissociative and delusional syndrome, vague and poorly systematized, with hallucinatory and intuitive mechanisms. In view of the subsequent evolution, the diagnosis of schizophrenia was retained. After stabilization under antipsychotic drugs, the patient asked to be repatriated to join her child.

The evidence is still thin, and there is a clear need for further research to replicate and extend findings linking specific aspects of the social environment and risk of psychosis in migrant groups.

No significant relationships.

Patient who comes to the Hospital accompanied by the Emergency Services from the Santa Justa train station, coming from Madrid, after being repatriated from Bangladesh.

There he was serving a five-year sentence for drug trafficking.

He is a patient who has had several hospital admissions at UHSM and clinically prosecuted as a paranoid schizophrenic. In prison, the first years he had no antipsychotic medication and recognizes the presence of auditory pseudohallucinations.

psychopathological stabilization

case report

In the psychopathological assessment upon arrival, the patient was hostile and suspicious, even refusing to take food and medication because he was demanding his freedom. He also relates this point to delirious interpretations of passers-by who approached him at the Madrid airport.

During the admission, the patient was referred to Internal Medicine for a global evaluation and analytical tests of his organic situation, finding normocytic anemia without other findings and with good response to the treatment established.

The patient’s psychopathological evolution is very favorable. Progressively more approachable and critical of the phenomena of psychotic nature. Interventions are carried out with Social Work for his overnight stay.

We have the odyssey of one of many patients with a mental illness where their life journey leads them to marginal situations and where elements of a legal nature are intermingled; either by the stay in prison itself or by the need for an admission against their will for psychopathological stabilization and to redirect this shipwrecked life course.

No significant relationships.

Cultural differences influence understanding and therapeutic adherence of migrant patients, therefore it is very important to acquire cultural competence.

The objective of this paper is to study, from the following case, the effect of cultural competence in approach to psychosis in migrant patients.

A bibliographic search was performed from different database (Pubmed, TripDatabase) about the influence of culture on psychosis and its resolution. A 25-year-old Moroccan man who came to Spain two years ago fleeing his country and suffered violence in different countries until he arrived. He lived on the street until they offered him a sheltered house with other Moroccans. He felt lack of acceptance and loss of his roots. In this context, he developed a first psychotic episode in which he described “the presence of a devil”.

He distrusted antipsychotic treatment and believed “that devil” was still inside him, being convinced that he needed a Muslim healer to expel him. We followed up with the patient and a cultural mediator, better understanding his cultural reality, uprooting and traumas, and he could feel understood and trust us. During the process, he decided to go to the Muslim healer who performed a symbolic rite for which he felt he “expelled the devil”, while accepting antipsychotics. With all this, the psychotic symptoms and their acculturation process improved.

It is very important that psychiatrists have cultural competence to understand the context of migrant patients, and to be able to provide them with the best treatment.

No significant relationships.

In the past decade, millions of Syrians have sought refuge in neighboring countries and Europe. Refugees are at increased risk for the development of common mental disorders (CMD), such as depression and posttraumatic stress disorder (PTSD), but only a small percentage access mental health services. Problem Management Plus (PM+) is a brief, scalable intervention targeting symptoms of CMDs that can be delivered by non-specialist helpers in communities affected by adversity, such as refugees.

The aim of this randomized controlled trial (RCT) is to evaluate the effectiveness of PM+ among Syrian refugees in the Netherlands.

Adult Syrian refugees and other Arabic-speaking refugees of 18 years and older with self-reported psychological distress (K10 >15) and functional impairment (WHODAS 2.0 >16) are included. Participants are randomized into PM+ or care as usual. Follow-up assessments are conducted at one-week, three-month and twelve-month follow-ups. Clinical outcomes are symptoms of depression/anxiety (HSCL-25), PTSD (PCL-5), and functional impairment (WHODAS 2.0).

By November 2021 [recruitment ends by December 2021], 214 participants were screened for eligibility and 184 participants were included. Participants are M=36.5yrs old (range 18-69yrs), and 73 participants are female (39.7%). We will present preliminary results for the effects of PM+ on depression, anxiety, PTSD, and functional impairment at one-week follow-up, as well as barriers and facilitators for implementing PM+ in a European country.

After positive evaluation of peer-refugee delivered PM+, the Arabic manual and training materials will be made available through WHO to encourage scaling-up.

No significant relationships.

Refugees have been shown to be a vulnerable population with increased psychiatric morbidity and lack of access to adequate mental health care. By establishing cooperations between psychosocial centers and psychiatric clinics the state funded project refuKey by NTFN e.V. and DGPPN aims to improve access to and quality of mental health care for traumatized refugees pursuing a stepped-care model.

As part of a larger project evaluation study four focus-groups among experts were conducted to explore the impact of refuKey on refugees’ mental health care.

Data analysis was conducted using Mayring qualitative content analysis as well as an additional quantitative survey with state refugee reception centers’ employees.

The results indicate that refuKey faciliated the access to mental health care for refugees in terms of systematic identification of mental disorders, eased transitions and increased networking between the mental health care institutions and sectors. Planning and implementation of treatment is described as being more coordinated, solution oriented and sustainable due to multiprofessional collaboration and regular use of qualified interpreters. Reduced distress as well as increased transcultural expertise was found for professionals.

The persisting barriers for refugees in access to mental health care, especially to psychotherapeutic treatment and the emotional burden for professionals underlines the need for further support and research. The experts highly endorse the continuance of refuKey. Furthermore, they call for expansion of the project in terms of staff and new sites and changes of health policies to guarantee the access to adequate health care for traumatized refugees.

No significant relationships.

The grey matter heterotopias are a relatively common group of conditions characterized by interruption of normal neuronal migration from near the ventricle to the cortex. Subependymal grey matter heterotopia, also known as periventricular heterotopia, is the most common form.

To search a link between bipolar disorder and grey matter heterotopia

A case report of a woman with grey matter heterotopia who is diagnosed as bipolar

A 34 year old woman was admitted at Razi psychiatric hospital 3 months after childbirth. She was agitated, logorrheic with multiple projects and insomniac. The diagnosis was a manic episod with a marked score of 28/44 at The Bech-Rafaelsen Mania Scale (MAS). The patient was treated with 4 mg of risperidone and 1000 mg of sodium valproate with partial remission after two weeks. One month after her discharge, she had depressive mood, asthenia, anhedonia and insomnia. She had a score of 19 at Hamilton Depression Rating Scale (HDRS). She was switched from risperidone to olanzapine 15mg/j with partial remission after two weeks. In front of persistent symptoms with labile mood, she took lithium 1000 mg/j. She was complaining of a headache and a fluctuating heaviness of the right upper limb. At brain imaging, she had periventricular nodular heterotopia. The patient was adressed to neurology department.

Grey matter heterotopia can cause a variety of neuropsychiatrc symptoms which can lead to diagnosis difficulties. Therefore, in front of atypical symptoms or drug-resistance, patients should be referred for brain imaging.

No significant relationships.