With both the Russian invasion of Eastern Ukraine and Crimea in 2014, and the war that began in February 2022, Ukraine has faced extensive damage, numerous casualties, widespread displacement of people, and significant psychological trauma. These events have strained health care and, particularly, mental health care systems that were ill-equipped to handle such stresses.

The Commission was created in February 2023, coincident with the first anniversary of the Russian attacks. Prof. Irina Pinchuk was invited to lead The Lancet Psychiatry Commission on Mental Health in Ukraine, with Prof. Norbert Skokauskas and Prof. Bennett Leventhal as Co-chairs. The Commission brought together 40 experts in mental health, economics, law, and science from 12 countries, formed into five workgroups (Clinical Services, Clinical Training, Research, Forensics and Legal Advocacy, and Finance).

The Commission recommends a stepped-care model in which low-intensity services are provided by non-specialist personnel, with proper training, integrated in primary care, augmented by digital tools, all directed to moving individuals from institutional to community-based services; Developing a multidisciplinary mental health research infrastructure that is adequately funded and initially focused on relevant issues such as PTSD, the war’s impact on Ukrainians, and innovative service models for Ukraine; Policy and legislative changes; Increase in Ukraine’s mental health spending, to 4.5% of total healthcare expenditures.

The Lancet Commission supports Ukraine’s goals to end the war, provide evidence-based services for its citizens and to join the global community with improved resources clinical education, research, legal structures, funding, and care.

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Despite growing awareness of the mental health damage caused by air pollution, the epidemiologic evidence on impact of air pollutants on major mental disorders (MDs) remains limited. We aim to explore the impact of various air pollutants on the risk of major MD.

This prospective study analyzed data from 170 369 participants without depression, anxiety, bipolar disorder, and schizophrenia at baseline. The concentrations of particulate matter with aerodynamic diameter ≤ 2.5 μm (PM2.5), particulate matter with aerodynamic diameter > 2.5 μm, and ≤ 10 μm (PM2.5–10), nitrogen dioxide (NO2), and nitric oxide (NO) were estimated using land-use regression models. The association between air pollutants and incident MD was investigated by Cox proportional hazard model.

During a median follow-up of 10.6 years, 9 004 participants developed MD. Exposure to air pollution in the highest quartile significantly increased the risk of MD compared with the lowest quartile: PM2.5 (hazard ratio [HR]: 1.16, 95% CI: 1.09–1.23), NO2 (HR: 1.12, 95% CI: 1.05–1.19), and NO (HR: 1.10, 95% CI: 1.03–1.17). Subgroup analysis showed that participants with lower income were more likely to experience MD when exposed to air pollution. We also observed joint effects of socioeconomic status or genetic risk with air pollution on the MD risk. For instance, the HR of individuals with the highest genetic risk and highest quartiles of PM2.5 was 1.63 (95% CI: 1.46–1.81) compared to those with the lowest genetic risk and lowest quartiles of PM2.5.

Our findings highlight the importance of air pollution control in alleviating the burden of MD.

The increasing incidence of mental disorders poses an urgent challenge for psychiatry—one that cannot be addressed by treatment alone. The only sustainable path forward is to prioritize mental health promotion and primary prevention at all levels: universal, selective, and indicated. While often seen as a long-term investment, primary prevention is cost-effective and essential for reducing the future burden of mental illness. This is not science fiction; it is a necessary shift that must happen now within our clinical services. In this lecture, I will show how primary prevention is already being implemented within the Institute of Psychiatry and Mental Health in Madrid, showcasing real-world programs that integrate prevention into everyday psychiatric practice. By embedding prevention into mental healthcare, we can move from a reactive to a proactive model—one that truly addresses the root causes of mental disorders and ensures a healthier future.

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Temperature increases in the context of climate change affect numerous mental health outcomes. One such relevant outcome is involuntary admissions as these often relate to severe (life)threatening psychiatric conditions. Due to a shortage of studies into this topic, relationships between mean ambient temperature and involuntary admissions have remained largely elusive.

To examine associations between involuntary admissions to psychiatric institutions and various meteorological variables.

Involuntary admissions data from 23 psychiatric institutions in the Netherlands were linked to meteorological data from their respective weather stations. Generalized additive models were used, integrating a restricted maximum likelihood method and thin plate regression splines to preserve generalizability and minimize the risk of overfitting. We thus conducted univariable, seasonally stratified, multivariable, and lagged analyses.

A total of 13,746 involuntary admissions were included over 21,549 days. In univariable and multivariable models, we found significant positive associations with involuntary admissions for ambient temperature and windspeed, with projected increases of up to 0.94% in involuntary admissions per degree Celsius temperature elevation. In the univariable analyses using all data, the strongest associations in terms of significance and explained variance were found for mean ambient temperature (p = 2.5 × 10−6, Variance Explained [r2] = 0.096%) and maximum ambient temperature (p = 8.65 × 10−4, r2 = 0.072%). We did not find evidence that the lagged associations explain the associations for ambient temperature better than the direct associations.

Mean ambient temperature is consistently but weakly associated with involuntary psychiatric admissions. Our findings set the stage for further epidemiological and mechanistic studies into this topic, as well as for modeling studies examining future involuntary psychiatric admissions.

Recent years show an exponential increased interest (“renaissance”) in the use of psychedelics for the treatment of mental disorders and broader. Some of these treatments, such as psilocybin for depression, are in the process of formal regulation by regulatory bodies in the US (FDA) and Europe (EMA), and as such on the brink of real-world implementation. In the slipstream of these developments increasing commercial initiatives are taking shape. The European Psychiatric Association (EPA) acknowledges both the therapeutic potential of psychedelic substances and the challenges for both research and clinical implementation. Steps need to be taken toward a well-balanced policy based upon sound scientific evidence and research, aiming at safe, ethical responsible integration of psychedelic therapy available for all patients who can potentially benefit.

In this EPA policy paper, we highlight the potential benefits, and also the challenges of psychedelic treatments, which can be relevant for the future real-world implementation of these treatments.

In addition to an overview of the current evidence and hypotheses of working mechanisms of psychedelic treatment, this policy paper specifically highlights the importance of the psychosocial components of the treatment as well as the ethical and professional aspects playing a role in real-world implementation.

Four recommendations are formulated for further research and clinical implementation.

The transition from institutional to community-based mental health care has been a key policy goal for decades. Despite progress, challenges such as inadequate funding, political prioritization, and a lack of clear frameworks persist. The European Community Mental Health Services Provider (EUCOMS) Network created a shared vision.

EUCOMS aims to outline the principles and key elements for implementing effective community-based mental health care systems. The primary goal is to bridge the gap between evidence, policy, and practice while promoting recovery-oriented, inclusive, and effective care models.

The development process involved a collaborative, multi-phase approach. Starting with expert workshops and literature reviews, the framework was refined through input from 100 stakeholders, including mental health professionals, researchers, and peer experts across Europe. Structured feedback rounds and consultation workshops further shaped the consensus.

EUCOMS identifies six principles for high-quality community-based mental health care: Human Rights: Ensuring dignity, liberty, and equality for all individuals, with a focus on reducing stigma and discrimination. Public Health: Adopting a population-based approach to promote mental health and prevent illness. Recovery: Supporting personal, functional, and clinical recovery through individualized care. Effectiveness: Implementing evidence-based interventions and practices tailored to local contexts. Community Networks: Strengthening formal and informal support systems to enhance resilience. Peer Expertise: Integrating the lived experiences of service users into service design, delivery, and evaluation. In my presentation I will focus on how these principles are turned into practice in 3 countries in 3 different regions: The Netherlands, Portugal and Ukraine. The Netherlands: the nationwide implementation of the Flexible Assertive Community Treatment model, professionalization of peer expertise and the ecosystem approach on mental health. In Portugal, a nationwide guide for establishing and evaluating community mental health teams in Portugal, promoting integrated, accessible care. In Ukraine, the a nationwide All Ukraine mental Health program was launched during the war, implemented supported by all ministries supported by WHO.

The EUCOMS Network presents a comprehensive framework for regional implementation of community-based mental health services. These principles advocate for systems that are inclusive, recovery-oriented, evidence-based, and integrated within the community. The model requires adaptable implementation, considering cultural, economic, and systemic contexts. Future efforts should focus on stakeholder engagement, capacity building, and sustained advocacy to align policy and practice with these principles.

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One of the most relevant risk factors for suicide is the presence of previous attempts. The symptomatic profile of people who reattempt suicide deserves attention. Network analysis is a promising tool to study this field.

To analyze the symptomatic network of patients who have attempted suicide recently and compare networks of people with several attempts and people with just one at baseline.

1043 adult participants from the Spanish cohort “SURVIVE” were part of this study. Participants were classified into two groups: single attempt group (n = 390) and reattempt group (n = 653). Different network analyses were carried out to study the relationships between suicidal ideation, behavior, psychiatric symptoms, diagnoses, childhood trauma, and impulsivity. A general network and one for each subgroup were estimated.

People with several suicide attempts at baseline scored significantly higher across all clinical scales. The symptomatic networks were equivalent in both groups of patients (p > .05). Although there were no overall differences between the networks, some nodes were more relevant according to group belonging.

People with a history of previous attempts have greater psychiatric symptom severity but the relationships between risk factors show the same structure when compared with the single attempt group. All risk factors deserve attention regardless of the number of attempts, but assessments can be adjusted to better monitor the occurrence of reattempts.

Disorders due to addictive behaviors have been included in the eleventh revision of the International Classification of Diseases (ICD-11). Such conditions include gambling disorder and gaming disorder, and each has online specifiers given the relevance of the internet to each of these conditions in modern societies. This presentation will consider problematic usage of the internet with respect to formally specified disorders (gambling, gaming) as well as other online behaviors (e.g., use of social media) for which problematic engagement may be considered as an “other specified disorder due to addictive behaviors” in the ICD-11. European and global initiatives (e.g., the Lancet Psychiatry Commission on Problematic Usage of the Internet and the development of screening and diagnostic instruments involving World Health Organization workgroups) will be discussed. Clinical, developmental and public health implications will be presented to provide an up-to-date understanding of rapid changes in this area.

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Hippocampal disruptions represent potential neuropathological biomarkers in depressed adolescents with cognitive dysfunctions. Given heterogeneous outcomes of whole-hippocampus analyses, we investigated subregional abnormalities in depressed adolescents and their associations with symptom severity and cognitive dysfunctions.

MethodsSeventy-nine first-episode depressive patients (ag = 15.54 ± 1.83) and 71 healthy controls (age = 16.18 ± 2.85) were included. All participants underwent T1 and T2 imaging, completed depressive severity assessments, and performed cognitive assessments on memory, emotional recognition, cognitive control, and attention. Freesurfer was used to segment each hippocampus into 12 subfields. Multivariable analyses of variance were performed to identify overall and disease severity-related abnormalities in patients. LASSO regression was also conducted to explore the associations between hippocampal subfields and patients’ cognitive abilities.

Depressed adolescents showed decreases in dentate gyrus, CA1, CA2/3, CA4, fimbria, tail, and molecular layer. Analyses of overall symptom severity, duration, self-harm behavior, and suicidality suggested that severity-related decreases mainly manifested in CA regions and involved surrounding subfields with disease severity increases. LASSO regression indicated that hippocampal subfield abnormalities had the strongest associations with memory impairments, with CA regions and dentate gyrus showing the highest weights.

Hippocampal abnormalities are widespread in depressed adolescents and such abnormalities may spread from CA regions to surrounding areas as the disease progresses. Abnormalities in CA regions and dentate gyrus among these subfields primarily link with memory impairments in patients. These results demonstrate that hippocampal subsections may serve as useful biomarkers of depression progression in adolescents, offering new directions for early clinical intervention.

Suicide is a huge public health problem with 700,000 deaths per year. United Nations are aiming to reduce suicide rates with 33 percent before 2030. Some countries have experienced declining trends, especially in Asia, partly due to restrictions in access to highly lethal pesticides. USA are facing increasing trends and in many western European countries there has been declining tendencies, but most recently rates have been rather stable.

Suicide preventive strategies have focused on universal prevention, thus intervention targeting the who population, selective prevention aiming to reduce risk in different high risk groups, and indicated prevention targeting people who are already having suicidal behavior. In most cases, suicidal acts are carried out within a short period of time, and in many cases without a long period of warning signals. In a way, suicidal acts resemble heart attacks or epileptic episodes more than other complications that often develop slowly and gradually. This makes the task of creating awareness programmes even more difficult.

However, a thorough mapping of risk groups and risk situations will enable us to plan a more targeted intervention. Thus, epidemiology and clinical research can play together.

The most important task is to identify those of immediate risk of suicide and provide treatment and support. There are four distinct risk groups with a very high suicide rate. These are 1) people sent home from psychiatric emergency room visits, 2) people recently discharged from psychiatric hospitalization 3) people who were hospitalized due to attempted suicide 4) people who have called life-line or other NGO-driven helplines because of suicidal thoughts. It can be helpful to evaluate the population attributable risk associated with different risk factors. The population attributable risk is an estimate of the proportion of the problem that could be avoided if the increased risk in a specific risk group could be reduced to the level of the general population. All these four groups have a very high risk of suicide and together they accounted for 25 - 50 percent of all suicides in Denmark, and the help they are offered are in most countries fragmented and not well organized. Coherent and assertive interventions are needed in order to reduce suicide rates. Interventions will need to involve monitoring persons in high-risk groups for longer periods.

All mental disorders are associated with increased risk of suicide, especially the first years after first hospital contact.

Safety plans have proven to be an effective tool for suicide prevention, and this concept will be presented

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People exposed to more unfavourable social circumstances are more vulnerable to poor mental health over their life course, in ways that are often determined by structural factors which generate and perpetuate intergenerational cycles of disadvantage and poor health. Addressing these challenges has become an imperative matter of social justice. In this paper we provide a roadmap to address the social determinants that cause mental ill health. Relying as far as possible on high-quality evidence, we first map out the literature that supports a causal link between social determinants and later mental health outcomes. Given the breadth of this topic, we focus on the most pervasive social determinants across the life course, and those that are common across major mental disorders. We draw primarily on the available evidence from the Global North, acknowledging that other global contexts will face both similar and unique sets of social determinants that will require equitable attention. Much of our evidence focuses on mental health in groups who are marginalized, and thus often exposed to a multitude of intersecting social risk factors. These groups include refugees, asylum seekers and displaced persons, as well as ethnoracial minoritized groups; lesbian, gay, bisexual, transgender and queer (LGBTQ+) groups; and those living in poverty. We then introduce a preventive framework for conceptualizing the link between social determinants and mental health and disorder, which can guide much needed primary prevention strategies capable of reducing inequalities and improving population mental health. Following this, we provide a review of the evidence that has tested candidate preventive strategies to intervene on social determinants of mental health. These interventions fall broadly within the scope of universal, selected and indicated primary prevention strategies, but we also briefly review important secondary and tertiary strategies to promote recovery in those with existing mental disorders. Finally, we provide seven key recommendations, framed around social justice, which constitute a roadmap for action in research, policy and public health. Adoption of these recommendations would provide an opportunity to advance efforts to intervene on modifiable social determinants that affect population mental health.

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Racial and ethnic experiences of discrimination (EODs) are associated with numerous psychiatric symptoms, including outcomes along the psychosis spectrum; however, less is known about mechanisms by which EODs confer risk for psychotic-like experiences (PLEs; common subthreshold psychotic symptoms). Furthermore, work on gendered racism asserts that the intersection of race and gender impacts the nature of EODs experienced and, in turn, may impact the relationship between EODs and PLEs.

To utilize an intersectional lens (race and gender) to examine whether psychological correlates of EODs (post-traumatic stress, anxiety, depression, and dissociation) mediate the EOD–PLE relationship.

Undergraduates at a diverse, semipublic university (N = 1,759) completed self-report questionnaires (Experiences of Discrimination Scale, Prodromal Questionnaire, Center for Epidemiologic Studies Depression Scale, State–Trait Anxiety Inventory, Dissociative Experiences Scale, and Post-Traumatic Stress Disorder Checklist – Civilian Version). Analyses stratified the sample by race (non-Hispanic White, Black, and Asian) and examined three multiple mediation models, moderated by gender, examining the pathway from EODs to PLEs, through other psychiatric symptoms.

In the full sample, all psychiatric symptoms significantly mediated the relationship between EODs and PLEs. Only depression varied by gender, such that the indirect effect was only significant in female participants (β = 0.09; 95% CI [0.02, 0.16]). Across race-stratified groups, significant mediators varied by both race and gender.

These findings underscore the importance of accounting for intersectionality and multiple psychological symptoms in understanding the EOD–PLE associations, which differ by race and ethnicity as well as gender, and should be considered in clinical treatment of individuals with PLEs and history of EODs.

Polygenic risk scores for educational attainment (PRSEA), cognitive reserve (CR), and clinical symptoms are associated with functioning in first-episode psychosis (FEP). Nevertheless, the mechanisms underlying their complex interaction are yet to be explored. This study assessed the mediating role of CR and clinical symptoms, both negative (NS) and positive (PS), on the interrelationship between PRSEA and functionality, one year after a FEP.

A total of 162 FEP patients underwent clinical, functional, and genetic assessments. Using genome-wide association study summary results, PRSEA were constructed for each individual. Two mediation models were performed. The parallel mediation model explored the relationship of PRSEA with functionality through CR and clinical symptoms. The serial mediation model tested a causal chain of the three mediators: CR, NS, and PS. Mediation analysis was performed using the PROCESS function V.4.1 in SPSS V.22.

A serial mediation model revealed a causal chain for PRSEA > CR > NS > Functionality (β = −0.35, 95%CI [−0.85, −0.04], p < 0.05). The model fit the data satisfactorily (CFI = 1.00; RMSEA = 0.00; SRMR = 7.2 × 10−7). Conversely, no parallel mediation was found between the three mediators, PRSEA and functionality and the model poorly fit the data (CFI = 0.30; RMSEA = 0.25; SRMR = 0.11).

Both CR and NS mediate the relationship between PRSEA and functionality at one-year follow-up, using serial mediation analysis. This may be relevant for prevention and personalized early intervention to reduce illness impact and improve functional outcomes in FEP patients.

Worldwide, social media and touch screen device use has rapidly increased over the past decade and are particularly popular among young people. To obtain more insight in the potential negative associations with compulsive social media use and touch screen devices in Dutch children, we assessed its relation with self-reported well-being and cognitive function in primary school children. We found social media to be negatively associated with life satisfaction and increasing touch screen device use with increased reaction time. This suggests that the compulsive social media use and touch screen device use have negative consequences on mental well being and cognitive performance already at a young age. Therefore the use of social media in children under the age of 15 years should be restricted or forbidden.

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Currently, there are few affordable, high-quality long-term care options available for a significant segment of people with serious mental disorders. This population includes adults characterized as poor insight, chronically ill, lacking autonomy, consuming drugs, and severe behavioural disturbances. These individuals frequently suffer from schizophrenia, bipolar disorder, toxic psychosis, severe personality disorders and substance abuse disorder, comorbidity being common. The void is ethically unacceptable and societally costly. Progressive reformers, consumers, civil libertarians, and health economists all advocated for a similar goal—the closure of publically funded psychiatric institutions. But deinstitutionalization has actually been trans-institutionalization. As psychiatric hospitals closed, patients with chronic psychiatric illnesses who lacked family support were moved into nursing homes or other forms of non-specialized residential care, occasionally visiting the psychiatric units of general hospitals. Many became homeless and intermittently used hospital emergency services for urgent care. Most disturbingly, prisons have become the largest mental health care facilities in some countries. The number of people affected may increase as a result of the crisis of the family institution, immigration and the epidemic of drug use.

Realistically, the deployment of both private and public resources is now imperative to provide appropriate care for a number of seriously mentally ill persons. They deserve a safe place to live with proper supports—not cycling between the streets, emergency departments, and prisons. Of course, psychiatric hospitals are a necessary but not sufficient component of a reformed spectrum of psychiatric services, where palliative psychiatry should have a role. A return to asylum based long-term psychiatric care will not remedy the complex problems of the mental health system, especially for patients with milder forms of mental illness who can thrive with high quality outpatient care. However, reforms that ignore the importance of expanding the role of such institutions will fail mental health patients who cannot safely live alone or care for themselves.

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Recent advances in natural language processing (NLP), particularly in language processing methods, have opened new avenues in semantic data analysis. A promising application of NLP is data harmonization in questionnaire-based cohort studies, where it can be used as an additional method, specifically when only different instruments are available for one construct as well as for the evaluation of potentially new construct-constellations. The present article therefore explores embedding models’ potential to detect opportunities for semantic harmonization.

Using models like SBERT and OpenAI’s ADA, we developed a prototype application (“Semantic Search Helper”) to facilitate the harmonization process of detecting semantically similar items within extensive health-related datasets. The approach’s feasibility and applicability were evaluated through a use case analysis involving data from four large cohort studies with heterogeneous data obtained with a different set of instruments for common constructs.

With the prototype, we effectively identified potential harmonization pairs, which significantly reduced manual evaluation efforts. Expert ratings of semantic similarity candidates showed high agreement with model-generated pairs, confirming the validity of our approach.

This study demonstrates the potential of embeddings in matching semantic similarity as a promising add-on tool to assist harmonization processes of multiplex data sets and instruments but with similar content, within and across studies.

In some European and non-European countries assisted suicide (AS), defined as supporting a person in committing suicide by providing e.g. a lethal dose of pentobarbital, is a common practice since decades. In most of these countries, AS initially was considered legitimate only, if a person has a limited expected survival time and/or suffers in an unbearable manner. Hence, AS was implicitly or explicitly not available for persons with psychiatric disorders.

Meanwhile, however, in some countries psychiatric disorders are acknowledged to cause unbearable suffering in certain cases and, in addition, a ruling of the highest court of Germany stated in 2020 that the right to seek suicide assistance might not be restricted to certain conditions or diseases, but solely tied to the competence to freely choose to end ones own life.

Because there is no indication that psychiatric disorders in general render affected person incompetent to freely choose suicide, a general exclusion of affected individuals from AS is incompatible with the biomedical principle of justice.

Clinically, however, psychiatric disorders in persons seeking AS must be seriously taken into account when a judgement has to be made on the individuals’ competence to choose freely. This kind of judgements are particularly difficult because both, the persons competence and his or her will to seek AS might be quite variable across time.

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The lifetime prevalence of PTSD ranges from 6 to 20% and is often associated with comorbid disorders. Despite the significant impact of PTSD, specific data on healthcare utilization related to PTSD remain limited. This study aims to characterize PTSD-related hospitalizations in France over the past decade.

This nationwide longitudinal retrospective study analyzed PTSD-related hospitalizations in France from 2013 to 2022 using the French National Hospitals Database. Data included discharge records from general and psychiatric hospitals, detailing demographics, admission/discharge dates, ICD-10 diagnoses, and hospitalization specifics.

Between 2013 and 2022, 69,108 patients underwent 125,349 hospitalizations with a PTSD diagnosis (0.4% of all inpatient cases) in France. Psychiatric facilities accounted for 74,988 hospitalizations (1% of all psychiatric inpatient cases in France), while general hospitals recorded 50,361 hospitalizations (0.02% of all non-psychiatric inpatient cases). The percentage of inpatients diagnosed with PTSD increased from 0.68 to 2.22% in psychiatric facilities and from 0.02 to 0.04% in general hospitals over the study period. Females were younger in both settings and had longer stays compared to males in psychiatric facilities. Over time, there was a decrease in median age and an increase in part-time hospitalizations in psychiatric facilities. Mood disorders, stress-related disorders, and substance use disorders were prevalent comorbidities in both settings.

This study highlights a rise in PTSD-related hospitalizations in France, particularly in psychiatric facilities and after 2019, with high rates among women and an increase in hospitalization of younger individuals. These findings highlight the necessity for improved care strategies tailored to the increasing number of younger patients with PTSD.

Several challenges exist rendering people with mental disorders particularly vulnerable to wrongful assisted suicide. Their desire to die may be a symptom of the mental illness rather than an autonomous choice; their decision-making competence may be compromised by the illness and hence more troublesome to determine; the severity of suffering may be more challenging to assess from an external perspective; the very wish to die may be variable over time; and prognostic uncertainty in mental illness may impede determining of whether severe suffering is, in fact, resistant to treatment. An ethically sound argument for excluding people with mental disorders from assisted suicide is their potential inability to make a free, autonomous decision. A person’s request for assisted suicide should be considered in the context of an assessment of their capacity to make a well-informed and deliberated decision. Opponents of legalising euthanasia and assisted suicide agree that the suffering caused by mental illness can be just as severe and agonising as in cases of somatic conditions. However, one cannot with all certainty assume that the illness is incurable and that the suffering cannot be minimised to such an extent that the patient experiences relief. The task of psychiatry is to prevent suicide. What follows is that diseases such as depression should be treated, while the patients should be supported and not facilitated to part with their lives. Considering their potentially illness-affected request for suicide, it seems better to prolong their suffering than let them die. One cannot grant the right to die to all those who have the competence to make decisions. Furthermore, legalising euthanasia and assisted suicide also in the case of patients with mental illnesses risks distorting the doctor-patient relationship. Euthanasia is not a balance between the interest of the state and the benefit of the individual in terms of choosing the time and manner of their death. What happens if the interest of the state is not to protect the lives of citizens, especially the most vulnerable and defenceless, including the mentally ill? Once values are rejected, only practical ‘benefits’ remain, such as financial savings on psychiatric care and treatment. And this is extremely risky. Drawing a clear line in the light of the above considerations seems to be impossible. In the current situation, where many people are exposed to mental suffering, e.g. in the form of depression, the priorities are suicide prevention policies and funding programmes for psychiatric treatment. The debate will take into account arguments for and against euthanasia in patients with mental disorders.

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