Ikigai is a Japanese word coined by the multilingual psychiatrist Dr. Kamiya, which roughly translates as “purpose in life.” Ikigai has attracted attention in health research and practice due to its association with positive health outcomes. Another Eastern-influenced construct that has gained increasing focus in health research and practice is self-compassion. Self-compassion involves being kind toward oneself during difficult times, mindfully balancing negative emotions, and recognizing that suffering is part of the shared human experience. Empirical studies report that self-compassion is strongly associated with mental well-being and purpose in life. This chapter examines ikigai and self-compassion and discusses key similarities and differences that exist between the two constructs. Similarities include their foundations in Eastern philosophy, their contribution to eudaimonia-type happiness, and their role in alleviating suffering. Differences between them highlight a lack of scientific evaluation of ikigai, including no standardized definition or measurement, and limited research on mental health outcomes. Self-compassion research can be advanced by identifying components of the standard self-compassion program.

Ghanaian artist and academic Bernard Akoi-Jackson developed and led a multi-year art therapy programme with patients at Pantang Psychiatric Hospital, one of Ghana’s three psychiatric hospitals. Chapter 6 focuses on an exhibition I co-curated with Akoi-Jackson on mental health promotion at the Nubuke Foundation, Accra, in 2009, inspired by this programme. Artwork produced by patients was exhibited alongside commissioned paintings on a pre-determined theme of ‘mental health’ from established Ghanaian contemporary artists and photographs from an anthropological study on mental healthcare in shrines and prayer camps. I detail the rationale and process of curating the exhibition and discuss visitors’ responses, which converged on two themes: the art exhibition as a viable approach for mental health promotion and arts therapies as methods of rehumanising the psychiatric space. I reflect on what the curating process revealed about the multilayered challenges faced by communities affected by severe chronic mental illness and where the arts can play a role in forging more robust collaborations between psychiatric and indigenous healing systems.

Clinical trials are a cornerstone of evaluating new interventions. Although there are similarities between clinical trials across medical specialties there are specific issues that need to be considered when designing, running and evaluating clinical trials in mental health. The purpose of this chapter is to present an overview of the common principles and methods of interventional clinical trials with illustrations drawn from general psychiatry. The chapter provides a guide to understanding clinical trials from design to analysis, drawing on recent work to illustrate fundamental concepts and covers novel factorial and platform designs. outlining advantages and disadvantages of each. This chapter summarises essential steps of interventional clinical trials in psychiatry describing the process from initial hypothesis generation, the role of patient and public involvement, steps to prepare a trial protocol, statistical considerations dissemination of results. The aim is to provide the reader with the tools to be able to understand different methodologies and in design of clinical trial in mental health.

This chapter has been written from the stance of a patient and public contributor to mental health research. It examines the role of patient and public involvement in mental health research which has evolved since the mid 1960s and continues to do so. Examining the people, roles and research and providing a definition for the different stages of Patient and Public Involvement, the chapter looks at how these roles interact, the ethics and rationale for involvement, the power relations between the various parties, whether involvement is moving the research agenda closer to preventative health care, and the subject of equality, diversity and inclusion. The difficulties of working with people with serious mental health issues are addressed. Case studies are given to illustrate various points. Subjects such as training and language are included. The complex subject of evaluation and impact and how they can be resolved are raised. Finally, the chapter concludes by inviting the reader to consider what ‘good PPI’ is, and how it is done.

The case highlights the importance of advancing the voice of minoritized individuals in a clinical or mental health setting. The case introduces us to a Black woman who had been battling anxiety for a long time. The symptoms increase as she experiences persistent adversity in her workplace. Specifically, she faces microagressions, which leaves her feeling overlooked, undervalued, and unheard. Informed by the CRT tenet of advancing the voices of the marginalized, the clinician working with the client uses liberation psychology, hip-hop psychology, and cognitive writing strategies to help the client develop skills to address her mental health. The chapter makes the case that creating the space for minoritized groups to tell their stories of oppression, discrimination, and stigma in an authentic way is central to their mental healing and well-being.

This chapter discusses care considerations for the immediate puerperium. This includes an overview of routine postnatal care for the mother’s physical and mental health, as well as important signs and symptoms of maternal and infant compromise. Common puerperal complications are described and risk factors, as well as management reviewed. Presentation and management of postnatal emergencies such as postpartum haemorrhage and haematomas, sepsis, venous thromboembolism and pulmonary embolus are discussed. Chronic postnatal complications including hypertension, problems of the lower urinary tract and pelvic organs, anaesthetic complications, wound breakdown, breast pain and anaemia are detailed, with a final section dedicated to mental health and the care of a woman presenting with a stillbirth.

The general hospital environment is one in which the needs for child and adolescent mental health provision are many and varied. These needs may link directly to underlying aspects of the condition itself, the impact of the illness or condition or the treatment proposed. Each of these may impact or be impacted upon by underlying or emerging mental health issues. The disorders discussed in this chapter include: those where somatic and psychological medicine services are intertwined and interdependent, such as for eating disorders; neuropsychiatric presentations including ASD; psychiatric emergencies and finally chronic health conditions. There are a number of models for the delivery of mental health services in hospitals, ranging from services that are mostly separate, usually entitled ‘liaison’ psychiatry services, to those where both mental and somatic health services work closely together, in the same team and sharing the same sets of notes – often referred to as Psychological Medicine.

Self-harm and suicidal behaviours in children and young people are increasingly common. These behaviours sit on a broad continuum from relatively risk-free behaviours that may be used as coping mechanisms to life-threatening acts with suicidal intent. Self-harm is more likely in patients with co-morbid mental health conditions, but most young people who self-harm do not have a mental health diagnosis. Family adversity, educational stressors, physical health illnesses, bullying, and substance misuse may all increase the risk of self-harm. Young people may find internet support groups helpful as they may value the discretion of online support for a behaviour about which they may be embarrassed. However some internet sites teach young people more dangerous self-harming strategies and young people may be bullied or encouraged to complete suicide. Historical methods of risk stratification have poor predictive validity and it is instead recommended that clinicians engage collaboratively with young people in an individualised approach to risk assessment, developing a detailed risk formulation and safety plan. Young people who self-harm are 30 times more likely to die by suicide, and it appears that those from minority groups are at greater risk. Mild self-harm may only require a ‘listening ear’ from a trusted friend or adult, but more severe difficulties may need professional assistance from mental health services that should be trauma-informed and relational in approach, offering evidence-based interventions such as DBT-A or MBT-A. Crisis services should be responsive and flexible to young people’s needs so as to be able to engage them and de-escalate risks effectively.

This chapter provides an overview of young people with mental health needs and the development of forensic mental health and youth justice services for young people. The provision of inpatient and community forensic child and adolescent mental health services is outlined in more detail, including referral criteria, characteristics of the young people who access the service and outcomes of the provision.

A survey found that 1 in 6 (16%) of children aged between 5 and 16 years has a probable mental illness. Furthermore, research has shown that most of these disorders have their origins in childhood, even if they are typically diagnosed in adulthood. Childhood represents a critical period of physical, cognitive, psychological, behavioural and social transformation. Identifying risk and protective factors that alter the typical developmental trajectory could have long-term educational, social, societal and economic implications. This chapter will address what is meant by the term risk factor and how these can be identified, provide examples of risk factors thought to be important in child and adolescent psychiatry. It concludes with some case vignettes to highlight the importance of taking a developmental biopsychosocial approach to identifying risk, considering predisposing, precipitating, perpetuating and protective factors.

Chapter 2, ‘The Embodied Letter’, examines the embodied consciousness in selected letters of the writers and painters. Drawing on critical thought in the medical humanities and in sensory studies, the chapter investigates the epistolary articulacy of body and mind through modes that span the documentary and the fantastic. First, the work of the sensorium is explored through the epistolary entanglement of the senses – from touch and taste to kinesthetics and proprioception. The chapter examines epistolary representations of wellbeing and illness, stories of embarrassing bodies, chronicles of everyday ‘troubles’, and the letterish discussion of public health, self-care, work, and leisure. The preoccupation with mental health and mental illness comes sharply into relief in epistolary evocations of boredom, exasperation, and depression, and their physical manifestations. Whilst such instances echo nineteenth-century literary evocations of spleen, they speak powerfully to some of our pressing contemporary concerns. End-of-life letters reveal a profound engagement with finitude through fragmentary narratives of struggle, separation, and mourning threaded with sustaining resilience.

Gender diversity is relatively common in youth, with rates increasing in the general population. This increase may be related to decreased stigma in gender expression, adolescent experimentation, environmental factors or due to the recent interest in quantitatively measuring this trait. Gender diversity in and of itself is a not a psychiatric disorder. But mental health providers might see gender diverse youth if there is the desire for gender-affirming treatment, for assessing and treating of co-occurring psychiatric disorders or to promote resilience in situations where bullying and stigmatisation are taking place. As such, clinicians should be prepared to provide a confidential and competent environment that recognises the vast range of gender diversity currently seen in youth. In addition, while research on mental health in gender diverse youth has substantially expanded in the past decade, limitations of these data influence interpretation and generalisability. Well-designed studies should address gaps, such as long-term follow-up periods for gender diverse youth and those who have received gender affirmative care. They should also examine developmental trajectories and the stability of gender identity. Gender diversity in racial and ethnic minorities who may have different psychiatric presentations should also be addressed in future research.

Clinicians navigating the legislation when working with young people and their families in the United Kingdom (UK) may need to use several relevant frameworks of legislation at the same time. This may appear complex in practice. Clinicians need to consider how a young person’s development across multiple domains, for example, cognitive, emotional, moral, social and so on, can have an impact upon their decision-making. Clinicians who work with children and young people often also work with parents or their local authority statutory equivalents, as well as other statutory and non-statutory agencies, to help find the best outcomes for children and young people (CYP). This requires good knowledge of legal frameworks, competence in working within complex multi-agency systems and being able to understand and work with different perspectives around an issue.This chapter specifically discusses aspects of the law in relation to children and adolescents (all those under 18 years) including the Human Rights Framework, Mental Capacity Act 2005, Children Act 1989 (amended 2004), Mental Health Act (amended 2007), and Criminal Justice Act (2003) within England and Wales. We have not addressed the differences in legislation in Northern Ireland or Scotland but have commented on distinct issues where relevant.