Susan McPherson

Background: Common mental health conditions are increasing in England, with growing severity and unmet need. Evidence shows that mental wellbeing is strongly shaped by wider social determinants such as income, housing, employment, and relationships. Conventional clinical approaches may not adequately address these underlying factors, highlighting the need for preventative, community-based solutions. Aim: This paper describes the community involvement and engagement (CEI) approach used to develop CoSign, a digital signposting tool designed to help individuals identify social determinants contributing to mental distress and access appropriate community support. Involvement and engagement approach: The development of CoSign incorporated CEI throughout the research process, guided by the INVOLVE research-cycle framework and the IAP2 Spectrum of Public Participation. A total of 29 stakeholders—including healthcare professionals, voluntary sector representatives, policymakers, and individuals with lived experience—contributed through workshops, consultations, and collaborative activities. Engagement focused on shaping the tool’s design, content, accessibility, and implementation considerations. Activities and impact: Stakeholder input informed key aspects of CoSign, including the identification of relevant domains of need, refinement of language to improve accessibility, and the structure of the user experience. Practical considerations, such as service capacity, inclusivity, and potential barriers to engagement, were highlighted and addressed. The resulting web-based tool enables users to self-identify areas of social need and receive tailored signposting to community resources. CEI enhanced the relevance, acceptability, and usability of the tool. Conclusion: Meaningful community involvement is essential in developing accessible, preventative mental health tools grounded in real-world needs. However, challenges such as limited resources, stakeholder fatigue, and equity in participation must be managed. The CoSign project demonstrates the value of CEI while underscoring the importance of flexible, context-sensitive approaches to engagement.

Objectives: Exploring how Turkish‐speaking immigrants understand and express common mental health conditions is crucial, as discrepancies in this area have real‐life consequences for treatment. Some key concepts to examine within this are the long‐standing belief that Turkish‐speaking immigrants somatise emotional difficulties and cannot identify them, and that they predominantly rely on traditional explanatory models of mental health. Accordingly, this study aimed to explore how this population experiences, expresses and understands these conditions and to examine their coping resources and help‐seeking attitudes. Design: Qualitative design. Methods: Semi‐structured interviews were conducted in Turkish with 18 Turkish‐speaking immigrants who self‐identified as having experienced common mental health difficulties. Data were analysed inductively using reflexive thematic analysis within a critical realist framework. Results: Four themes with ten subthemes were generated: symptom presentation, explanatory models, coping strategies and help‐seeking attitudes. Participants reported both emotional and physical symptoms, often expressed through rich idioms and metaphors. They attributed their distress to upbringing, traumatic events, chronic adversities, discrimination, interpersonal relationships and their own perceived shortcomings. Coping included personal, interpersonal, community and religious resources alongside lay resources. While most participants were open to professional help, all expressed distrust towards UK services and many preferred Turkish‐speaking professionals. Conclusions: Contrary to popular belief, Turkish‐speaking immigrants articulated distress in both emotional and physical terms. Their explanatory model was mainly psychosocial but also included biological and traditional elements, reflecting a dynamic, multi‐model approach. Moving beyond reductive stereotypes about Turkish‐speaking immigrants and Global South populations is crucial for providing meaningful and effective care.

In 2022, the National Institute of Health and Care Excellence (NICE) introduced “patient choice” as a major new principle in the guideline “Depression in adults: treatment and management.” In 2024, NICE launched a “patient decision aid” to provide practical support for this principle. We explore data on the treatment of depression from the United Kingdom's National Health Service before and after the guideline was published to consider whether patient choice has been enabled by these developments. The types of treatment most commonly delivered prior to the new guideline (Guided Self-Help books, Counseling for Depression, Cognitive Behavior Therapy, and antidepressant prescriptions) are now more common than before. This suggests that the inclusion of patient choice in the guidelines has not yet translated into patients making a wider range of choices. We consider how patient choice came to be prioritized over patient experience in the guideline development process; whether the patient decision aid is likely to support patient choice and shared decision making; and whether there may be underlying ideological barriers which mean a more straightforward emphasis on patient experience would be a more logical route to enhancing patient choice.

When the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM‐5) was published in 2013, there was a firestorm of controversy about the elimination of the bereavement exclusion. Proponents of this change and of the proposed “complicated grief” designation believed that this change would help clinicians recognise major depression in the context of recent bereavement. Other researchers and clinicians have raised concerns about medicalising grief. In 2022 “prolonged grief disorder” (PGD) was officially included in the DSM‐5‐TR in the trauma‐ and stressor‐related disorders section. Not surprisingly, there has been a push to identify biomarkers and to use neuroimaging to identify the neurobiological basis of PGD. Some researchers have even suggested that PGD is a ‘reward circuit disorder’ akin to addiction and that naltrexone, an opioid antagonist, may be a promising treatment. The purpose of this paper is to show how medicalising grief reinforces a research agenda dedicated to the search for pharmaceutical and psychological ‘magic bullets.’ Following George and Whitehouse (2021), we propose that an ecopsychosocial approach—one that incorporates environmental and contextual factors—is needed.

In this paper, we present a qualitative meta‐ethnographic synthesis of 26 articles reporting experiences of subjective burden in 389 parents of children with mental illnesses. The studies were identified through a systematic literature search of PubMed, CINAHL Ultimate, APA PsycInfo, and MedLine Ultimate. We conducted a quality appraisal and followed the seven stages of meta‐ethnographic synthesis. We developed a line of argument synthesis in the form of a model that depicts the subjective, temporal, and psychological experiences of parents. The model proposes a cyclical process characterized by five stages, each depicting a transitional point in which parents re‐evaluate their experiences: caring for an intimate stranger; turning point; unavoidable role; uncertain future; transcendence. This model highlights the complex psychological processes that parents endure when caring for a child with a mental illness. The review highlights several methodological issues in this field of research, including issues related to sampling, poor reporting of data analysis, limited critical appraisal, and a lack of reflexivity. Future research should address the gaps in the literature while also attending to the issues that have been highlighted by this review.

The evidence base for psychological benefits of GnRHA for adolescents with gender dysphoria (GD) was deemed "low quality" by the UK National Institute of Health and Care Excellence. Limitations identified include inattention to clinical importance of findings. This secondary analysis of UK clinical study data uses Reliable and Clinically Significant Change approaches to address this gap. The original uncontrolled study collected data within a specialist GD service. Participants were 44 12-15-year-olds with GD. Puberty was suppressed using "triptorelin"; participants were followed-up for 36 months. Secondary analysis used data from parent-report Child Behavior Checklists and Youth Self-Report forms. Reliable change results: 15-34% of participants reliably deteriorated depending on the subscale, time point and parent versus child report. Clinically significant change results: 27-58% were in the borderline (subclinical) or clinical range at baseline (depending on subscale and parent or child report). Rates of clinically significant change ranged from 0 to 35%, decreasing over time toward zero on both self-report and parent-report. The approach offers an established complementary method to analyze individual level change and to examine who might benefit or otherwise from treatment in a field where research designs have been challenged by lack of control groups and low sample sizes.

Between 2017 and 2020, the UN Special Rapporteur (SR) Dainius Puras published three reports that called for significant changes to organisation, funding and service provision in mental health care in ways that emphasise inclusive, rights‐oriented, democratic and sustainable community health services. This article aims to examine formal organisational responses to the UN mental health reports and consider the underlying arguments that either support or delegitimise the SR stance on the need for a paradigmatic shift towards a human rights‐based approach to mental health. By combining several different search strategies to identify organisational responses across the web, a total of 13 organisational responses were included in the analysis. Given the political nature of the responses, concepts from discourse theory were used to analyse the responses. The analysis showed how the responses articulated two binary positions and contesting articulations of good mental health care, which formed a backdrop for rejecting the SR reports in defence of psychiatry. The discussion elucidates how the responses tend to resemble previous ways in which critique has been dealt with mainly by ‘biological psychiatry’, but that the counter‐critical nature of the medical and psychiatric organisational responses remains in contrast to the broader reception within the UN community.

Being a close relative of a person with depression can take a heavy toll on the former, but these relatives are increasingly made responsible for taking on extensive carer roles. Research on relatives of people with depression is currently dominated by a focus on “carer burden” and although such a focus can explain many relatives' experiences and daily lives, it provides very limited insight into the everyday life of a person living with someone with depression. Therefore, we scoped qualitative research on people who are relatives of people living with depression and identified knowledge gaps caused by explicit or implicit theoretical or methodological assumptions. We conducted an exhaustive literature search in CINAHL, PubMed, PsycINFO, Sociological Abstracts, and Eric. In total, 34 publications were included, their quality evaluated and their findings mapped and summarized. We identified four interrelated and overlapping themes that dominated the findings of the publications: (a) recognition of “depression”, (b) emotional responses, (c) interruptions of relationships, and (d) a staged psychosocial process. The vast majority of studies presented de‐contextualized and underinterpreted analyses assuming a homogeneity of (illness) experiences and disregarded the important influence of social contributors to social relationships, connectedness, and mental health problems.