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Objective: Potentially morally injurious experiences (PMIE) (events that transgress an individual's subjective moral standards) have been associated with psychologically distressing moral emotions such as shame and guilt. Military leaders and clinicians have feared that those with PMIEs may be less likely to seek help due to the withdrawing nature of shame/guilt; however, to date, help-seeking patterns of military personnel with PMIEs has not been explored. Our objective is to address this research gap. Method: Data from a nationally-representative mental health survey of active Canadian military personnel were analysed. To assess the association between exposure to three PMIEs and past-year help-seeking across different provider categories (i.e. professionals, para-professionals (those delegated with mental health advisory tasks but are not licenced to practice as medical professionals), non-professionals), a series of logistic regressions were conducted, controlling for exposure to other deployment and non-deployment-related psychological trauma, psychiatric variables, military factors, and sociodemographic variables. Analytical data frame included only personnel with a history of Afghanistan deployment (N = 4854). Results: Deployed members exposed to PMIEs were more likely to seek help from their family doctor/general practitioner (OR = 1.72; 95%CI = 1.25-2.36), paraprofessionals (OR = 1.72; 95%CI = 1.25-2.36), and non-professionals (OR = 1.44; 95%CI = 1.06-1.95) in comparison to members not exposed to PMIEs. Those exposed to PMIEs were also more likely to seek professional care from the civilian health care system (OR = 1.94; 95%CI = 1.27-2.96). Conclusion: Contrary to long-held, but untested, assumptions regarding the impact of PMIEs on help-seeking, we found those with PMIEs are more likely to seek help from gatekeeper professionals (i.e. general practitioners), para-professionals, and non-professionals rather than specialized mental health professionals (e.g. psychologists). Increased utilization of civilian professionals raises concerns that active military members may be avoiding military health services. Clinically, this highlights the need to increase awareness of moral injury to ensure that actively serving military members are provided with appropriate advice and treatment.

Health equity is shaped by multiple factors intersecting with service delivery in community-based organizations (CBOs). Providers in under-resourced areas are often the first point of contact for families seeking child development, mental health, and behavioral support. However, system-level barriers hinder service delivery and access. This study explores provider perspectives to identify barriers and inform system-level changes that promote equity in child and family health. Using a narrative qualitative design, in-depth interviews were conducted with 21 health and mental health professionals from child- and family-serving CBOs. Guided by ecological and strengths-based frameworks, interviews examined provider insights on challenges, strengths, and supports affecting service delivery. Key themes emerged across macro (rights-based policies, racism/oppression), community (environmental impacts, social cohesion), organizational (secondary stress, system fragmentation, provider supports), and family levels (basic needs, parenting support, service access). Findings highlight the need for a multilevel approach that prioritizes rights-based policies, strengthens community cohesion, and improves system integration. Enhancing CBO capacity to address these determinants could advance equity-oriented service delivery and mitigate structural barriers that perpetuate health disparities.

Mindfulness and social work values go hand in hand and this book is the perfect guide in self-care for social workers who want to incorporate mindfulness into their working lives to positive effect. Looking after your mental health in your working life is so important so that you can do the best job you can and learning mindfulness is a great way to incorporate this. Studies have suggested that mindful social workers can have greater emotional awareness with less emotional reactivity, develop stronger interpersonal skills, and other valuable skills that are important for a relationship-based practice. The Mindful Social Worker gives the reader mindfulness guidance to not only improve themselves but also see how this can have an impact on their work. In this book, the reader will be provided with practice tools such as meditation and relaxation techniques to help the practitioner to be more present and have a stronger propensity to reflection. Case study reflection and self-assessments are also used in this book to enable any practitioner from students and the newly qualified to the experienced social worker or care professional. This is all done within the framework of professional standards for Social Work education and practice, showing how much mindfulness can relate to the social work profession.

Background Adolescence is a unique and distinct stage of development that involves changes in the physical, psychological and social aspects of adolescents. It is a critical transition into adulthood whereby heightened risk-taking and sensation-seeking takes place, such as substance abuse. In a South African context, this transition sometimes occurs under economic stress, poverty, unemployment, high levels of crime and political instability. This can place adolescents at risk of substance abuse. Objectives To explore and describe the lived experiences of adolescents abusing substances in the Greater Giyani Municipality in the Limpopo province, South Africa. Method A qualitative, exploratory, descriptive and contextual research design with a phenomenological approach was used. Data were collected through individual, in-depth, phenomenological interviews and field notes. Thematic coding was utilised to analyse the collected data, and literature was reviewed to support the findings. Moreover, measures to ensure trustworthiness and ethical principles were applied throughout the research process. Results Five themes were identified: substance abuse behaviour among adolescents, adolescents’ motivation for continuing substance abuse, the effects of substance abuse on the lives of adolescents, factors affecting adolescents’ discontinuation of substance abuse and a need to discontinue substance abuse. Conclusion The study concluded that adolescents abusing substances in the Greater Giyani, Limpopo province, experience loss of control, broken relationships, poor academic performance, stigma attached to mental illness and negative emotions. The adolescents foresaw their future as uncertain and without direction. It is recommended that mental healthcare professionals introduce and implement interventions that will assist the adolescents who abuse substances in the Greater Giyani, Limpopo province. Contribution The findings in this study could add knowledge in developing and implementing of strategies for psychiatric nurses to support adolescents abusing substances in the Greater Giyani, Limpopo province.

Mentally ill offenders face stigma, being perceived as both dangerous and unpredictable. This leads to social discrimination, which causes devaluation, distancing, and unequal treatment towards them. Critical and dismissive attitudes of healthcare professionals and police toward these patients undermine their care, treatment, and prospects for rehabilitation. This study investigated the attitudes and stereotypes of health professionals and police officers who frequently interact with mentally ill offenders. Participants completed three scales: Attitudes Toward Mentally Ill Offenders (ATMIO), Community Attitudes Toward the Mentally Ill (CAMI), and Familiarity Level Scale. The sample included 523 professionals, 283 health professionals, 139 mental health professionals, and 101 police officers, with an average age of 41.4 years and 40.3% having over 20 years of experience. Results showed that all groups displayed negative attitudes toward mentally ill offenders, with little variation between them. This highlights the need for professionals to recognize their biases when caring for this population.

Background Seclusion is an invasive clinical intervention used in inpatient psychiatric wards as a continuation of milieu therapy with vast behavioural implications that raise many ethical challenges. Seclusion is in Norway defined as an intervention used to contain the patient, accompanied by staff, in a single room, a separate unit, or an area inside the ward. Isolation is defined as the short-term confinement of a patient behind a locked or closed door with no staff present. Few studies examine how staff experiences the ethical challenges they encounter during seclusion. By making these challenges explicit and reflecting upon them, we may be able to provide better care to patients. The aim of this study is to examine how clinical staff in psychiatric inpatient wards describes and assess the ethical challenges of seclusion. Methods This study was based on 149 detailed written descriptions of episodes of seclusion from 57 psychiatric wards. A descriptive and exploratory approach was used. Data were analysed using qualitative content analysis. Results The main finding is that the relationship between treatment and control during seclusion presents several ethical challenges. This is reflected in the balance between the staff’s sincere desire to provide good treatment and the patients’ behaviour that makes control necessary. Particularly, the findings show how taking control of the patient can be ethically challenging and burdensome and that working under such conditions may result in psychosocial strain on the staff. The findings are discussed according to four core ethical principles: autonomy, beneficence, non-maleficence, and justice. Conclusion Ethical challenges seem to be at the core of the seclusion practice. Systematic ethical reflections are one way to process the ethical challenges that staff encounters. More knowledge is needed concerning the ethical dimensions of seclusion and alternatives to seclusion, including what ethical consequences the psychosocial stress of working with seclusion have for staff.

Mental health professionals form an important component of the response teams currently working in the Democratic Republic of the Congo to treat what is historically the second-largest Ebola outbreak. They provide psychological treatment to patients under extraordinary conditions, helping them cope with anxiety and the daily death of other patients.

This study explores Bangladesh’s mental health services from an individual- and system-level perspective and provides insights and recommendations for strengthening it’s mental health system. We conducted 13 in-depth interviews and 2 focus group discussions. Thirty-one participants were recruited using a combination of purposive and snowball sampling methods. All interviews and group discussions were audio-recorded and transcribed, and key findings were translated from Bengali to English. Data were coded manually and analysed using a thematic and narrative analysis approach. Stakeholders perceived scarcity of service availability at the peripheral level, shortage of professionals, weak referral systems, lack of policy implementation and regulatory mechanisms were significant challenges to the mental health system in Bangladesh. At the population level, low levels of mental health literacy, high societal stigma, and treatment costs were barriers to accessing mental healthcare. Key recommendations included increasing the number of mental health workers and capacity building, strengthening regulatory mechanisms to enhance the quality of care within the health systems, and raising awareness about mental health. Introducing measures that relate to tackling stigma, mental health literacy as well as building the capacity of the health workforce and governance systems will help ensure universal mental health coverage.

In the rural villages of the Sierra Madre region of Chiapas, women experiencing hardship show signs of emotional distress that are diagnosed as depression and anxiety by health professionals. In this study, we critically analyze the impact of a pilot mental health group intervention (Women’s Circles) facilitated by community mental health workers. The intervention consisted of eight structured sessions that included psychoeducation from a gender perspective, mindfulness exercises, interactive activities, arts and crafts, and sharing personal experiences. We carried out participant observation and 27 semi-structured interviews with the participants. The main outcomes were, first, that participants’ moods improved, and second, that the improvement was mainly due to gathering with others and having someone to talk to. In addition, we observed that lessons during the Circles were often prescriptive, which, rather than creating a space for reflection on personal experiences, imposed globalized views of mental health and gender. In sum, we describe both the positive impact this program had on mental well-being and the problematic spreading of psychoeducation.

In the line of duty, law enforcement officers are exposed to various stressors. Therefore, they are vulnerable to the onset of mental health disorders. Unfortunately, many officers in need may not readily seek out mental health assistance because of the stigma associated with mental illness that persists within the culture of law enforcement. Psychoeducation and a judgment-free environment can reduce the stigma surrounding mental health treatment. Though both mental health professional (MHP)-led programs and peer-led support programs for law enforcement do help, we argue that neither one on its own is enough to combat stigma and increase treatment access and adherence. Therefore, we argue that a model that incorporates both peer-led initiatives and the expertise of mental health professionals may help dispel stigma, increase trust, and increase service use among law enforcement officers. Following a discussion of the theoretical basis for a hybrid model, we describe the Texas Post-Critical Incident Seminar (PCIS) program as a real-world application of a hybrid model.