There are six literature review papers in this issue of Mental Health and Social Inclusion. The first is from Dawid Storman and colleagues from Poland. They looked at randomised controlled trials (RCTs) of the treatment of depression in primary care settings. They used the Template for Intervention Description and Replication (TIDieR) checklist to evaluate the 22 studies included in their review. Of 34 different interventions used in these studies, 19 were pharmacological with only two pure psychotherapy studies. Interestingly the same number looked at the effectiveness of herbaceous plants!
Dara Mojtahedi and his colleagues looked at burnout interventions for UK healthcare workers. Fifteen studies were chosen for more detailed analysis. They divided these into two groups. The first were self-awareness interventions, these covered mindfulness and other positive psychology interventions. They also reported on an interesting study which used art therapy with trainee doctors working in palliative care and oncology. The second group of interventions was skills acquisition training. These ranged from restorative clinical supervision to CBT-based approaches. They caution that more attention needs to be paid to the causes of staff burnout, which are often unhealthy work environments and overwork.
Rabia Haddad addresses a clinical issue rarely seen in this journal, that of trichotillomania. This is also known as hair pulling disorder characterised by recurrent and irresistible urges “to pull out one’s own hair, leading to noticeable hair loss, functional impairment and significant distress”. Rabia’s review focussed on 25 studies, 15 of which were RCTs. All the studies used CBT as the main intervention. Habit reversal training (HRT) is a key element of the CBT approach. This involves developing “[…] awareness of hair-pulling triggers and teaching the use of competing responses to interrupt the behaviour”. This approach goes right back to early work on behaviour therapy conducted by Nathan Azrin in the USA. Rabia concludes that both CBT and HRT are effective interventions for reducing hair pulling frequency and severity.
Recent issues of MHSI have featured papers from Professor Jairo Stefano Dote Pardo linked to economic factors and mental health. In this paper along with his co-author Jorge Valdebenito-Niesel, he continues this strand of research. These authors identified 14 papers that examined the link between financial behaviour and mental health. They conclude that financial literacy is strongly linked to mental well-being.
Two papers from India look at the issue of stigma. Siva and colleagues looked at papers, published between 1997 and 2025, some 738 publications. The peak year for papers was 2024, with 107 papers published that year. Of the three most cited studies in the field, two were British and one was American. The US produced 268 papers and the UK 110. The authors used bibliometric analysis. This is used increasingly to provide comprehensive overviews of different fields in mental health. It is disappointing not to see MHSI in the top 10 journals publishing papers on stigma. This is sure to change.
The second paper on stigma is by Ershad Hussain and Diptarup Chowdhury. They looked at culturally adapted anti-stigma interventions for substance use in India. Their scoping review could only identify three relevant studies. The need for such culturally adapted interventions can be justified in terms of gender, caste, religion, ethnicity and settlement. Programs need to look at local beliefs, concepts and social inequalities.
We have two case reports in this issue. The first is from Elly Davey. This is an autoethnographic account of the development of non-epileptic attack disorder, which came on after she had been knocked down by a car. Amazingly she only sustained only minor physical injuries. Not long after this she experienced fainting episodes, which turned into seizures. These started on a weekly basis, then daily, and then on multiple occasions every day. Eventually she was referred privately to Great Ormond Street Hospital, where her problem was finally diagnosed, and she was referred to a clinical psychologist. The seizures eventually stopped after a year in therapy. The story has a happy ending as the author went onto obtain a first-class honours degree in Psychology and hopes to train as an educational psychologist.
Jofin Joy in her case report looks at the effects of increasing militarisation of the Indian Ocean region and its effects on coastal communities. She comments on the geopolitical rivalries between China and India with their deceptively named “String of Pearls” strategy (China) and the Indian “String of Pearls” counter strategy. She presents data showing a steady increase in Perceived Stress scores amongst four coastal communities over the last decade. Jofin argues that inhabitants of The Maldives, Mauritius, Sri Lanka and the Andoman and Nicobar Islands, all experience persistent anxiety, identity dislocation, forced relocation and intergenerational trauma. Her paper is a timely reminder of the dangerous world we are all living in.
In the first of two Viewpoint papers, Poornima Viswanathan provides an autoethnographic account as a late-diagnosed autistic woman. She connects a number of her diary entries to the published literature on autism. She speculates, “Perhaps, I should have known considering that my training and career is in clinical psychology […]” When she was diagnosed with autism she showed little initial reaction. She highlights the problems many people with autism have in public spaces, bright lights, noise, too many people etc. She suggests that more attention needs to be paid to the needs of those with ADHD, trauma histories and autism into account, when designing public spaces. There is a lot of divergence within neurodivergence. She quotes Dr Stephen Shore in this regard, he stated, “If you’ve met one person with autism, you’ve met one person with autism”.
The second viewpoint paper is from S. Visalakshmi and colleagues on gender-based violence against transgender individuals. Violence against transgender people ranges from 7% to 89%, which is a staggering statistic. Transgenders “[…] experience pervasive social marginalisation and abuse by family, community members, intimate partners, police, educators, sex work clients, health care workers and other state actors perpetrated across the life span”.
There are four research papers in this issue. The first by Iona Burnell Reilly looks at how working-class academics experienced writing their autoethnography. She interviewed six academics who had written book chapters for her. All of the academics said that writing their own autoethnography had been a very helpful process and had enabled them to revisit previous painful episodes in their lives.
Madison White and Francois Potgeiter describe a low-cost intervention to try and reduce occupational burnout and improve mental well-being in a small Psychology Department with 12 staff. Tis intervention, “The Appreciation Station”, meant that staff could post positive comments about their colleagues on a shared staff space on the Intranet. These notes were then read out at staff meetings and posted onto a display board. Staff completed questionnaires before the intervention and again three months after is started. While there were no statistically significant differences, qualitative feedback was very good. There is a shortage of such positive initiatives in most services.
Francois Potgeiter reports on the use of HoNOS Secure as an outcome measure on three different low secure forensic wards. Some 30 residents were evaluated three times over a 12-month period. A number of improvements were noted, but these were not statistically significant. This version of the HoNOS scales has been modified to address specific issues around security, such as a “Need to escort on leave”. The last item showed the most positive change.
The final paper in this issue is from Dr Roz Austin. This is on the use of poetry to help manage the relationship voice hearers have with their voices. The paper features three case studies drawn from a larger study of 30 voice hearers. The author is one of the case studies. Writing a poem about your voices might be a different way of exploring the relationship each person has with their voices.
