Despite the existence of effective public mental health (PMH) interventions, only a minority across the European region receive treatment for mental health conditions (MHCs). Even fewer receive interventions to prevent MHC-associated impacts, with negligible coverage of interventions to prevent MHCs, or promote mental well-being and resilience. Various reasons account for implementation failure which breaches the right to health and results in population scale preventable suffering, broad impacts and associated economic costs. Public mental health involves a population approach to improve coverage, outcomes and coordination of PMH interventions. Required actions to scale up PMH implementation include effectively making the case through assessment of PMH need, highlighting economic impacts of PMH implementation failure and improved coverage, and coordinated advocacy and leadership. Public mental health practice involves the use of PMH needs assessment to inform choice of interventions, policy development, and required coverage and resources for effective PMH intervention delivery by different sectors. This is supported by the collection of PMH-relevant data. Further actions to scale up PMH implementation include adopting human rights-based approaches and legislation, PMH training to different sectors and improved population PMH literacy, maximizing existing resources, settings-based and integrated approaches, use of digital technology, prioritizing interventions with large population impact, and implementation-focused research. Scaled up PMH implementation results in broad population impacts, achievement of a range of policy objectives, sustainable reduction in impacts of MHCs and promotion of mental well-being across the population of the European region. Associated economic savings also make PMH practice an essential part of sustainable economic development.

Tic disorders are common neurodevelopmental conditions in children and young people. However, although evidence-based support and interventions exist, families often struggle to access these for their children, in part due to a lack of assessment and treatment pathways in UK healthcare services. This article describes a quality improvement project involving the development and implementation of a tics pathway in a generic children and young people’s mental health (CYP MH) service in the UK. This process included building appropriate knowledge, skills and confidence in the team; designing and implementing a pathway, including assessment/diagnosis, provision of psychoeducation/resources, as well as further group and individual treatment where needed; and reflecting on and adapting the process with the support of specialist consultation. The introduction of the tics pathway has resulted in reduced waiting times in all areas of the pathway for those referred to the service, including assessment, diagnosis and the provision of evidence-based support. Feedback from children, young people and families has been very positive. This paper demonstrates that with minimal training and consultation, it is possible for a generic CYP MH service to assess and provide evidence-based resources and support for those referred with tic disorders. It is hoped this paper will provide a model of service delivery that can be utilised by other services, enabling them to support families within their local communities and make a meaningful difference in the lives of children, young people and their families.

Key learning aims

1. (1) To raise awareness about the prevalence of tic disorders in children and young people, and the existence of effective evidence-based support and treatment.

2. (2) To highlight challenges faced by families seeking timely and local diagnosis and support.

3. (3) To provide a model of service delivery for the evidence-based assessment and treatment of tic disorders in a generic CYP MH service that can be utilised by other services.

4. (4) To demonstrate that the development and implementation of a tics pathway can be straightforward, cost-effective, and hugely beneficial to children, young people and families.

5. (5) To inspire other CYP MH services to provide support of this kind, thus increasing the provision of timely support for children, young people and families with tic disorders in their local communities.

Large-scale quality improvement programmes (QIPs) have diverse factors that may influence their success and can undergo rapid changes throughout their lifecycle. The COllaboratioN on QUality improvement initiative for achieving Excellence in STandards of COPD care (CONQUEST) programme has recently been implemented in primary care practices in the UK. The CONQUEST programme aims to identify patients with already diagnosed and undiagnosed COPD at high risk of COPD-related adverse outcomes and optimize their management. CONQUEST has been successful in identifying COPD patients who may represent an outsized opportunity to improve patient outcomes and healthcare utilization, whilst focusing on relatively few patients per primary care practice. This paper reviews the steps involved in implementing CONQUEST in the UK, focussing on the challenges encountered, the solutions used to overcome these challenges barriers, and the lessons learned for the implementation of QIPs more widely. Key lessons from this process include that QIPs need to be designed with the flexibility to adapt to multiple and different local contexts, that early monitoring of data across the lifecycle of a QIP allows efficient detection of issues and troubleshooting, and that planning for allocation of limited resources to a QIP is essential for real-world implementation. The problems and solutions described here are applicable to QIPs in a wide variety of high-risk diseases and different healthcare settings.

The Mental Treatment Act 1930 amended the Lunacy Act 1890 for England and Wales. It sought to make access to treatment for mentally unwell people more accessible and less stigmatising. The 1930 Act introduced ‘voluntary’ patient status, permitting any adult to seek early treatment for their mental symptoms, rather than waiting until they were legally ‘certifiable’ as insane. The Act also created a new category of ‘temporary’ treatment without certification, which was conceptually challenging to understand and awkward to put into practice.

This paper explores the implementation of the 1930 Act over its first five years. It draws on national and London County Council archival sources to gain insights at all levels of implementation.

Implementation was a vast undertaking. Considerable cultural adaptation was necessary among those providing services in the community and in institutions. Culture shift was slow, as is common when new interventions are perceived to be more liberal and potentially riskier than tried and tested methods.

In the context of the Great Depression, the Act faced competition with other societal and healthcare needs. These matters appeared as influential as whether the Act’s directives were mandatory or optional. Lessons from this episode may help inform processes for implementing new mental healthcare legislation in the twenty-first century.

Despite empirical support for cognitive behavioural therapy in the treatment of eating disorders (CBT-ED), real world adherence to CBT-ED is poor. The current study assessed the extent to which clinicians’ intolerance of uncertainty and attitudes towards evidence-based practice (EBP) are associated with adherence to CBT-ED. Licensed mental health clinicians (n = 221) who self-identified as having treated >4 patients with EDs in the past year completed the Intolerance of Uncertainty Scale (IUS), EBP Attitude Scale (EBPAS), and reported the percentage of patients with whom they used 15 CBT-ED techniques. Most clinicians (>55%) reported using cognitive-related techniques with >90% of patients, whereas less than half (<42%) reported using behavioural-related techniques with >90% of patients; only 7% reported regularly weighing >90% of patients. IUS was negatively and EBPAS was positively associated with adherence to CBT-ED techniques. There was a significant interaction between IUS and EBPAS, such that clinicians with favourable attitudes towards EBP reported high adherence regardless of their intolerance of uncertainty, whereas IUS was associated with lower adherence among clinicians with unfavourable attitudes towards EBP. Clinical training that fosters positive attitudes towards EBPs, particularly among clinicians with high intolerance of uncertainty, may improve CBT-ED adherence.

Key learning aims

1. (1) Clinicians indicated less adherence to behavioural than to cognitive components of cognitive behavioural therapy for eating disorders (CBT-ED).

2. (2) Clinician intolerance of uncertainty was associated with less adherence to CBT-ED.

3. (3) Clinicians’ attitude towards evidence-based practice buffers the association of clinician uncertainty intolerance with adherence to CBT-ED,

Violence risk is elevated during the early phase of psychosis and can have significant consequences for engagement, recovery, and safety. BRAVE (Behavioral Response Against Violence Engagement) is a cognitive-behavioural intervention adapted from the PICASSO model for use in early intervention services (EIS) that targets dynamic, modifiable mechanisms associated with psychosis-related violence. This open pilot trial evaluated the feasibility, acceptability, fidelity, and preliminary target engagement of BRAVE when delivered by clinicians within routine EIS care. Seven clinician–client dyads were enrolled across OnTrackNY sites; five completed the intervention, with a mean of 11.4 sessions. Feasibility and acceptability were high: clinicians rated BRAVE as useful and deliverable within standard visit structures. Fidelity ratings were high across both clinician and client checklists. Although violent behaviour was infrequent at baseline, exploratory clinical outcomes suggested reductions in violent ideation over time. The primary hypothesized mechanistic target, impulsivity, remained stable but secondary mechanistic outcomes showed directionally positive movement across the affective, cognitive, behavioural, and physiological domains expected to shift with BRAVE, including reductions in hostility, negative self-appraisal, persecutory thinking, substance use, and sleep disturbance, alongside increased coping self-efficacy. Overall, findings indicate that BRAVE can be implemented with high fidelity and strong acceptability within participating clinician–client dyads in EIS settings, and offer preliminary descriptive patterns consistent with the hypothesized mechanistic model.

Key learning aims

1. (1) To describe how BRAVE was adapted for early intervention services (EIS) and delivered by clinicians within routine care, including considerations of feasibility, acceptability, and fidelity.

2. (2) To summarize descriptive, pre–post observations from an open pilot trial of BRAVE, including changes in impulsivity and related affective, cognitive, behavioral, and physiological processes.

3. (3) To identify implications for future implementation and evaluation, including lessons learned about fidelity measurement, patient-facing materials, and considerations for a larger pragmatic trial.

As trauma-informed care (TIC) becomes more integrated into healthcare systems, consistent and meaningful evaluation remains limited. Educational interventions are central to implementation, yet outcome measures vary widely. This scoping review systematically mapped outcome measures used to evaluate TIC educational interventions in healthcare settings to identify current practices, methodological gaps and opportunities for more coherent and context-sensitive assessment. The review followed PRISMA-ScR guidelines. Five databases (MEDLINE, EMBASE, PsycINFO, CINAHL, ERIC) were searched from database inception to October 2024. Eligible studies described TIC educational interventions for healthcare providers and reported at least one outcome related to knowledge, attitudes, confidence, competence, or behavior. Two reviewers independently screened and extracted data on study design, participants, intervention characteristics and outcome measures. Outcomes were categorized using Moore’s Expanded Outcomes Framework, which includes seven hierarchical levels from participation to patient or community health outcomes. Twenty-eight studies met inclusion criteria, most published after 2020 and conducted in the United States. Outcome measurement was dominated by self-reported data, primarily custom pre–post surveys assessing knowledge, confidence or attitudes. Only eight studies used validated tools, most commonly the ARTIC-35 or ARTIC-45. Few assessed behavioral or system-level change, and none directly measured patient outcomes. Educational formats ranged from brief online modules to multi-session interdisciplinary trainings. A small subset explored relational or equity-oriented outcomes such as empathy or cultural humility, often using qualitative methods. This review highlights the field’s reliance on short-term, self-reported outcomes and limited use of validated or standardized measures. Developing accessible, equity-informed tools that capture behavioral and system-level change is essential to advance research, guide policy and sustain trauma-informed transformation across healthcare systems.

Rural and low-socioeconomic status women face social determinants of health barriers leading to disproportionately low rates of breast cancer screening and markedly reduced participation in clinical trials. To address this gap, we developed the WeCARE (Women’s Engagement for Cancer Awareness, Resources, and Education) intervention using a community-engaged approach. This paper describes how Community Advisory Board feedback informed the development of Mayo Clinic Health System’s WeCARE intervention components. Their input was systematically analyzed using the Consolidated Framework for Implementation Research (CFIR 2.0) to identify determinants of acceptability, appropriateness, and feasibility and to guide actionable refinements to intervention content and delivery.

The Health Technology Assessment International (HTAi) 2025 annual meeting featured three main plenaries to explore next-generation (NextGen) evidence in health technology assessment (HTA). In this commentary, we capture the discussions of Plenary 2: NextGen Methods: Hype or Here to Stay? Each plenary panelist was tasked to convincingly debate the need, rigor, and implementability of one of three emerging method domains in HTA: (1) Environmental Sustainability, (2) Adaptive HTA, and (3) Artificial Intelligence (AI)-enabled Real-World Evidence (RWE). The three panelists convincingly debated that their method would endure beyond initial hype; all three methods were perceived to have a moderate to high level of need, rigor, and implementability by the audience. Key questions from the audience included a request for examples of where HTA reviews have considered environmental sustainability, a challenge for adaptive HTA to embrace other value elements outside of cost-effectiveness, and a question about how the human-in-the-loop principle fits into AI-driven RWE and what this means for HTA agencies that are already stretched for resources. In this commentary, we summarize the presentations, discussions, and audience engagement to provide readers with accessible insight into the debate about which method(s) are anticipated to endure beyond their initial hype.