We evaluated proportions of autism screening outcomes among adults accessing crisis mental health services in Sussex, UK, and examined associations with quality of life and joint hypermobility as an indicator of physiological complexity. Fifty-five participants (mean age 35.7 years, 56% male, 85% White) completed autism and hypermobility screening questionnaires and the Mental Health Quality of Life Questionnaire. Forty-three participants (78%) scored above screening threshold for autism, although only eight had a prior diagnosis, and 27% scored above the published autistic median. Higher Ritvo Autism and Asperger Diagnostic Scale (RAADS-14) scores were associated with lower quality of life (p < 0.001) and poorer well-being (p < 0.01). Those screening positive for hypermobility also had higher RAADS-14 scores (p = 0.01), suggesting a possible biological contribution to distress. Findings indicate high frequency of possible autism in crisis services and a need for tailored, biopsychosocially informed support.

Intelligent kindness has been proposed as a management model for reviving the UK welfare state and returning it to adequate functionality. Its goal, to deliver kindness as a core good, resembles that of the Liverpool Care Pathway (LCP), which sought to provide the compassion of hospice care across all end-of-life care, irrespective of setting. Analysis of the LCP’s eventual failure suggests intelligent kindness faces similar risks, which can be avoided. Distinguishing between providing and enabling kindness, managing the relationship between kindness, material and cognitive resources, having dedicated staff to champion it past the roll-out stage, concurrent research planning and implementation, and careful management of its scope and boundaries as it becomes more mainstream should protect it, and help it become established as part of UK welfare regulatory culture.

Neurodevelopmental and psychiatric disorders differ in onset and course but comorbidity between groupings is high. Diagnostically siloed services risk fragmented care, misdiagnosis, inefficiency and clinical risk. Such services also deskill clinicians and intensify waiting list pressures and budget competition. We propose more person-centric systems to reduce risk and improve outcomes.

The National Health Service (NHS) 10-year health plan for England calls for transformational changes to service delivery, encompassing three fundamental ‘shifts’: hospital to community, analogue to digital and sickness to prevention. This editorial reflects on the plan, the three shifts and their implications for mental health service provision across the life course.

National implementation of early intervention in psychosis offers a lens on sustaining evidence-based mental health reform at scale. Experience from England and Ireland highlights tensions between fidelity and flexibility, the centrality of capacity and the need for system-level leadership to protect core mechanisms and prevent dilution during national roll-out.

This opinion article looks at how autism services for children and young people are organised within child development and child and adolescent mental health services. Although both play vital roles, their responsibilities often overlap, which can lead to delays and uncertainty for families. Rising demand, limited resources and differing pathways have added further pressure, especially since the COVID-19 pandemic. The article highlights key challenges, including age cut-offs, gaps in continuity, the need for a collaborative integrated model, the impact of stigma and the difficulties faced by children whose main needs relate to developmental delay. It argues for clearer pathways and more coordinated care.

India’s Tele-MANAS (Tele Mental Health Assistance and Networking Across States) programme, launched in October 2022, is the world’s largest government-led tele-mental-health initiative. Operating via a multilingual 24/7 helpline, it provides stepped-care support, offering immediate counselling and escalating complex cases to psychiatrists or local services. In its first few years, Tele-MANAS has responded to more than 3.43 million calls across all Indian states and union territories. The majority of callers present with anxiety, depression or psychosocial stressors, while a critical minority report suicidal distress. Features such as linguistic inclusivity, anonymity and integration with India’s digital health ecosystem have driven rapid uptake, particularly among young adults. A World Health Organization (WHO) assessment has recognised Tele-MANAS as a scalable and equity-focused solution. The initiative illustrates how low- and middle-income countries can leverage technology and task sharing to reduce the treatment gap, offering a potential global blueprint for digital mental health care. This article aims to provide a programmatic overview of Tele-MANAS, including its design, early outcomes and key implementation challenges.

What can we learn from the principles of feminism that might improve care for our patients – of any gender? How can psychiatry address its historically difficult relationship with women, and what can we, as mental health professionals, consider doing differently in our everyday work? We discuss what psychiatrists might learn from the work of feminist theorists, and what we can do as a profession to create a feminist psychiatry. This includes acknowledging and owning our troubled history, pressing for gender-sensitive mental healthcare, promoting trauma-informed care that is focused on the importance of developing collaborative therapeutic relationships and improving our ability to listen.

A new service for adults with intellectual disabilities and mental health problems was developed in Qatar. However, numerous challenges were identified. In this paper, we reflect on the service development project, model of service delivery and achievements during the initial phases. The collaboration between government agencies to achieve improvement in the quality of life for this population was highlighted. Investment in training mental health staff to enhance their knowledge and skills in intellectual disability helped to facilitate improvement in care needs. An assessment was conducted on the service provision, and the results were reviewed to determine key priorities and offer recommendations. Local social and cultural perspectives highlighted requirements for improved understanding of the needs of the intellectual disability population and future service plans.

The protracted hostilities in Gaza have significantly affected the mental health of children and young people, many of whom have witnessed extreme violence. This article describes Qatar’s coordinated humanitarian and mental health response to the crisis, focusing on displaced youth from Gaza. The initiative includes trauma-focused care, integrated primary care and mental health services, safe accommodation and appropriate psychosocial support. Specialist mental health clinics were established, diagnosing post-traumatic stress disorder and other mental disorders in a significant proportion of children. Tailored psychological interventions were provided, alongside pharmacotherapy, where necessary. Qatar’s model offers a comprehensive and replicable approach for other humanitarian settings.

We always treat fluent language as a marker of intelligence and trustworthiness, often independent of factual accuracy. Large language models (LLMs) exploit this bias by producing confident, human-like texts that are perceived as intelligent and trustworthy, even when they lack accurate contextual understanding or are factually incorrect. This creates particular risks in mental healthcare, where communication, trust and context are central, and where errors are difficult to detect but highly consequential. This article examines how linguistic fluency shapes judgement, how LLMs amplify these effects and why their use in mental healthcare poses ethical and clinical dangers. It argues for strict limits on deployment, restricting LLMs to supervised, assistive tasks rather than clinical judgement.

People with complex emotional needs (CEN) often receive poor care and struggle to access the evidence-based therapy they require. As part of community transformation, the Help to Overcome Personal and Emotional problems (H.O.P.E) team in Northumberland, and the Relational and Emotional Difficulties Service (REDS) in Cambridge, were set up to ensure that people with CEN could receive timely therapy without accessing secondary or tertiary services. Both services focus on providing adapted versions of dialectical behaviour therapy (DBT). The present study aims to understand the process followed to establish the two teams, identify whether they have been able to deliver accessible and acceptable treatment, and reflect on shared learning points for other services to consider. The study provides descriptions of the two service designs, further to quantitative and qualitative feedback from participants that completed treatment with the services. The results confirm that people in Northumberland and Cambridgeshire who accessed the services found the therapy to be acceptable and reported significant improvement in their ability to regulate their emotions, a decrease in symptoms associated with CEN, and a greater sense of progress towards achieving meaningful goals in their lives. However, in line with the broader literature, a high number of people dropped out and did not complete the interventions. The results suggest that the H.O.P.E team and REDS are providing acceptable and accessible evidence-based treatment for people with CEN. Reflections for future services to consider regarding reducing drop-out rates, the length of treatment, inclusion criteria, engaging people from minority groups and the use of online vs face-to-face therapy are provided.

Key learning aims

1. (1) Understand the process followed to establish two different CEN services in primary care settings.

2. (2) Identify whether two CEN services have delivered accessible and acceptable treatment.

3. (3) Compare how two CEN services are structured, and highlight shared learning points for other services.

Over the past two decades, the number of academic psychiatrists in the UK has declined by more than a third, despite an expansion in medical schools and growth in most other medical academic specialties. Drawing on direct experience of establishing a new academic unit, we argue that the long-term sustainability of academic psychiatry departments is critical for service quality, innovation and talent development. This paper outlines the structural, cultural and strategic factors needed to create academic units that endure and flourish beyond individual careers, enabling better integration of research and clinical practice.