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Objective: Mental health promotion and primary prevention have been evident in government policies in recent decades and this focus may also be visible in response to the COVID-19 pandemic. However, there has yet to be a review of promotion and prevention in current mental health plans in relatively high-income countries with small populations. The objective of this review was to analyse recent government mental health plans in relatively high-income countries with small populations in order to compare and contrast their plans on promotion and prevention. Method: The review focussed on mental health policies, strategies or action plans published in English between 2017 and 2020 in Finland, New Zealand, the Republic of Ireland, Scotland and Wales. The research team developed an analytical framework for the review based on online interviews with policy and mental health experts and WHO guidance. Individual plans were then reviewed against the policy framework to produce an analysis in table form which provided the basis for a narrative discussion of developments. Results: There is evidence of attention in current mental health plans to ‘whole of population’ mental health and prevention which suggests a consensus on the need for action at this end of the spectrum. The extent of commitments to prevention and to reducing inequalities in mental health varies and is evidenced by commitments to cross-departmental structures for action on mental health and dedicated actions to reduce inequalities. Discussion: The results of this review can help to inform the development of national mental health policies.

Erworben im Rahmen der Schweizer Nationallizenzen (http://www.nationallizenzen.ch), Introduction: The coronavirus disease 2019 (COVID-19) pandemic increased multiple risk factors for mental health. Evidence-based, intersectoral public mental health responses are therefore critical. The primary aim of this study was to collate public mental health responses from across Europe. Methods: We conducted a cross-sectional survey in March 2021. Participants were public and mental health professionals from across Europe. We developed an online instrument exploring five domains: changes in mental health supports during the pandemic; mental health support for vulnerable groups; multi-sectoral and service-user involvement; published mental health response plans; and perceived quality of overall country response. Results: Fifty-two individuals from 20 European nations responded. Reported changes in mental health supports included an increase in online mental health supports (n = 18); but no change in long-term mental health funding (n = 13); and a decrease in access to early interventions (n = 9). Responses indicated mental health support for vulnerable groups was limited, as was multi-sectoral and service-user involvement. Few national mental health response plans existed (n = 9) and 48% of respondents felt their countries mental health response had been ‘poor’ or ‘very poor’. Conclusions: Our results give insights into the changes in mental health support at a country level across Europe during the COVID-19 pandemic. They indicate countries were not prepared to respond and people with existing vulnerabilities were often neglected in response planning. To be prepared for future pandemics and environmental disasters Public Mental Health preparedness plans are highly needed. These must be developed cross-departmentally, and through the meaningful inclusion of vulnerable groups.

Introduction Amongst its advocates, one of the key arguments for a Universal Basic Income (UBI) is its potential to improve population mental health. However, while previous authors have variously examined the potential effects of UBI on income, employment and labour market demand, the direct mental health consequences of previous pilots have been less frequently examined. The purpose of this paper is therefore to conduct a review of the literature on UBI and to re-examine the existing research with a mental health focus. Methods Six electronic databases were used to conduct a review of the literature. We searched for empirical research studies of any design, conducted since the year 2000 in High Income Countries, exploring the effects of interventions similar to a UBI on the mental health of children or working-age adults. Grey literature and government reports were also included. Results A total of 1566 articles were screened of which seven peer reviewed studies and eight governmental reports were ultimately selected for inclusion. None of the identified studies directly compared the impact of individual payments with those made on a household basis, or the effects of payments which were truly universal. However, several studies evaluated the mental health outcomes associated with payments provided unconditionally, and consistently reported clear and significant improvements in mental wellbeing. Potential mediating factors included improved time with family and friends, a reduction in perceived stigma and a renewed sense of hope for the future. Conclusions Our review has produced evidence to suggest that prophesies surrounding the mental health benefits of a UBI are at least partially justified. However, future studies should aim to be conducted at an area level, with an adequately powered sample size, and investigate interventions of a considerable duration using a longitudinal design.

The COVID-19 pandemic has affected people’s physical and mental health. Quarantine and other lockdown measures have altered people’s daily lives; levels of anxiety, depression, substance use, self-harm and suicide ideation have increased. This commentary assesses how international governments, agencies and organisations are responding to the challenge of the mental health impact of COVID-19 with the aim of informing the ongoing policy and service responses needed in the immediate and longer term. It identifies some of the key themes emerging from the literature, recognises at-risk populations and highlights opportunities for innovation within mental health services, focusing on the published academic literature, international health ministry websites and other relevant international organisations beyond the United Kingdom and Ireland. COVID-19 has challenged, and may have permanently changed, mental health services. It has highlighted and exacerbated pre-existing pressures and inequities. Many decision-makers consider this an opportunity to transform mental health care, and tackling the social determinants of mental health and engaging in prevention will be a necessary part of such transformation. Better data collection, modelling and sharing will enhance policy and service development. The crisis provides opportunities to build on positive innovations: the adaptability and flexibility of community-based care; drawing on lived experience in the design, development and monitoring of services; interagency collaboration; accelerating digital healthcare; and connecting physical and mental health.

ObjectivesThere has been speculation on the impact of the COVID-19 pandemic and the associated lockdown on suicidal thoughts and self-harm and the factors associated with any change. We aimed to assess the effects and change in effects of risk factors including loneliness and coping, as well as pre-existing mental health conditions on suicidal thoughts and self-harm during the COVID-19 pandemic.DesignThis study was a repeated cross-sectional online population-based survey.Participants and measuresNon-probability quota sampling was adopted on the UK adult population and four waves of data were analysed during the pandemic (17 March 2020 to 29 May 2020). Outcomes were suicidal thoughts and self-harm associated with the pandemic while loneliness, coping, pre-existing mental health conditions, employment status and demographics were covariates. We ran binomial regressions to evaluate the adjusted risks of the studied covariates as well as the changes in effects over time.ResultsThe proportion of individuals who felt lonely increased sharply from 9.8% to 23.9% after the UK lockdown began. Young people (aged 18–24 years), females, students, those who were unemployed and individuals with pre-existing mental health conditions were more likely to report feeling lonely and not coping well. 7.7%–10.0% and 1.9%–2.2% of respondents reported having suicidal thoughts and self-harm associated with the pandemic respectively throughout the period studied. Results from cross-tabulation and adjusted regression analyses showed young adults, coping poorly and with pre-existing mental health conditions were significantly associated with suicidal thoughts and self-harm. Loneliness was significantly associated with suicidal thoughts but not self-harm.ConclusionsThe association between suicidality, loneliness and coping was evident in young people during the early stages of the pandemic. Developing effective interventions designed and coproduced to address loneliness and promote coping strategies during prolonged social isolation may promote mental health and help mitigate suicidal thoughts and self-harm associated with the pandemic.

This paper reports on exploratory, qualitative research conducted with eight people with experience of mental health treatment about their understanding of decision-making capacity. While acknowledging that there are times when mental or emotional distress can interfere with the capacity to make decisions, participants described how their capacity can be reduced by a set of social and environmental factors. These factors include the lack of treatment options available from which to choose, lack of trust of the information provider, inaccessible information, the effects of medication that literally ‘stops your ability to think’, lack of empathy with mental or emotional distress, and lack of time to process information. Participants highlighted the issue of power and powerlessness when describing how incapacity is determined within mental health services. Participants’ articulations of capacity in relation to mental health are in accord with a social model of disability approach to capacity.

The term ‘empowerment’ is in danger of becoming an empty concept in the field of mental health. In the mental health literature, political empowerment has been taken over by a usage referring to personal self‐development, while efforts to increase service user power have largely been directed at the mental health services. Still, the term has the potential to provide an important communicative function within the mental health movement. There is a need to connect the term ‘empowerment’ to a relevant power theory. In this article, I draw on Hannah Arendt's conception of power which explains how political power grows. From an Arendtian perspective, empowerment can be defined as rooted in collective, public, political action. This conceptual clarification helps to distinguish activities focussed on increasing an individual's self‐confidence and skills from those that aim at changes in power relations.