Mental Health Foundation

Healing Traumas to Redefine Relationship Intimacy: A Journey from Fear to Safety explores how past emotional wounds and traumatic experiences influence intimacy, trust, and connection in adult relationships. Many individuals carry unresolved trauma that affects how safe they feel with others, often leading to fear, emotional distance, or repeated relationship difficulties. This book brings together insights from psychology, counseling, trauma studies, and attachment theory to explain how trauma shapes relationship patterns. The chapters discuss trauma bonds, emotional safety, communication challenges, and the process of healing within intimate relationships. Practical perspectives are offered to help individuals and professionals understand pathways toward rebuilding trust, emotional closeness, and healthy boundaries. By focusing on healing and growth, this book emphasizes that recovery from trauma is possible. It is intended for mental health professionals, researchers, students, and readers interested in understanding relationships through a trauma-informed lens. The book aims to encourage compassion, self-awareness, and the creation of safer, more fulfilling relationships.

Depression is a significant yet underexplored mental health concern among older adults in Pakistan, where cultural stigma and limited institutional support often hinder diagnosis and care. This study aimed to examine the relationship between perceived mastery and depressive symptoms among older adults in urban Lahore, while assessing the moderating influence of gender and living arrangements. Using a quantitative, cross-sectional design, data were collected from 100 participants aged 55–75 years through purposive sampling. Two standardized instruments, the Geriatric Depression Scale–Short Form (GDS-SF) and the Pearlin and Schooler Mastery Scale, were administered alongside a pilot-tested Perceived Institutional Mastery Index (PIMI). Data were analyzed using SPSS (Version 27) through descriptive statistics, Pearson correlation, t-tests, and linear regression. Results indicated a significant negative correlation between mastery and depression (r = –0.45, p < .001), with lower mastery among women and institutional residents. The study concludes that Mastery serves as a key protective psychological factor against depression in older age. It recommends developing gender-sensitive and autonomy-enhancing mental health programs and integrating mastery-based interventions into community and institutional care to improve geriatric well-being in collectivist societies.

BackgroundDialectical Behaviour Therapy (DBT) combines cognitive-behavioural techniques and mindfulness practices to more skilfully regulate intense emotions and navigate interpersonal issues. While traditional DBT (skills group, individual therapy and crisis support) is well-studied in clinical populations, particularly for emotion regulation in conditions like borderline personality disorder or emotionally unstable personality disorder, recent research has explored alternative formats, such as skills-only groups. Although quantitative studies report positive outcomes (e.g., reduced self-injury and suicidality), less is known about patient experiences, which are crucial for developing effective interventions. This systematic review explored patient experiences of DBT skills groups across mental health conditions and age groups, considering the processes patients perceived as contributing to therapeutic change and outcomes.MethodA systematic search was conducted across five databases following PRISMA guidelines, using search terms related to DBT and patient experience. Peer-reviewed papers employing qualitative or mixed-methods were included. Thematic synthesis was used for analysis.ResultsThirty-two papers were eligible for inclusion. Three main themes were generated: 1) the challenging road to DBT, 2) the difficult journey through DBT, and 3) patients’ path for the future. Theme two contained three sub-themes (from theory to practice, transformative relationships - self and others, scaffolding and supporting change) and theme three included two sub-themes (therapeutic gains, future directions).ConclusionsFindings highlight the importance of pre-treatment and in-treatment experiences alongside relational factors like safety and validation and practical skill application. Key processes, including peer support and changed perspectives, shape therapeutic outcomes. Recommendations include flexible delivery formats and aligning patient preferences with intervention to maximise gains.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/login, identifier PROSPERO (CRD42024604496).

ABSTRACTDigital health technologies' potential to democratize healthcare access appears constrained by implementation challenges that may reproduce existing inequities. This paper examines systemic barriers potentially impeding translation, suggesting prevailing frameworks inadequately address structural determinants. Despite substantial investment, limited FDA approvals for digital‐derived endpoints indicate possible regulatory‐innovation disjunctures, while constrained funding and incomplete reimbursement structures systematically exclude essential services. We propose a precision implementation framework repositioning implementation science as integral to technological development, potentially challenging linear translational paradigms. This approach emphasizes examining sociotechnical systems, organizational readiness variations, and community‐specific contexts. Whether digital health mitigates or exacerbates disparities likely depends on reconceptualizing implementation as socio‐organizational transformation requiring regulatory harmonization, sustainable economic models, and equity‐centered engagement.

Purpose: While growing evidence highlights the challenges faced by autistic females during diagnostic assessments, it remains unclear how well this research is applied in clinical practice. This study aimed to gather consensus among clinicians on recommendations for autism assessments to improve diagnostic validity for cis-gendered females. Method: A three-round Delphi study was conducted with registered healthcare professionals experienced in conducting autism diagnostic assessments with females. Results: Thematic analysis of Round 1 responses identified five themes: Attributes of the Assessor, Post-Clinical Qualification Education and Learning, Diagnostic Tools, Questions Asked, and Sources of Information. These themes produced 28 statements evaluated in Rounds 2 and 3. Eighteen reached 80% consensus in the final round. Experts emphasized the important of assessors having strong knowledge of research into autism in women, co-occurring conditions, other developmental conditions, and masking. Ongoing professional development on autism in women was considered essential and it was recommended that new assessors shadow female assessments. Experts agreed the ADOS-2 is not always useful for females, whereas screening tools can provide valuable narrative insights, though these need to be interpreted carefully due to potential male bias. Experts supported including more prompts to explore subtle differences in social communication and repetitive patterns of behaviour and stressed the importance of masking behaviours and experiences across different relationships. Masking should also be considered when interpreting informant information. Conclusions: Findings reveal inconsistencies in how clinicians consider sex-related factors in autism assessments, highlighting the need for formal guidance. The next steps will be to develop this guidance, incorporating research evidence, the perspectives of autistic women and girls, and Delphi results. This aims to improve the experience, and accuracy of diagnosis for girls and women undergoing autism assessment, increasing consistency across services, and supporting clinicians.

Purpose This paper aims to share ideas and innovative approaches that help to tackle the “demand/supply” gap currently experienced by mental health services, particularly interventions with a specific focus on tackling significant health inequalities and improving mental health outcomes for families and children. Design/methodology/approach This paper provides detail on applying a task sharing model, informed by a four-year Trans-Atlantic learning partnership funded by the EU Horizon 2020 research programme. The model is applied to an intervention “Together to Thrive” delivered in Dundee, Scotland with learning from the Connections to Care programme delivered in New York City. Findings Together to Thrive is in its early days of development. The scope of the challenge is significant with referrals to CAMHS continuing to increase resulting in long periods on waiting lists, increased rejected referrals and families continuing to struggle often leading to crisis. New innovative ways of working need to be explored. and the application of a task sharing model offers some promise. Research limitations/implications There continue to be gaps in our knowledge about the task sharing model, particularly in the way it has been applied within Together to Thrive, i.e. as an “enhancement”. A current external evaluation into impact will provide some insight into how it is experienced by families. In the longer term, a data linking comparison study to gain insights into the journey of families on CAMHS waiting lists who receive support from Together to Thrive, compared with those who do not, would be worthwhile further study. Practical implications Further operational insights are needed particularly when funding cuts mean a lack of capacity at a systems level making even the trialling of innovations a challenge. Originality/value This paper offers an original insight into the application of the core principles of a task sharing model, with a focus on increasing capacity for mental health improvement, to enable parents and children to access more timely and appropriate support. It draws on learning from Connections to Care and how this has been applied in a very different context through the Together to Thrive programme.

Aims: Presented is a 33-year-old gentleman with a diagnosis of emotionally unstable personality disorder (EUPD) well-known to mental health services, including inpatient, community, liaison, and psychological care teams, with a long-standing history of self-harm and suicide attempts, which included deliberately placing himself in high-risk public areas which have at times resulted in detention under mental health legislation.Methods: Over the past several years, this gentleman has fabricated claims of a cancer diagnosis, terminal prognosis, and multiple surgical procedures – assertions refuted by his medical records – while leveraging these falsehoods on social media and through a crowd sourcing campaign to raise funds by misrepresenting his physical health. Furthermore, he has strategically leveraged medical admissions to access medications, including strong analgesics and for a self-reported diagnosis that remains unverified.During conducted assessments, he has expressed a desire for psychological therapy and enhanced crisis support yet consistently avoids engaging with the planned, regular support offered by teams who are familiar with his history, including appointments scheduled after episodes of self-harm.While services have considered a factitious component in his presentation others contest it aligns more strongly with malingering. Consensus with professionals is that given his presentation there are difficulties in developing and maintaining a safe therapeutic relationship due to his disingenuity, threats of complaints, and his active avoidance of any meaningful, structured, recovery-focused work.Results: Factitious disorder is driven by an internal need to assume the sick role and receive attention or care, with patients intentionally producing symptoms rooted in psychological need rather than for external rewards where the behaviour is characterized by a willingness to undergo invasive tests and treatments, reinforcing their patient identity. Factitious disorder is recognised as a psychiatric diagnosis warranting treatment, whereas malingering is motivated by external incentives and is not considered a mental illness but rather a behavioural strategy. Individuals who malinger tend to avoid procedures that might expose their deception and selectively engage in behaviours that yield tangible benefits.Conclusion: This case underscores the importance of comprehensive, multidisciplinary assessments in achieving accurate diagnoses by clarifying key differences in motivation, behaviour, and clinical classification. Enhanced diagnostic clarity not only improves patient care, but also safeguards healthcare resources. Despite evident secondary gains in this case, the long-standing emotional instability and interpersonal dysfunction associated with EUPD still necessitate a balanced, empathetic therapeutic approach.