Involuntary psychiatric detentions have been increasing in Ontario, raising concerns about patient rights and health equity. Social determinants such as immigration status, indigeneity, housing instability, and socioeconomic disadvantage are known to contribute to this trend. However, population-level evidence on how these factors influence involuntary admissions remains limited. Using data from the Ontario Mental Health Reporting System (2013-2023), the authors analyzed 53,088 adult psychiatric detentions. Sociodemographic and clinical variables from the Resident Assessment Instrument-Mental Health were assessed by logistic regression, adjusted for age, sex, psychiatric diagnosis, and previous psychiatric admissions. Joinpoint regression was used to evaluate temporal trends. Involuntary admission and psychiatric assessment accounted for 28.2% and 25.2% of hospitalizations, respectively. Recent and long-term immigrants had significantly higher odds of involuntary admission (adjusted OR [AOR]=1.37 and 1.51, respectively). Indigenous identity was associated with increased odds of psychiatric assessment (AOR=3.06) but not involuntary admission. Postsecondary education lowered the risk for involuntary psychiatric admission (AOR=0.84). Homelessness and no income were associated with increased odds of psychiatric assessment (AORs=1.73 and 1.11, respectively) and with involuntary admission (AOR=1.87 and 1.43, respectively). Recent and long-term immigrants also had lower odds of psychiatric assessment (AOR=0.81 and 0.95, respectively). Annual involuntary admission rates increased by 3.3% over the decade. Immigrants, homeless individuals, and those with lower education or income face disproportionate risks for involuntary psychiatric detention in Ontario. Policies that address upstream social determinants, such as housing and income support, and ensure culturally safe preventive care are needed to reduce coercion and promote equity.

The aim of this study was to analyze the supply, demand, and adequacy of psychiatrists serving adults (PSAs) in the United States. The authors performed a cross-sectional analysis of full-time equivalent (FTE) PSAs, using the Health Workforce Simulation Model. Supply was defined as the number of FTE physicians, demand as the number of FTE physicians needed under status quo and improved access scenarios, and adequacy as supply over demand. From 2024 to 2037, the national supply of PSAs was projected to decrease by 12.3% (p<0.001), whereas demand was projected to increase by 43.7% (p<0.001). As a result, PSA workforce adequacy was projected to decrease under status quo (from 70.2% to 42.8%, p<0.001) and improved access (from 49.3% to 29.3%, p<0.001) scenarios. Critical PSA workforce shortages were identified, including states affected the most severely. Efforts in education and government are needed to improve PSA workforce adequacy.

The authors assessed the impact of a program in Austin that embedded behavioral health clinicians in a 911 call center. An observational study design consisting of a treatment and a comparison group was used to estimate the impact of the program on peace officer emergency detentions (POEDs), arrests, use of force, and officers' time on scene. The unit of analysis was the 911 call. Data included all 911 calls between December 2019 and February 2025 that were operator identified as eligible for live transfer to an embedded clinician. The treatment group (N=16,264) comprised calls that were transferred to a clinician; the comparison group (N=4,365) comprised calls that arrived when the clinicians were unavailable and so a live transfer was not possible. Analyses adjusted for call timing and location revealed that the program significantly reduced the likelihood of a POED (adjusted OR [AOR]=0.57, 95% CI=0.48-0.68) and an arrest (AOR=0.65, 95% CI=0.43-0.98), as well as the average length of officers' time on scene (25.8 minutes, p<0.001). Evidence of the impact on the likelihood of officers' use of force was mixed. Embedding behavioral health professionals in a 911 call center provides important public health and public safety benefits, mainly by reducing the likelihood of involuntary detentions and arrests, as well as officers' average length of time on scene.

The rising prevalence of mental health crises in the United States highlights the need for innovative care models. One such model uses faculty from an academic medical center to staff rural inpatient psychiatric units via telepsychiatry. This column reviews such a partnership within an affiliated health system (in-person care: N=1,064; virtual care: N=722). The authors highlight changes in unit workflow and review administrative, financial, and satisfaction outcomes. The findings suggest that telepsychiatry might provide an effective approach to extending high-quality inpatient psychiatric care to underserved rural populations, offering a viable solution to psychiatric provider shortages. Further research is necessary to confirm these findings.

Provision of psychotherapy during medication management checks has decreased, despite its benefits. The authors evaluated the feasibility and acceptability of integrating recovery-oriented cognitive therapy (CT-R) into psychiatric medication management visits for individuals with schizophrenia spectrum disorders through the Increasing Medication Check Participation Through Applying CT-R (IMPACT) program. All participants who started IMPACT (N=22) completed the 12-month treatment. Study psychiatrists provided elements of CT-R in 74% of sessions. Patients had significant improvements in overall symptoms (Cohen's d=0.83) and social functioning (Cohen's d=0.88) and a moderate improvement in beliefs about recovery. This study provides preliminary evidence that IMPACT is an acceptable and feasible treatment for individuals with schizophrenia spectrum disorders. A randomized controlled trial of IMPACT appears to be warranted.

Rigorous research robustly supports individual placement and support (IPS) as the leading evidence-based vocational rehabilitation practice for adults with serious mental illness. Randomized controlled trials have consistently shown positive competitive employment outcomes over 1 or 2 years for IPS participants, compared with those who receive a variety of comparison interventions. Although long-term follow-ups are scarce, they matter because recovery is a longitudinal process. In this narrative review, the authors examined the available evidence from long-term IPS follow-ups (≥3.5 years). A literature search included an examination of recent IPS systematic reviews and a Google Scholar search. Among eight long-term IPS follow-up studies, all but one showed persistence of competitive employment, some for as long as 10 years. The studies did not consistently collect data regarding ongoing support, other important recovery outcomes, and disability status. IPS often leads to long-term competitive employment, but other critical recovery issues remain uncertain.

Hospitals face ongoing challenges in managing unnecessary readmissions. The aim of this study was to implement a novel, pattern-focused approach in order to identify and describe distinct patterns of readmissions among recurrently admitted psychiatric inpatients. Admission records from 11,986 inpatients of an acute psychiatric hospital in the territory of Western Australia were retrospectively analyzed, with a focus on 1,831 patients with recurrent admissions (three or more admissions within 5 years). Cluster analysis grouped these patients on the basis of overall and dynamic temporal patterns of their readmissions across time. Five distinct readmission patterns were identified, characterized by patients' admission frequency (mild, moderate, or intense) and whether they were readmitted in an episodic or stable pattern. The pattern-focused approach identified novel readmission patterns reflecting both static and dynamic characteristics of recurrent inpatient care. This study provides the foundation for research into early indicators, risk prediction, and time-sensitive, patient-specific interventions. These clinical applications can guide hospitals to effectively prevent unnecessary inpatient readmissions.

Understanding is limited about how youths (ages 12-24) engage with peer support services across in-person, virtual, and hybrid formats, particularly within integrated youth services (IYS) settings. This study aimed to examine the demographic, health, and social characteristics of youths accessing peer support services; explore the types of peer support services utilized at an IYS initiative; and identify potential differences between clients who access in-person, virtual, and hybrid (i.e., in-person and virtual) services. A secondary data analysis was performed for all youths who accessed youth peer support services at an IYS initiative in British Columbia, Canada, from April 2018 to February 2023. Self-reported demographic characteristics, mental health, and distress and the services accessed were examined across three modalities (in-person, virtual, and hybrid services). During the study period, 3,586 unique youths attended 12,343 peer support visits. Youths had low self-rated mental health (poor, 35%; fair, 36%) and high distress (mean±SD Kessler Psychological Distress Scale score=30.73±9.08 out of 50) upon initial presentation. Significant differences were found among the in-person, virtual, and hybrid groups by age, race, and sexual and gender minority status. This large cohort of youth peer support clients had extremely high distress at initial presentation. Youth peer support, provided through an IYS model with multiple modalities to improve service access for diverse youths, should be considered as one option for addressing systemic inequity in health care and the current global youth mental health crisis.

Natural disasters are associated with new-onset mental disorders and distress and may exacerbate preexisting mental health issues. To date, no systematic review has examined rates and correlates of mental health service (MHS) use among adults exposed to natural disasters. This study aimed to synthesize findings examining MHS use among adults exposed to natural disasters. The review was preregistered with PROSPERO (CRD42023430815). PsycInfo, MEDLINE, Embase, CINAHL, and Scopus were searched to identify studies. Studies reporting rates or correlates of MHS use among adults exposed to natural disasters were eligible for inclusion. Narrative syntheses summarized study findings, and the Mixed Methods Appraisal Tool guided quality assessments. Forty-one articles (representing 39 studies) were identified across 18 countries. Studies were conducted in varied postdisaster settings and were characterized by considerable methodological heterogeneity. Rates of postdisaster MHS use were generally low (<10%) among general population samples but higher among samples with greater degrees of disaster exposure. Among participants reporting postdisaster MHS use, nonspecialist primary health care services were utilized most frequently. A substantial proportion of participants reporting distress or disorder did not use MHSs. Few consistent correlates of MHS use were identified. Rates of postdisaster MHS use are likely to depend on disaster-specific contextual factors. Generally, most adults exposed to natural disasters do not utilize MHSs, although rates appear to increase as a function of exposure severity. Mental health recovery efforts may benefit from prioritizing nonspecialist primary health care services and utilizing outreach approaches targeted toward groups with high degrees of exposure severity.

In the past 5 years, significant federal, state, and local efforts have focused on building behavioral health crisis response services and on shifting this responsibility away from law enforcement. However, these efforts have been hampered by limitations of the behavioral health workforce. Strategies are needed to expand the workforce and to ensure that crisis responders have the competencies and skills necessary to meet the needs of the individuals they serve. Existing federal, state, and local mechanisms can be leveraged to support the development of this workforce. This effort includes investing in crisis response workforce development and training, supporting the development of a community behavioral health crisis responder credential, partnering with community colleges to expand the workforce pipeline, and establishing regional centers of excellence for training. It also includes developing strategies to ensure adequate and sustainable funding.