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The future increase of chronic diseases in the world requires new challenges in the health domain to improve patients' care from the point of view of the organizational processes, clinical pathways and technological solutions of digital health. For this reason, the present paper aims to focus on the study and application of well-known clinical practices and efficient organizational approaches through an innovative model (TALIsMAn) to support new care process redesign and digitalization for chronic patients.

In addition to specific clinical models employed to manage chronic conditions such as the Population Health Management and Chronic Care Model, we introduce a Business Process Management methodology implementation supported by a set of e-health technologies, in order to manage Care Pathways (CPs) digitalization and procedures improvement.

This study shows that telemedicine services with advanced devices and technologies are not enough to provide significant changes in the healthcare sector if other key aspects such as health processes, organizational systems, interactions between actors and responsibilities are not considered and improved. Therefore, new clinical models and organizational approaches are necessary together with a deep technological change, otherwise, theoretical benefits given by telemedicine services, which often employ advanced Information and Communication Technology (ICT) systems and devices, may not be translated into effective enhancements. They are obtained not only through the implementation of single telemedicine services, but integrating them in a wider digital ecosystem, where clinicians are supported in different clinical steps they have to perform.

The present work defines a novel methodological framework based on organizational, clinical and technological innovation, in order to redesign the territorial care for people with chronic diseases. This innovative ecosystem applied in the Italian research project TALIsMAn is based on the concept of a continuum of care and digitalization of CPs supported by Business Process Management System and telemedicine services. The main goal is to organize the different socio-medical activities in a unique and integrated IT system that should be sustainable, scalable and replicable.

Few studies assess how child abuse and neglect (CAN) affects adolescents’ mental health. Further, the majority of studies conducted to date discount the individual CAN items and report overall prevalence rates for different types of abuse and neglect. The purpose of this study was to examine the levels of and gender differences in CAN subtypes, lifetime prevalence of individual CAN items and the contribution of different CAN subtypes for explaining depression, anxiety and irritability.

The sample included Jamaican (n = 7,182, 60.8% female) and Ugandan (n = 11,518, 52.4% female) youths. The authors used a population-based cross-sectional study design. Youths completed an anonymous survey in school settings.

The authors found gender differences in the levels of CAN subtypes. Maltreatment behaviors of lesser severity were more commonly endorsed by the youths than those of greater severity. Neglect and emotional abuse were the strongest correlates of depression (e.g. neglect: ß = 0.23, among Jamaican youths; emotional abuse outside-the-home: ß = 0.23, among Ugandan girls), anxiety (e.g. neglect: ß = 0.17, among Ugandan girls; emotional abuse outside-the-home: ß = 0.27, among Ugandan girls) and irritability (e.g. emotional abuse in-the-home: ß = 0.17, among Jamaican boys; emotional abuse outside-the-home: ß = 0.17, among Ugandan girls) in most samples.

These findings will inform policymakers and professionals working with youths in Jamaica and Uganda, providing comprehensive contemporary insights beyond existing research in these regions.

Further investigation is needed of network effectiveness in healthcare and how it is influenced by unpredictable events like COVID-19. Based on Provan and Milward’s (2001) framework, this study investigates the effectiveness criteria of healthcare networks and their potential contribution to network effectiveness during the pandemic’s challenges.

This research employs an explanatory case study in a local area of Italy’s Lombardy Region and analyzes network effectiveness at the network level based on network member perceptions.

Network effectiveness refers to the network’s ability to address patient needs, guaranteeing services through network members' coordinated efforts and a central coordinator that facilitates their interaction. Members’ capacity to strengthen their roles played a crucial part in sustaining network effectiveness when COVID-19 revised other members’ priorities and threatened achievement of network goals.

This study’s findings equip healthcare managers and policymakers with knowledge about network effectiveness criteria at the network level, offering suggestions for managerial practices and network design to address exogenous shocks.

This study identifies factors that influence network effectiveness criteria and provides insight into how network members can contribute to sustaining effectiveness during crises.

Older people living in nursing homes have complex care needs and frequently need specialists’ advice and support that can be challenging to deliver in a rural setting. The aim of this paper is to describe a model of integrated care in a rural area supported by a nurse case manager.

A real-world evidence study of people living in Ribes de Freser nursing home, was conducted between specific timeframes in 2019 and 2022, comparing the casemix and outcomes of a traditional care model with the integrated interdisciplinary model.

The integrated care model led to a significant reduction in transfers to the emergency department, hospitalisations, outpatient medical visits and a reduction in the number of medicines. In addition, the number of residents receiving end-of-life care at the nursing home showed a substantial increase.

This case study contributes valuable evidence supporting the implementation of an integrated model of nurse case manager support in nursing homes, particularly in the rural contexts, where access to specialist medical staff may be limited. The findings highlight the potential benefits of person-centred integrated care for older adults, addressing their complex needs and improving end-of-life care in nursing home settings.

Clinically, it is often observed that autistic people may have a heightened need for rules and may find rule violations very distressing. It is clinically plausible that autistic individuals may be prone to hyper-morality and greater reactivity and adverse experiences arising from moral threats and violations. Such adverse experiences may, in some instances, lead to moral distress (MD) or in more extreme cases moral injury. Thus, this study aims to examine how MD can operate in the context of autism.

The authors explore clinical hypotheses on how MD can intersect with different features of autism by drawing on clinical and research knowledge of autism spectrum disorder and how it contextualises experiences of morality.

Based on a review of the literature and theory, the authors hypothesise that autistic individuals may be more prone to MD where they have a lower threshold for MD. As a result of this lower threshold, they may have more frequent exposure to MD, experience more immediate and intense subjective reactions to moral transgressions, for more protracted periods. Also, they may find it more difficult to over-ride and neutralise moral outrage. As a result, they may be more susceptible to mental health sequelae and impaired social and occupational functioning. Practical recommendations are made for clinicians supporting people with autism with a propensity for MD or moral injury, to improve their quality of life.

Practical recommendations are made for clinicians supporting people with autism with a propensity for MD or moral injury, to improve their quality of life.

Understanding MD in an autistic context is important for detecting and treating the adverse impacts of MD on autistic individuals. Importantly, erroneous preconceptions about moral reasoning in autism need to be mitigated to fully understand the moral experiences and harness the many strengths of people with autism.

Adolescence and emerging adulthood are key developmental stages with high risk for trauma exposure and the development of mental and substance-use disorders (SUDs). This study aims to compare the clinical profiles of adolescents (aged 12–17 years) and emerging adults (aged 18–25 years) presenting for treatment of posttraumatic stress disorder (PTSD) and SUD.

Data was collected from the baseline assessment of individuals (n = 55) taking part in a randomized controlled trial examining the efficacy of an integrated psychological therapy for co-occurring PTSD and SUDs (PTSD+SUD) in young people.

Both age groups demonstrated complex and severe clinical profiles, including high-frequency trauma exposure, and very poor mental health reflected on measures of PTSD, SUD, suicidality and domains of social, emotional, behavioral and family functioning. There were few differences in clinical characteristics between the two groups.

Similarity between the two groups suggests that the complex problems seen in emerging adults with PTSD + SUD are likely to have had their onset in adolescence or earlier and to have been present for several years by the time individuals present for treatment.

To the best of the authors’ knowledge, this is the first study to compare the demographic and clinical profiles of adolescents and emerging adults with PTSD + SUD. These findings yield important implications for practice and policy for this vulnerable group. Evidence-based prevention and early intervention approaches and access to care are critical. Alongside trauma-focused treatment, there is a critical need for integrated, trauma-informed approaches specifically tailored to young people with PTSD + SUD.

The transtheoretical model (TTM) has been applied to varying areas of physical health, e.g. diabetes. However, research into its applicability to psychotherapy is mixed. The TTM is applied through the University of Rhode Island Change Assessment (URICA). Investigating the utility of the URICA is needed to improve patient care and outcomes. This study aims to assess whether the URICA scores relate to patient outcomes; patient attendance; practitioner ratings of patient readiness, appropriateness, insight, motivation and potential for improvement; and to explore practitioner’s perspectives on the URICA.

Correlational methods were used to assess the relationship between the URICA and therapeutic outcome, attendance and practitioner-rated areas. Content analysis was used to analyse practitioner qualitative data.

The URICA did not correlate with either therapeutic outcome or attendance. A significant negative correlation was found between the URICA and practitioner-rated appropriateness of the referral. This means practitioners perceived individuals with lower URICA scores to be a more appropriate referral, despite the score indicating a reduced readiness to change. Qualitative categories included positive views, negative views, ambivalence and changes to measure and process. To conclude, the URICA does not explain a patient’s outcome or attendance. The URICA may not be appropriate to use in its current format in mental health services; therefore, assessing the TTM verbally may be more helpful.

This study provides research into suitability of using the URICA to assess the TTM and its applicability to attendance and outcome in psychological therapies.

This paper aims to provide a living tribute to the mental health activist and international trainer Peter Bullimore.

Peter provided a list of people to who he wanted to provide tributes. Jerome approached all these people. All agreed.

Several people from around the world attest to the influence that Peter’s teaching and personality have had on their clinical practice and on their lives.

The disappearance of an Open Mind has left a shortage of journals, which welcome the user perspective. Mental Health and Social Inclusion have always championed the voice of people with lived experience. These are selected tributes to one man’s work in the field of mental health.

These accounts provide insights into the work of a remarkable individual.

Students of the mental health professions are mainly exposed to work produced by their peers. The history of mental health is filled with the stories of professionals, not the people who have used services.

Historically accounts of psychiatry are written by mental health professionals. Service user or lived experience accounts are often written from the perspective of the person’s story of illness and recovery. There are comparatively few, which celebrate the additional achievements of specific individuals with lived experience.