Editorial

As the Editors of Mental Health and Social Inclusion, we continue to be impressed by the international nature of our submissions. In this issue, we have 10 papers from different countries. While there are four papers from India and two from the UK, we have a paper each from Pakistan, Bangladesh, Egypt, Jordan, China, Greece and the USA. This issue features nine empirical research papers, three case studies, one viewpoint paper and one literature review. Let’s dive right in.Monaco based health psychologist Dr Freda Gonot-Schoupinsky contributes two papers to this issue. The first is another in her fascinating positive autoethnography series. This time she features Dr Evangelos Fradelos from Larissa in Greece. Dr Fradelos recounts how his mother was diagnosed with schizophrenia, which perhaps drew him towards working with people who had severe mental illness. His godmother Theano played a key role in his upbringing. He described her thus, “… although she had not seen the world, her heart could hold all of humanity”. From his childhood reflections he moves onto talk about how he became a nurse. He notes that providing meaningful care to people, has the power to be therapeutic, for not only the one who receives it but also the one who gives it. He goes on to say that not only is “… nursing not just a profession, it is a way of being … But above all it remains an act of love”. This is a wonderful account from a remarkable nurse academic.Freda’s second paper features Professor Corey Keyes. While there is less information in this account on Corey’s upbringing, the little there is suggests it was very traumatic. Corey was the first academic to introduce the concepts of flourishing-languishing. He has experienced significant mental health problems himself, as well as having endured alcoholism. He advises, “Do not walk alone with your mental illness, walk with others and talk about it …” He comments, “Sick care is necessary, but it is not health care. We need both”. Entering a state of flourishing reduces the risk of developing mental health problems. Corey also offers some straight-talking about positive psychology, which he is clearly disenchanted with. While this account is very brief, it is nonetheless highly illuminating.Three papers look at mental health care in scheduled tribes in India, which represent 8.6% of the total population of the country. Treesa Pulickel and colleagues conducted a scoping review. They attempted to answer six questions with their review. The first looked at the prevalence of mental disorders and found high rates of depression, anxiety and substance use amongst tribal groups. The second considered where people get their information about mental health from. Traditional healers and faith leaders were often consulted. Mothers played a significant role in handing down information through the generations. They also looked at the main barriers to service access and found these to be geographical isolation, cultural beliefs, limited awareness, financial constraints and poor mental health infrastructure. They noted that if services worked with traditional healers, this could improve the identification of mental health problems. Cultural factors also advocated different approaches to dealing with mental health issues, as they explained such problems as being caused by evil spirits, black magic or past life sins. However, to evaluate some of these traditional approaches is very complex.Aswathi P. and Akanksha Rani reported that tribal women face disproportionate exposure to intimate partner violence (IPV). They attribute this to gender discrimination, poverty, geographical isolation and limited access to health care and legal services. In tribal majority states in India, IPV rates exceed 35%. In this first paper they report on a culturally grounded intervention model. As part of their research, they conducted some baseline quantitative screening exercises. In a sample of 82 tribal women in Wayanad, they found a prevalence rate of 78% for IPV and 44% for anxiety and depression. They then held in-depth interviews with survivors, as well as focus group discussions with social health activists and mental health professionals. They developed their intervention based on these consultations. They used community-based healing circles, where IPV survivors could gather in safe spaces. Group sessions were co-led by a mental health counsellor and a woman elder. They also involved the Oorumoopan (tribal leader), to give the intervention cultural legitimacy. They used creative approaches such as theatre, art and songs to get their messages across. Trauma-informed approaches were re-interpreted through body mapping, grounding rituals and visualisation. This approach is in stark contrast to the urban-centric biomedical models. In a second paper, Aswathi P. and Akanksha Rani suggest that mindfulness and art have long existed in tribal groups as ways of coping, storytelling and spiritual engagement. They advocate mindfulness-based art therapy. They believe that these cultural practices should be reclaimed as they must have always served as pathways for resilience, dignity and belonging. They claim, “Mindfulness and art are not novel interventions but ancient companions on the journey of healing”.Studies involving university students feature regularly in the pages of Mental Health and Social Inclusion. While this is often linked to the incidence of mental health problems in university students, it is also the case that students are very accessible participants for academic researchers. Hence Professor Abdel-Khalek has recruited a huge sample of 5,729 Egyptian university students for his study of gender differences in personality. He used his Arabic version of the Big Five personality scales. Men came out as more extroverted, whereas women scored significantly higher on neuroticism, agreeableness and openness. There was no gender difference in conscientiousness. A second study by Abdul Muyeed and colleagues also of university students, looked at factors affecting levels of depression in Bangladesh. The authors received 689 valid questionnaires from four public universities. Binary logistic regression identified a number of variables as being associated with depression. These were female gender, a lack of sleep and a lack of extra-curricular activities. Being married was associated with lower odds of being depressed. Previous research on happiness suggest that it is the men who benefit most from marriage.Given the importance of social factors in mental illness, three papers have addressed this issue. Murad Younis and colleagues studied patients diagnosed with schizophrenia at two psychiatric hospitals in Amman, Jordan. Some 66 participants completed the Adverse Childhood Experiences Questionnaire, the Suicidal Ideation Questionnaire, and the Scale for the Assessment of Positive Symptoms in Schizophrenia. In terms of childhood adversity, age, hospital setting and educational level were the only factors associated with adversity. For suicidality, it was also age and education, along with the number of previous hospitalisations. Positive symptoms were not related to outcome. A second study by Anju Thakur and Rina Chaturvedi studied 1,280 adolescents from an orphanage in Shimla. They found poverty increases the likelihood of experiencing peer victimisation. Using structural equation modelling, the authors found that poverty and mental health, both good and bad, are mediated through self-esteem. A third study by Imran Shaikh and Kamaruzman Noordin, looked at “Takaful” products in Malaysia. They found that peoples’ intention to buy “Takaful” products was influenced by their perception of social security.Mahvia Gull and colleagues looked at the application of Acceptance and Commitment Therapy (ACT), for people with substances use disorders in Pakistan. They interviewed clinical psychologists, their clients and a sample of carers. They concluded that ACT needs to be adapted and simplified for use in the Pakistani context. The researchers drew on the work of Naeem, who previously adapted CBT for the Pakistani population. This has led the researchers to CA-ACT, or Culturally Adapted ACT. This research also complements the work of Positive Psychology 3.0, which focusses more on local psychologies, and away from a purely North American derived perspective.The COVID-19 pandemic was the focus for a study by Madison Harding-White and her collaborators. As part of a larger investigation, they asked participants, “Do you feel there were any positive aspects to the COVID-19 pandemic?” Responses were broken down into three main categories. The first, “personal life benefits”, had two main areas, “Having more time for oneself” (n = 55), and “Increased time with family and friends” (n = 50). There were two main working life benefits, which were the introduction of remote working and educational benefits. The final less popular category was getting more benefits from nature (n = 7) and wider benefits for society (n = 14). The authors conclude that for at least this sample of participants the pandemic provided opportunities for “life-crafting”.The penultimate paper in this issue is from Elly Davey and the editor. Like thousands of young psychologists, Elly wanted to get a training place to become a clinical psychologist. In the paper, which is a collaborative autoethnographic account, Elly and Jerome describe their school education and their psychology degree courses. In addition, Elly describes how during her adolescence she was badly traumatised by a car accident, which led to her developing a non-epileptic attack disorder, now thankfully remitted. It was during her treatment for this at Great Ormond Street Hospital in London, that she was seen by clinical psychologists. She was determined that this would be her future career. Both stories finish a year after graduation, with neither author able to secure a clinical psychology training post. While many people with experience of mental health problems are frustrated by the quality of care they receive, it is a paradox that thousands of young psychologists are so keen to enter the mental health field.The final paper in this issue is from Qing Han and Chenyang Zhao from China. The paper is a review of the applications of AI in mental health related disciplines between 2013 and 2024. Some 1,989 studies were included in this review. In 2014, there was only 19 papers linked to AI in mental health. In 2024, there were 477 papers just in that one year. The three top countries were the USA, China and the UK. The three top universities were Harvard, followed by University College London and King’s College London. AI can be used to improve clinical workflows, to standardise diagnostic practices, to develop chatbots and new therapeutic approaches. Modelling within electronic care records, may trigger early alerts for patients. It may also help predict who will require therapeutic interventions. We very much doubt that this paper will be the last paper we see on the potential of AI for the mental health field.