Substance use disorders and addictions are mental disorders deeply interconnected with other psychiatric conditions – and this connection is of fundamental importance. Although addictions are formally recognized as mental health disorders, they are often not addressed as such in research or clinical practice. Psychiatric research, clinical care, and treatment development remain largely organized along traditional diagnostic boundaries. While diagnostic classifications provide structure and clinical utility, it is increasingly evident that psychiatric diagnoses are neither fully separable nor independent entities. Despite extensive discussion on comorbidity, addictions are frequently excluded from broader conceptualizations of the intertwined nature of mental disorders. Yet, they share substantial commonalities with other psychiatric conditions across clinical presentation, psychopathology, genetic vulnerability, neurobiological mechanisms, socioenvironmental risk factors, and treatment strategies. Maintaining a conceptual divide between addictions and other psychiatric disorders reinforces diagnostic “tunnel vision,” constraining our understanding of neuropsychopathology and contributing to persistent gaps in care and treatment accessibility. This narrative review examines the overlapping risk factors, clinical features, and therapeutic approaches that link addictions with other mental disorders. We argue that advancing psychiatric research and nosology requires a deliberate acknowledgement of these transdiagnostic overlaps and shared mechanisms. The challenge is particularly evident in the understanding and treatment of dual disorders. Progress will depend on integrative, collaborative frameworks that bridge scientific and clinical perspectives and foster dynamic feedback between empirical research and clinical practice. Recognizing mental disorders as interdependent systems may offer a more coherent and effective foundation for understanding and treatment.

This paper outlines the experience of establishing a partnership for clinical services and academic training across two very different countries: Zambia and Ireland. Drawing upon the experience of setting up other similar international partnerships, the process of understanding the two very different cultural and clinical contexts has developed collaboratively over the course of the past 2 years, and has resulted in valuable insights and joint working. In line with local priorities, the Zambian colleagues in the partnership have prioritised the support for postgraduate training in psychiatry to enable the expansion of services, and allow greater population access. In particular, there is evidence of unmet need in the areas of substance use psychiatry, and child and adolescent psychiatry.

The collaboration will increase cultural awareness among psychiatrists and trainees in Ireland and deepen their knowledge and understanding of international psychiatry. This programme is mutually beneficial and has the potential to greatly improve relationships between the mental health service providers of the two nations.

Beliefs in evil spirits and the practice of deliverance from supernatural forces have been widespread throughout history. Many psychological and physical afflictions have been attributed to involuntary demonic possession. Traditional remedies, for those reporting inhabitation by evil spirits, can involve exorcism believed to expel such forces. Similar beliefs may be symptomatic of major mental illness and treatments namely medication and psychotherapy, are frequently recommended. An increasingly secular western world is also seeing growth in non-denominational Christian churches and other faiths, who accept spirit possession and exorcism. Culturally competent mental health professionals, seeking to understand their patients’ world view, may struggle with exorcism, seeing it as an interference to conventional treatment. They may be being unwilling thus to attempt differentiation between possession and mental illness. This paper explores the diversity of views on this topic and points of contention and overlap. The risks and cautions necessary in approaching this issue are stressed.

Individuals with mental health difficulties (MHD) have a substantial reduction in life expectancy compared to the general population. It is increasingly recognised that mental health services need to improve physical healthcare as a priority. Sexual health, including consideration of high-risk sexual behaviours, medication side effects, and challenges in romantic relationships, is a further important but under-recognised aspect of overall health. We discuss some of the current issues relating to physical and sexual health, with a particular focus on youth with MHD and how we might implement holistic care in Ireland. Prioritising the resourcing of these issues could facilitate the implementation of a Shared Model of Care as recommended in Ireland’s National Mental Health Policy, Sharing the Vision.

The position paper ‘The development of services for treatment of personality disorder in Adult Mental Health Services’ was published by the College of Psychiatrists of Ireland Personality Disorder Special Interest Group (PDSIG) in 2021. Following this, we are advocating for the development of a national treatment strategy for personality disorders in Ireland. As part of this process, we have examined international evidence and best practice guidelines for establishing personality disorder services. Key recommendations from the literature include access to services, continuity of care, a multidisciplinary approach, tiered models of care, collaboration with service users, staff training and supervision, and delivery of evidence-based interventions. These recommendations should form the backbone of a national personality disorder strategy for Ireland.

Consultation-liaison psychiatry (CLP) refers to the subspecialty of psychiatry and the specialist clinical services that deliver care at the intersection of mental and physical healthcare. CLP services provide specialist medical and multidisciplinary expertise for managing conditions in these areas of mental and physical healthcare overlap, and comorbidity. The Model of Care for CLP was identified as a key priority in Sharing the Vision, the 2020 national mental health policy in Ireland. Following four years of work by a writing group initiated by the Faculty of Liaison Psychiatry at the College of Psychiatrists of Ireland, the Model of Care for CLP in Ireland was launched in May 2025 (Cpsychi H (2025). Consultation-Liaison Psychiatry: A Model of Care for Ireland. Dublin: HSE.).). Consultation-Liaison Psychiatry: A Model of Care for Ireland. Dublin: HSE.). This reflects the collaborative efforts between the Liaison Faculty and the Irish Health Service Executive (HSE). This Model of Care, developed in collaboration with clinicians and patients, the College of Psychiatrists of Ireland, and the HSE, provides a potential template for future collaborations in the development and implementation of National Mental Health policy.

The recovery model of mental health care is distinct from the biomedical model of mental health care. To promote one runs the risk of marginalising the other. Both approaches have merit. Values of hope and optimism, social inclusion, collaborative decision-making, retaining a personal identity beyond an identity simply defined by a diagnosis of mental illness, are all central to the recovery model. A reorientation of mental health services is required, a change in culture which embodies the principles of a recovery model within which, the perspectives of patients and families are heard together with the perspectives of mental health professionals who have knowledge and expertise to offer. In Meath Community Mental Health Services we have implemented such a recovery model, the model of open dialogue where principles of dialogue, social inclusion, immediate help and collaborative decision-making are paramount. We began this service in 2019 and carried out an audit of the first 6 months of our implementation. The audit illustrated overwhelming satisfaction from service users and their families with the new approach. On foot of our successful pilot project we have extended the model of open dialogue to other teams in Meath and Louth, including the in-patient unit in Drogheda. Our open dialogue project illustrates how a recovery model of mental health care can be successfully implemented in a public mental health system.

“Dual disorders” (DD) refers to the co-occurrence of addiction and other mental health conditions, which often interact and complicate care. Despite scientific evidence showing shared brain mechanisms, current diagnostic systems treat them separately, leading to fragmented treatment and stigma. The World Association on Dual Disorders urges adopting “dual disorders” as a unified term to improve clarity, care integration, and outcomes.

In this editorial we set out the background to the advent and development of the concept of recovery in mental health care. We follow this with an overview of policy with specific reference to our own locale here in Wales where a recovery-focus is now written into national mental health legislation and policy directions. We briefly summarise our own research in this area and note positive relationships between recovery and social support and quality of life but also limited shared understanding of what recovery might mean alongside gaps in policy aspirations and everyday experiences of using services. The concept of recovery remains contested with concerns it has become a means for neoliberal thinking in services and in effect has been colonised by competing ideas. Despite this (sometimes) conflicting evidence and the polyvalent quality of the concept, recovery retains a sense of vitality and validity as evidenced by contributions to this special issue of the journal. Building on our reading of this growing literature we suggest that recovery necessitates social change, implies an understanding of systems and awareness of complexity and finally must account for and accommodate competing understandings. To achieve its foundational aims, it is imperative that research in this field directly engages and includes people with experience of using mental health services as co-researchers in generating new recovery-focused interventions to address the challenges of severe mental illness experiences.

This article addresses the questions of when mental health advance planning documents are created, the points when circumstances which they are intended to address arise and what consequences should flow when such a situation does arise. It addresses these points primarily from the perspective of what the law could/should be at a conceptual level. It looks at three stages: (a) creation of the document; (b) the period between the creation of the document and the point at which the intended circumstances arise; and (c) the point at which the intended circumstances arise. It does not purport to provide solutions at each stage, but rather to frame the dilemmas to aid discussion. In similar vein, it draws upon case studies from England & Wales, not to purport to dictate similarities of approach, but to flesh out dilemmas that have arisen to stimulate consideration.