Obsessive-compulsive disorder (OCD) may be present with distressing intrusive thoughts, urges, or images. When the content is violent, sexual, religious, or linked to magical thinking, severe OCD can be mistaken for psychosis. We present a 19-year-old man with a six-year history of ego-dystonic intrusive harm-related thoughts and images focused on family members, along with checking, touching, counting, reassurance seeking, religious mental rituals, and sexual obsessions. Symptoms began at age 13 after he read about asthma, and later developed a recurrent fear that his maternal grandmother might develop the illness. He recognized these thoughts and images arising from his own mind, experienced them as distressing and excessive, and used rituals to reduce anxiety. Examination did not elicit hallucinations, externally located perceptions, thought insertion, withdrawal, broadcasting, passivity phenomena, behavioral disorganization, or mood, substance-related, or neurological syndrome. The diagnosis was obsessive-compulsive disorder, International Statistical Classification of Diseases and Related Health Problems10th Revision (ICD-10), F42.2 mixed obsessional thoughts and acts. Fluvoxamine 50-150 mg/day was associated with a subjective 10%-20% improvement without documented adverse effects; the treatment was later switched to fluoxetine because of cost-related factors. Long-term follow-up and standardized severity scores were unavailable. This case highlights the importance of assessing thought ownership, resistance, insight, conviction, and the anxiety-reducing function of rituals before labeling vivid intrusive mental images as hallucinations or delusions.

Introduction Sleep disorders and psychiatric diseases are public health problems that have increased due to the COVID-19 lockdown. In Mexico, telemedicine was a frequently used treatment modality under the circumstances of the lockdown. The present study aimed to test the effectiveness of brief behavioral intervention for improving symptoms of insomnia, anxiety, and depression and increasing quality of life in patients who survived the COVID-19 infection. Method A randomized, parallel-group equivalence clinical trial was conducted without a passive control group. Pre-treatment, post-treatment, and three-month follow-up measurements were taken. The intervention consisted of four weekly sessions lasting 50 minutes each. Five questionnaires were applied: Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), General Anxiety Disorder 7 (GAD-7), Patient Health Questionnaire 9 (PHQ-9), SF-36 Health Questionnaire (SF36), and a sleep diary. Results In both therapy modalities, significant improvement was identified (p < 0.05) in ISI (14.57 vs 5.57), ICSP (12.43 vs 4.86), GAD-7 (13.00 vs 5.29), PHQ-9 (15.86 vs 5.00), and SF-36 (30.00 vs 77.14) scores, which coincided with sleep diary measurements. Conclusion Both intervention modalities were effective, indicating that teleconsultation is a viable treatment option for insomnia symptoms and mental health comorbidities.

Veterans may struggle with numerous challenges, including the transition to civilian life, physical or mental health issues (e.g., posttraumatic stress disorder), substance abuse, barriers to help-seeking, and difficulties accessing care. They are also at an increased risk of suicidal ideation and living without a home compared with the general population. These challenges have been associated with an increased risk for law enforcement interactions. The Military Veterans Wellness Program is a novel program whose mission is to improve the well-being of Veterans in crisis by providing law enforcement officers with a better understanding of Veterans, de-escalation training, and a streamlined referral process to three national support services. The program is a collaboration among the Toronto Police Service and multiple organizations, experts, and stakeholders in the areas of law enforcement and Veteran well-being. A performance measurement framework was developed for the program that includes a strategic framework, logic model, and key performance indicators for the purposes of internal program management, performance monitoring, external reporting, and the assessment of program effectiveness. Finally, limitations, preliminary results, achievements, and next steps are discussed.

The use of measurement-based care (MBC) can significantly improve outcomes for patients, including symptom reduction, improved functioning, and quality of life. However, existing barriers can lead to low implementation rates, especially among first responders, military personnel, and Veterans (FRMV). Overcoming barriers and identifying ways to measure implementation using aggregate data is the next step in integrating MBC into mental health care. This article outlines the current state of MBC implementation at a mental health and addictions hospital in Canada.

Aggregate data provided by an online MBC platform were used to review clinical outcomes (Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, PTSD Checklist for DSM-5, and Working Alliance Inventory-6) and implementation rates (patient adoption and continuous engagement) of a Guardians program tailored for FRMV and compare these outcomes with benchmarks of Canadian and U.S. organizations.

Clinical outcomes and MBC implementation rates for the program exceeded national median benchmarks. Patient adoption and engagement increased between 2022 and 2023 and dropped in 2024.

Results suggest that the program was aligned with patients' clinical needs and addressed hospital needs for a MBC system because patient adoption and engagement exceeded national benchmarks. The consistent rise in patient participation since the implementation of MBC reflects the system's relative success, although barriers such as limited familiarity and staff capacity likely persist. Future work addressing barriers through organizational training and MBC champions may enhance implementation. The complex treatment needs of FRMV underline the importance of evaluating the integration of MBC into programming for this population.

Military members and Veterans have an increased risk of mental health (MH) conditions compared with the general population. In light of the underutilization of MH services in this population, it is important to examine the factors that either obstruct or facilitate access to MH treatment, as well as ongoing participation. This knowledge is key to developing effective strategies that enhance accessibility to these services and encourage treatment-seeking behaviour. This study aimed to provide a nuanced understanding of personal and systemic factors that influence Canadian Veteran MH care.

Thirteen Canadian Armed Forces Veterans were recruited via physician referral from the Operational Stress Injury Clinic in London, Ontario, and interviewed using a qualitative interpretive phenomenological approach (IPA). Interviews were coded and analyzed using standard IPA guidelines.

Analyses revealed six superordinate themes: perceived need for treatment, motivation to seek treatment, accessibility and adequacy of MH resources, experiences during treatment, influence of social support, and impact of the COVID-19 pandemic on their MH.

This study emphasizes the importance of understanding Canadian Veterans as a distinct cultural group with unique needs and challenges, including stigma, self-reliance, and difficulties navigating health care systems. This research examined the mixed impact of the COVID-19 pandemic on the Veteran participants. It had a small sample size and primarily included male participants. Future research should focus on under-represented Veterans groups (e.g., women) and those who have not sought treatment to inform interventions and improve overall MH outcomes for this population.

The expansion of medical assistance in dying (MAiD) in Canada to include, as of Mar. 17, 2027, mental illness as a sole underlying medical condition (MI-SUMC) raises significant clinical, legal, and ethical concerns, particularly for Veterans, who are disproportionately affected by difficult-to-treat psychiatric conditions. Structural vulnerabilities, including poverty, discrimination, gender-based disparities, and poor access to care, compound psychiatric suffering and increase the risk of premature death among marginalized groups.

The authors conducted a comprehensive review of clinical, legal, and ethical literature, including expert reports, case law, and systematic reviews. Key areas of analysis include terminology regarding difficult-to-treat conditions, limitations of current capacity assessments, structural vulnerability, and ethical tensions between suicide prevention and MAiD for MI-SUMC.

There is no consistent definition of difficult-to-treat conditions, with over 150 existing for major depressive disorder alone. Prognoses remain highly variable, weakening claims of irremediability. Current capacity assessments often overlook trauma, emotional states, and systemic barriers, introducing bias. Suicidality, a common symptom of psychiatric illness, complicates distinctions between autonomous MAiD requests and crisis responses. Last, evidence from jurisdictions like Belgium and the Netherlands demonstrates that structurally marginalized individuals are over-represented in psychiatric MAiD, raising concerns of systemic coercion.

Given the unresolved uncertainties around irremediability, suicidality, and access to care, a precautionary approach is warranted. Without equitable access to advanced, neuroscientifically informed treatments, some may request MAiD because of lack of alternatives. Safeguards such as longitudinal monitoring, inter-blinded assessments, and expanded access to care are essential to protect vulnerable groups, especially Veterans.

The Road to Mental Readiness (R2MR) program delivers mental health training, which includes a guided discussion and wellness check for Canadian Armed Forces search and rescue technicians (SAR techs) during their annual dive proficiency and currency training to support their mental health and performance and helps to decrease barriers to care and encourage care seeking when necessary. A mixed-methods evaluation of SAR techs' perceptions of the wellness checks was conducted in July 2024.

Sixty SAR techs completed an anonymous survey three months post-training to capture their perceptions of the wellness checks, including their usefulness; common therapeutic factors identified as important mediators of wellness check effectiveness from previous research; and attitudes toward care-seeking, supporting others, stigma, and resilience.

Most SAR techs found their most recent wellness check to be at least a little helpful in supporting their mental health and well-being, and their attitudes toward the wellness check appeared to improve afterward. The learning of new skills was a common therapeutic factor that most related to perceptions of wellness check usefulness. In terms of related outcomes, those who rated the wellness check as more useful reported greater confidence in accessing mental health care, but not greater resilience or stigma. Finally, most SAR techs who received a follow-up recommendation followed through with it.

The findings indicate that SAR techs perceive the current R2MR training as useful for supporting their mental health and well-being, but the findings are limited to this unique occupation.

Adaptive sports offer active duty members and Veterans with physical or psychological injuries the opportunity to engage in sports with a focus on psychosocial recovery, rehabilitation, and overall well-being. This rapid review examined the experiences of competitors and their families and friends in the Invictus Games, Warrior Games, and winter adaptive sports programs to identify primary facilitators and barriers influencing participation.

Following Cochrane and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Rapid Reviews (PRISMA-RR) guidelines, the authors reviewed 156 articles, applying self-determination theory as an analytical framework.

For competitors, social relatedness (e.g., camaraderie) and competence (e.g., goal attainment, skill mastery) emerged as the primary motivators. For family and friends, witnessing competitor growth and progress was the main motivator. Key barriers for both groups included competitive pressures and limited resources, which sometimes conflicted with the rehabilitative goals of these programs.

Adaptive sports programming should consider the motivations of individual participants, as well as those of their family and friends, in its design. This review underscores the need for strategies that support sustainable, meaningful participation and informed policy and support practices that respect the rehabilitative ethos of adaptive sports.

Measurement-based care (MBC) involves routine monitoring of patient-reported outcomes to inform clinical decision-making. Despite evidence demonstrating its effectiveness in the treatment of patients with posttraumatic stress disorder (PTSD) and other psychiatric conditions, it remains underutilized in clinical settings. This review aimed to identify the barriers to and facilitators of the use of MBC in patients with PTSD.

We conducted a systematic review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, including articles that examined barriers to and facilitators of the use of MBC in patients with PTSD. Facilitators and barriers were defined as any factors that impacted the implementation, uptake, or use of MBC. The search was conducted in December 2024 in four databases.

Our search identified 6,036 unique articles, of which 15 met the inclusion criteria. All 15 articles were published in the United States, and 11 studied Veteran populations. Barriers to and facilitators of MBC in PTSD varied widely between studies; commonly identified barriers included irregular completion of outcome measures, technological challenges, and poor patient understanding of MBC purpose and results. Facilitators included technological accessibility to patients and clinicians, patient consultation on the selection of outcome measures, and use of frameworks to guide implementation.

This review identified a limited number of studies examining barriers to and facilitators of MBC use and implementation for PTSD, highlighting gaps in the literature. Implementation studies are needed to explore context-specific barriers and facilitators, providing a more comprehensive understanding of MBC in PTSD care.

The transition from military to civilian life represents a significant challenge for Canadian Armed Forces (CAF) Veterans, with approximately 39% experiencing difficulties. Veterans living with chronic pain face unique challenges during this transition, with impacts on their physical, mental, and social well-being. This study aims to explore the experiences and needs of Veterans living with chronic pain during their transition to civilian life and examine the implications of chronic pain on various life domains.

This qualitative and exploratory study investigated the effects of chronic pain on CAF Veterans' transitions to civilian life. Two three-hour focus groups were held with Veterans (n = 8) to explore their experiences with pain and its impacts on their social functioning during their transition to civilian life. Data were analyzed using thematic analysis.

Participants reported stigmatization of pain during military service, challenges in accessing civilian health care, significant emotional and relational impacts of chronic pain, and the importance of adaptive coping strategies. Participants also highlighted the need for peer support programs and specialized chronic pain clinics to facilitate the transition to civilian life and improve Veterans' quality of life.

Chronic pain significantly complicates CAF Veterans' transitions to civilian life by affecting various life aspects and adjustment processes. Findings underscore the need for enhanced access to civilian health care and Veterans Affairs Canada services, alongside preventive interventions, to support Veterans' well-being and facilitate successful transitions.