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Rockingham kwinana mental health service

Attitudes towards COVID-19 vaccination among patients with early episode psychosis

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  • SAGE Public Health Emergency Collection
  • PMC8990573

Australas Psychiatry. 2022 Apr; 30(2): 273–274.

doi: 10.1177/10398562221085955

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Dear Sir,

Schizophrenia is associated with poorer COVID-19 outcomes, highlighting the importance of promoting vaccination in those with severe mental illness.1,2 Hesitancy likely presents a barrier to vaccination, though research in patients with mental illness is lacking. We sought to characterize the attitudes and barriers to COVID-19 vaccination among patients with Early Episode Psychosis (EEP) from the Peel and Rockingham Kwinana Mental Health Service in Western Australia.

Following approval by the Rockingham Peel Group Mental Health Governance Committee, a questionnaire of Likert and free-text items was offered to consenting patients of the EEP service. Questionnaires were collected from May-July 2021, as first-dose vaccination rates in WA rose 15%–29%.3 83 patients were offered the survey, 48 questionnaires were received and two were excluded due to participants being vaccinated. 46 questionnaires (response rate of 55%) were assessed using descriptive statistics and thematic analysis.

Participants were mostly young (modal age of 16–25 years). All had a diagnosis of suspected early-episode psychosis. 23 participants (50%) agreed/strongly agreed they intended to get vaccinated, a small majority (n = 25) affirmed they were worried about side-effects, most (n = 24) believed vaccines to be effective, and under half (n = 17) believed vaccines were safe (). Ten participants believed vaccines would not be available to them. Questions assessing perception of COVID-19 infection revealed few (n = 6) believed it to be mild, many agreed/strongly agreed infection can result in serious illness (n = 32) and harm (n = 22), but only 19 participants worried about contracting the virus.

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Responses to Likert items on COVID-19 questionnaire by participants with early episode psychosis from the peel and Rockingham Kwinana mental health service.

In those not intending to get vaccinated (n = 23), concerns regarding blood clots were mentioned nine times, vaccine safety and other side-effects, eight times. Vaccine ineligibility (n = 16), side-effects and safety (n = 8), were the most frequently reported obstacles to vaccination. Many felt additional research and information (n = 13), and improved accessibility (n = 8), would assist them in being vaccinated.

While findings were limited by a single site and low response rate, they suggest vaccination rates in those with psychotic illnesses will not reach federal targets. WA’s low COVID-19 prevalence is likely fostering the belief among participants that contracting the virus is unlikely. Though participants would receive Pfizer, bloods clots remain concerning, possibly reflecting widely publicised reports of this rare side-effect. Importantly, psychotic symptoms rarely clouded attitudes towards COVID-19 vaccination and were not a barrier to vaccination.

To reduce morbidity and mortality, mental health services (MHS) must address vaccine hesitancy. Vaccination hubs within MHS, as well as efforts to deliver evidence-based COVID-19 vaccination information and education to patients, could improve accessibility and acceptance.

Many thanks to the staff of the Peel and Rockingham Kwinana Early Episode Psychosis team for their promotion of the survey within the service.

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

Adam Walton

1. Mazereel V, Van Assche K, Detraux J, et al. COVID-19 vaccination for people with severe mental illness: why, what, and how? Lancet Psychiatry 2021; 8(5): 444–450. [PMC free article] [PubMed] [Google Scholar]

2. Nemani K, Li C, Olfson M, et al. Association of psychiatric disorders with mortality among patients with COVID-19. JAMA Psychiatry 2021; 78(4): 380–386. [PMC free article] [PubMed] [Google Scholar]

3. COVID Live [internet]. Australia: [publisher unknown]; c2021. WA First Doses. (accessed 18 December 2021).

People with lived experience - City of Rockingham



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  • Re[Frame] Mental Health Public Mural
  • External support services
  • Opportunities


Re-[Frame] Mental Health Public Mural

The Re[Frame] Project was a collaboration project between the City, local residents with lived experience of mental illness, local support services and the creative community.  Participants engaged with workshops facilitated by Art Therapist Paul K. Davis of Reflective Visions to create visual representation of their own personal journeys towards recovery and wellbeing.

These artworks and reflections then formed the inspiration for the final design by Carol Clitheroe of Neverending Designs titled 'Find What Works For You'. The final design was installed on the west facing wall of McLarty Hall on McLarty Road, Shoalwater, located on the boundaries between Wadjuk and Binjareb Nyoongar peoples territories. The mural continues the conversation of the unique journeys each person takes for their self-care and wellbeing and encourages individuals to reach out for support when needed.



Re[Frame] Mural

Learn about how the idea for the project and the finished product evolved.

Video transcript

External support services

There are a number of external support services that can connect you to others who also have lived experience:

  • Roses in the Ocean - Support for people with a lived experience of suicide or suicide loss.
  • Mind Australia Kwelena Step Up, Step Down Service - Short term residential support as well as online support services to support recovery from mental ill-health.
  • Baldivis and Rockingham Circle of Friends - Circle of Friends, Mental Health Social Group - Run by people with a lived experience of mental health issues. 
    • Baldivis - Fridays at 10am - Upstairs at Baldivis Dome
    • Rockingham - Saturdays 11am-12.30pm - Meeting Room at Waikiki Dome

Meeting weekly

  • Helping Minds - Supporting the family and friends of people living with mental illness.
  • Carers Gateway - Emotional, practical and financial support for carers.  Call 1800 422 737.
  • Young Carers - Supporting people under the age of 25 who help support a member of their household who is experiencing a mental health challenge, disability, long term health condition, substance dependency or who is frail aged.
  • Solace Grief Support Group - Supporting those grieving the death of their spouse, partner or fiancée.
  • Compassionate Friends - Support to bereaved parents, siblings and grandparents.
  • Mental Illness Fellowship of Western Australia


People with lived experience have vital insights that can help to shape community to be more inclusive and accepting.

There are opportunities both within the City of Rockingham and throughout Western Australia to connect to organisations, develop skills in advocacy and representation and play a formal role in decision making.

  • City of Rockingham Advisory Committees
  • Rockingham Youth Centre Youth Reference Group
  • Share your thoughts with the City
  • Rockingham Alliance Against Depression - Chairperson: Tristram Reddick - 0485 825 491; [email protected]
  • Rockingham, Peel and Kwinana Mental Health Consumers Advisory Group - Chairperson: Lisa Langlands - 0402 155 656; [email protected]
  • headspace Youth Reference Group
  • WA Alliance for Mental Health - WAAMH advocates locally and nationally for effective public policy on mental health issues by drawing on the expertise and experience of members, including mental health service providers, consumer and carers.
  • Consumers of Mental Health WA - CoMHWA is the independent, state-wide, peak body for people with lived/living experience of mental health issues (consumers).
  • Recovery College WA - The Western Australia Recovery College Alliance (WARCA) aims to create opportunities for anyone in the community looking to connect, explore and transform. Recovery Colleges welcome people with lived experience with mental health or substance use challenges, family, friends, carers, volunteers, those who work in the mental health and AOD sectors, those who work in other social, health and welfare sectors and the broader community.
  • Shelter WA - Join a strong coalition to ensure that everybody has a place to call home.  Members are part of a strong, collective voice ensuring that everybody has a right to a place to call home. Leading change by ensuring all spheres of government, industry and the community are working together towards an effective housing system for all West Australians.

See also

  • Community support

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On the eve of the World Cup, a unique initiative "Friendship Benches" was launched to promote mental health

On the eve of the World Cup, a unique initiative "Friendship Benches" is presented to promote mental health
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    • In anticipation of the World Cup, a unique initiative "Friendship Benches" was launched to promote mental health

    Qatar Foundation
    English athlete Sir Mo Farah opened the England bench in the presence of H. E. Sheikha Hind bint Hamad Al Thani, Vice Chairman and CEO of the Qatar Foundation

    © A photo

    • 32 benches are being installed, each representing one of the 32 countries participating in the FIFA World Cup, as an action to promote mental health
    • health at the inaugural event at the 974 Stadium in Doha
    • As part of the World Health Innovation Summit, H.E. Sheikha Hind and Sir Mo Farah Unveil Bench Dedicated to England

    A unique project was launched today to install special benches to highlight the important topic of mental health and the role that football and sport in general can play in promoting mental well-being. 32 “friendship benches” will be installed at tourist attractions in Doha, including close to participating stadiums, each dedicated to one of the countries participating in the 2022 FIFA World Cup Qatar™.

    This project is part of the Sports for Health Partnership, led by the World Health Organization and the Qatar Ministry of Health. It aims to demonstrate the importance of mental health and draw attention to ways to promote mental well-being, including through the promotion of physical education and sports. The initiative is supported by FIFA, the Supreme Organizing Committee, the World Health Innovation Summit, Friendship Benches and the WHO Partnership on Universal Health Coverage.

    On the occasion of World Mental Health Day, the first few benches were unveiled to the public at Doha's 974 Stadium - one of the venues for this year's FIFA World Cup - on the occasion of World Mental Health Day. The inauguration of the initiative took place as part of the Qatar Health Foundation's Global Health Innovation Summit event, where an England-themed bench was unveiled to the public ahead of the display of other benches on the occasion of World Mental Health Day.

    English athlete Sir Mo Farah, winner of ten gold medals at the Olympic Games and World Championships, and the most decorated middle distance runner in history, opened the bench dedicated to England in the presence of Her Excellency Sheikha Hind bint Hamad Al Thani , Vice Chair and CEO of the Qatar Foundation, who, in symbolic recognition of the importance of the initiative, spoke about the role of sport in mental health.

    “Meeting Sir Mo and his amazing story of how he came to London as a little boy from Mogadishu and the mental problems he had to deal with highlights the importance of giving yourself the opportunity to sit down and talk about mental health,” said E. .P. Sheikha Hind. “I am proud that the Qatar Foundation Global Health Initiative is participating in bringing attention to mental health issues in such an innovative and convenient way.”

    The bench installation project is built into the overall goals and campaigns of each of the partner organizations, including the WHO and FIFA #REACHOUT campaign, the Qatar Ministry of Health project “Are you all right?” , and the innovative Friendship Benches project, originally launched in Zimbabwe with WHO support. In the past, the World Health Innovation Summit has been used as a platform to promote Friendship Benches. This initiative also aims to promote physical activity as one of the key objectives of the Sport for Health project. To this end, illustrations are placed on each bench with recommendations for simple and effective exercises that visitors can do to improve physical health.

    A bench is a simple yet important mental health tool, whether it be a park bench or a football stadium bench,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “The Friendship Bench project serves as a reminder to us how the simple act of sitting down and talking can mean a lot for mental health.”

    Her Excellency Dr. Hanan Al Kuwari, Minister of Health of Qatar, said that the Friendship Benches project will be a tangible and lasting symbol of the importance of the Sport for Health partnership, its goals in the context of the upcoming FIFA World Cup in Qatar - the first World Cup in the Middle East and the Arab world - and the legacy that the WHO and the Qatar Ministry of Health are striving to leave.

    “Mental health is a central component of the Sport for Health partnership, and our goal is for Friendship Benches to be a place where, during and after the World Cup, residents and visitors to Qatar can come together, ask a friend friend: "Are you okay?" and take advantage of this opportunity for communication and joint physical education,” said E. P. Dr. Al-Kuwari.

    His Excellency Hassan Al-Tawadi, General Secretary of the Supreme Organizing Committee, said: “We are proud to support this project and take advantage of the opportunity that hosting the World Cup brings us. These benches will forever be a reminder of the first World Cup in the Middle East and the Arab world, while also helping to promote the importance of mental health throughout the country.”

    The final locations for each of the 32 benches will be announced shortly. Once the benches are in place, Qatari residents and international visitors will receive information on how they can visit their country's and all other benches in support of mental health promotion.

    Editorial note

    Video materials and photos from the Friendship Benches opening ceremony will be made available to the media on 10 October.

    At 16:00 hrs QD, there will be a live stream on the WHO Facebook channel (https://www.facebook. com/WHO).

    Contact information:

    For interviews and other information:

    • Supreme Organizing Committee: [email protected]

    Mental health reform - urgent human rights need and imperative - Human rights commentary -

    Already in the early stages of a pandemic COVID -19 The World Health Organization (WHO) has warned that significant investment in the mental health system is needed to prevent a mental health crisis. There is now incontrovertible evidence of the devastating impact of the pandemic on mental health. The reasons are clear: the pandemic has caused fear and anxiety for everyone, and many of us have also had to deal with illness, the grief of losing family members, insecurity and loss of income. In addition to this particular burden on our mental health, we have been cut off from our usual sources of support, friends and family during a time when the pandemic has hampered access to existing mental health services.

    The pandemic has affected different people in different ways, and mental health is no exception in this regard. Among other things, the mental health of certain demographic groups, such as the elderly, children, adolescents, women, and vulnerable populations such as people with disabilities, LGBTI persons and migrants, have been affected more during the pandemic than the mental health of the rest of the population. In a statement signed by me with the UN Independent Expert on Sexual Orientation and Gender Identity and other human rights experts, we have warned governments about the rise in mental health problems, for example, among LGBTI people and, in particular, young people, arising most often as a result of the inevitability of communication with family members who do not support or are hostile to their sexual identity.

    I recently published an issue paper on “Protecting the right to health through the provision of inclusive and sustainable health care for all”, in which I made twelve recommendations. These are universal coverage in the provision of health services (one of the most important components of which are mental health services), greater equality and respect for the human dignity of patients, greater participation and empowerment of the population in relevant decision-making, promoting transparency and accountability of public authorities throughout all political cycles and improving health communication policy. Since the right to health is defined as the right to the highest attainable standard of physical and mental health, these recommendations naturally apply to mental health care as well. However, some recommendations are more specific in relation to mental health. For example, these are recommendations relating to the need to ensure that mental health services are accessible, of adequate quality and affordable to those who need them. A transition from an institutional model to a public one is needed, as well as the elimination of coercive practices in the field of mental health.

    The mental health system as a long-standing source of human rights violations

    While the emotional stress caused by the pandemic is a new factor, the mental health situation and the lack of services in Europe remain a crisis that is not addressed by for a long time. Despite the suffering and economic burden that mental illness creates, the cost of addressing these problems in the WHO European Region was estimated to be only 1% of total health spending in 2019year, and most of them went to the maintenance of psychiatric hospitals. In a landmark paper dated 2017, the UN Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health has already raised the alarm that “arbitrary separation of physical and mental health, exclusion and denial of services in in this area have contributed to an unacceptable situation of unmet needs and violations of human rights.”

    In my issue paper on health, I urged the authorities to address the underlying social determinants of health in order to rebuild more inclusive and resilient health systems, in particular social protection, living conditions, working and educational environments. They are all the more relevant for mental health, because mental well-being is determined not only by the qualities of the individual, but also by the environment, which is able to prevent, provoke or exacerbate mental health problems. In recent decades, a rights-based, holistic and psychosocial understanding of mental health has emerged. However, this approach still faces a lot of resistance in many Council of Europe member countries, where the reductionist biomedical paradigm still prevails. Other issues identified in the aforementioned Special Rapporteur's paper are power asymmetries in mental health policies and services and biased interpretation of mental health evidence. Taken together, they reinforce the vicious cycle of stigmatization, disenfranchisement, social exclusion and coercion.

    To solve the problem of mental health services caused by the pandemic, it is urgently necessary to reform them from the ground up, and to adopt and implement appropriate laws and policies. As in the field of health in general, the guiding principle of the reforms and their imperative must be the prevention of violations of human rights.

    The rights of persons with mental health problems or psychosocial impairments (i.e., impairments resulting from a person's interaction with a mental illness and their environment) are commonly violated in two main ways. First, their rights continue to be violated by mental health services themselves because they often display paternalism, coercion and institutionalization. Second, they may not have access to the health care they need to achieve the highest attainable standard of health. In this regard, it should be borne in mind that this right is dependent on the realization of many other human rights, in particular those enshrined in the UN Convention on the Rights of Persons with Disabilities (CRPD).

    Coercion a constant source of human rights violations

    personnel: they were beaten, pushed, kicked, beaten with fists and sticks, chained to beds and subjected to medical treatment without their consent. While this example is particularly troubling, we must not forget that such institutions and the coercive approach that underlies them are still prevalent in most of our Member countries, as demonstrated, for example, in recent revelations about the state of affairs in psychiatric hospitals in Malta. My Office has dealt with human rights violations caused by the practices of such institutions in a large number of member countries, notably in my third party presentation before the European Court of Human Rights.

    Why is this still acceptable in 2021? Historically, fear, rejection, and isolation have been our standard response to people with mental health problems. The ingrained fear and stigmatization of mental illness continues to be highly significant, fueling prejudice and narratives that people with mental health problems are a danger to themselves and to society, despite all the available statistics to the contrary: people with mental health problems on in fact, they are far more likely to be victims of violence than perpetrators. Mental health laws that justify institutionalization and involuntary treatment confirm and reinforce these prejudices. While there is ample evidence that coercive treatment can lead to serious injury, and fear of coercion may actually deter people with mental disorders from seeking help, there is little scientific evidence to support the supposed benefits of coercive treatment.

    In 2019, the Parliamentary Assembly of the Council of Europe unanimously adopted a progressive resolution calling on member states to end mental health coercion, pointing out that the number of coerced people is still on the rise in Europe. The document notes that the so-called guarantees to prevent excessive use of coercion have not decreased, but rather strengthened it, for example, in France after the 2011 reform. What is defined in legislation as a last resort often becomes the default approach, especially when resources are limited. The report to the Parliamentary Assembly also reflects my observations of marked differences in forced placements between different countries, between regions of the same country, or even between institutions, suggesting that the root cause of coercion is not inherent human danger or medical necessity, but institutional culture, rather growing out of prejudices or habits. This interpretation is supported by research.

    In my address to the Parliamentary Assembly, as part of the discussion and adoption of this Resolution, I pointed out how my work in different countries has allowed me to see firsthand the vicious circles caused by a coercive approach to mental health, which reinforces the isolation of those most in need of support from their surrounding individuals, fueling further stigmatization and irrational fear. The lack of public and voluntary mental health services also leads to more coercion and incarceration.

    I also shared my observation that guarantees to protect people from arbitrariness and abuse are reduced to formalities, as they operate in a legal system in which people with mental health problems do not even have the opportunity to be heard due to the deep asymmetry of power authority between patient and physician in most psychiatric institutions. Judges almost always follow the opinion of the psychiatrist and not the patient, although the law provides them with such an opportunity. At worst, such guarantees only ease the conscience of those who are actually involved in human rights violations.

    My position on coercion in psychiatry and the Parliamentary Assembly resolution must be read against the backdrop of a growing consensus in the international community that coercion against a person with a mental disorder without their informed consent is a violation of human rights or even amounts to torture. This is largely due to the paradigm shift of the CRPD, which came into force in 2008, and the efforts of civil society, in particular survivors of mental health and psychosocial disabilities, sufficient to judge policy development. As a result, a growing number of relevant international and national human rights bodies are now calling for an end to coercion and its replacement with community-based, consent-based treatment options. This approach is gradually moving forward in the medical community as well, as evidenced by the growing number of WHO recommendations to governments to reduce coercion, create community alternatives, and mainstream mental health into primary health care. In October 2020, the World Psychiatric Association issued a statement on the need to reduce the use of coercive measures.

    This revolutionary statement is rooted in the CPI and it would be a mistake to cling to old Council of Europe standards that lower the bar. In this context, it is regrettable that the Council of Europe is still working on a draft Additional Protocol to the Oviedo Convention, reflecting an outdated application of a biomedical approach that reduces mental health to mental disorders and allows doctors to forcibly isolate and treat people without their consent. , with virtually no temporary restrictions on isolation or such treatment. The vagueness of the definitions in this document and the reliance on the judgment of a single physician, which seems out of place given the daily human rights violations, can easily give the impression that even the worst types of human rights violations are sanctioned by psychiatry. The opposition to this approach from the Parliamentary Assembly, several UN documents, including the mechanism for implementing the CRPD, the unanimous protests of representatives of organizations of people with psychosocial disabilities, as well as my opposition to this initiative, have not yet been taken into account.

    I call on Member States to stop supporting initiatives at the international level that could create confusion and stumbling blocks to necessary progress in advancing the human rights agenda when it comes to mental health. If new international standards do not promote a paradigm shift from an institutional to a community approach, and from coercive treatment to consent-based therapy, such standards should at least not cause harm or confusion.

    Looking ahead

    With these considerations in mind, some Member States, such as Ireland and the United Kingdom, have begun to review their mental health legislation. What I find particularly positive in these two examples is the commitment to engaging with civil society, with patients and with mental health service providers. The initiatives of representatives of organizations of persons with psychosocial disabilities to promote more inclusive policies should also be commended. For example, within discussion between three interested parties in Germany. sine qua non the success of mental health reform, in particular, the exclusion of mental health care from the discussion so far allowed them freely violate human rights. The participation of such persons in decision-making is also an obligation under Article 4(3) CRPD.

    The realization of the right to the enjoyment of the highest attainable standard of mental health depends on the realization of many other important human rights. In particular, Member States need to carry out the required reforms of their mental health laws simultaneously with reforms in two significant areas affecting the fundamental rights enshrined in the CRPD: legal capacity (Article 12) and the right to an independent life while remaining included in society (Article 19). ). Psychiatric care that truly preserves the autonomy, dignity, will, and preferences of the patient is simply not possible as long as legal systems continue to tolerate substitutive decision making or segregation in care settings. Of great importance in this regard are the ongoing reforms of legal capacity in our member countries. States should ensure that persons with mental health problems or psychosocial disabilities, including children, are never deprived of a voice in decisions affecting their health, but are able to receive appropriate support when needed, thereby providing mental health care based on their free and informed consent. As long as coercive measures remain a reality, it is also essential that those concerned have full access to justice so that they can challenge any decision taken against them. Some experience has also been accumulated in this area, for example, in the Netherlands.

    As far as hospitals are concerned, I would like to refer to recommendations long ago issued by my Office for their closure, starting with an immediate moratorium on future design. Experience shows that ending the use of large psychiatric hospitals in which people are held involuntarily is a key factor. In this regard, perhaps Italy was a pioneer, starting in 1978 with the gradual closure of psychiatric hospitals, replacing them with more social alternatives. While Italy also faces a number of problems related to the use of coercive measures in psychiatric institutions, it must be borne in mind that the rate of involuntary admission to hospitals in Italy today is known to be an order of magnitude lower than in neighboring countries.

    Another urgent priority should be to reduce the practice of coercion in psychiatric hospitals, including the use of restraints and coercive medication, and to phase out such practices. As mentioned above, the prevalence of such measures is largely determined by the institutional culture. For example, my predecessor in 2013 recommended that Denmark drastically reduce the use of coercion in psychiatry. I am pleased to note that the Ballerup Psychiatric Center has succeeded for the first time in the country in ending the use of restrictions by training staff to manage conflict and by increasing the physical activity of its residents without increasing drug treatment. This is done in the interests of both patients and staff.

    The ultimate goal should be to replace hospitals and the entire coercive mental health system with a rehabilitation and communication model that promotes social inclusion and offers a wide range of human rights-based treatments and psychosocial support options. They can take a variety of forms and modalities, including support from peers or networks, providing patients with advocates and/or personal advocates for their rights, extensive planning, and crisis resolution within the community or through open dialogue. It is also critical to break down the lingering stigma associated with seeking help for mental health issues—whether in the educational setting, the workplace, or in primary health care centers—through targeted awareness-raising and advocacy. Only then can mental health services, as an integral part of primary health care, be available to all people throughout their lives. Once again, it is critical that people with a wealth of experience in designing, implementing, delivering and monitoring these services are crucial.

    Member State authorities can draw on several compendiums of promising practices at European and global levels, as well as ongoing projects and studies in the field of community-based recovery-oriented service delivery. This is, for example, the project RECOVER -E implemented in Bulgaria, Romania, North Macedonia, Croatia and Montenegro. It also appears possible to impact on the mental health of stakeholders through the use of new technologies, which present both new opportunities and serious risks to human rights. In this area, it would be useful to refer to their recommendations on the interaction between human rights and artificial intelligence.

    In this context, I call on States to pay special attention to the mental health of children and adolescents, not least because of the extraordinary burden that the COVID-19 pandemic has placed on them. Lockdown measures and prolonged school closures have deprived them of their usual daily routines, subjected them to isolation, violence and abuse to a greater extent than other population groups. We must not forget that childhood and adolescence are crucial periods for maintaining mental health throughout life. Mental illness experienced in the early years of life as a result of adversity or trauma affects brain development and the ability to form healthy relationships and life skills. Therefore, children and adolescents need non-bureaucratic access to mental health support services, if necessary, at the earliest possible stage, using the least invasive methods and without any moral stigma. On the other hand, the institutionalization of children has a negative impact on their development, as I emphasized in a letter to the authorities of Bosnia and Herzegovina. We must also keep in mind that even before the pandemic, suicide was one of the most common causes of death among adolescents in the European region. Of particular concern in this context are recent data showing an increase in the incidence of anxiety, depression and self-harm among young people. In order to prevent stress on mental health systems, it is essential to scale up early psychosocial interventions for children based on innovative and community-based child mental health services, rather than on the use of psychotropic drugs on children, which is, unfortunately, a widespread practice.

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