The Student Health Service, known in France as the Service Sanitaire, occupies a unique position in the landscape of health professional education. Introduced as a compulsory component of French health curricula, it requires students from six distinct disciplines to work side by side on prevention projects aimed at communities, schools, and other beneficiary populations. According to the study’s authors, it is the only mandatory and universal interprofessional training experience embedded in French health education. That universality makes it an unusually powerful natural laboratory: unlike voluntary electives or single-institution pilots, the program reaches essentially every health student in a given region, allowing researchers to assess skill development across an entire cohort rather than a self-selected sample of enthusiasts.

To quantify the change, the research team turned to a validated instrument called the Interprofessional Collaborative Competency Attainment Survey, or ICCAS. The tool asks respondents to rate their own competence across the domains of interprofessional collaboration, including roles and responsibilities, teamwork, communication, and collaborative patient- or client-centered practice. The French version was used with written permission from Professor Douglas Archibald, with a minor contextual adaptation: references to the patient or family were reworded to refer to the beneficiary of the preventive action, matching the prevention-focused mission of the Student Health Service. The survey uses a seven-point scale, and the study’s primary endpoint was the change in mean score between a retrospective pre-program rating and a post-program rating collected at the same time.

That retrospective pre-post design deserves a technical note, because it is both the study’s methodological strength and a source of interpretive caution. Rather than asking students to rate their skills before the program and then again afterward, the researchers collected both the before and after ratings simultaneously once the program was complete. This approach, widely used in educational research, is thought to reduce response-shift bias, the phenomenon in which participants’ internal standards shift during an intervention, making their earlier self-assessments incomparable with later ones. By anchoring both judgments to a common frame of reference at a single moment, the retrospective design attempts to isolate genuine perceived growth from mere changes in how students understand the rating scale itself.

The scale of the data collection was ambitious. All 1,141 students completing their Student Health Service during the 2024–2025 academic year in the departments of Maine-et-Loire, Mayenne, and Sarthe were eligible. Of these, 943 received the questionnaire, 638 responded, and 553 questionnaires met the predefined completion criterion and entered the final analysis. The results were striking in their consistency. The mean ICCAS score rose from 5.81 before the program to 6.37 afterward, a statistically significant mean improvement of 0.55 points with a p-value below 0.001. In practical terms, students moved from a self-assessment comfortably above the scale’s midpoint to one approaching its upper range, and every one of the ICCAS domains showed significant improvement.

The distribution of individual responses adds texture to the headline numbers. A decisive majority, 86.6 percent of students, reported an improvement in their self-perceived interprofessional skills. A small fraction, 9.9 percent, reported no change, and 3.4 percent actually reported a decrease. The researchers also ran exploratory analyses to see whether the size of the gain varied by field of study, by department, or by the prevention topic students worked on. No significant differences emerged, although the authors caution that some subgroups were small, limiting the statistical power of those comparisons. The apparent uniformity of benefit across professions is itself notable: it suggests the program’s effect is not driven by one discipline’s curriculum or one region’s implementation but appears to operate broadly across the interprofessional mix.

One of the study’s most intriguing findings came from its sensitivity analysis, which compared paper-based questionnaires with digital ones. Students who completed the survey on paper reported a mean improvement of 0.586 points, while those using the digital format reported a mean gain of only 0.251 points, a difference that was itself statistically significant at p below 0.001. The authors do not overinterpret this gap, but it raises genuine methodological questions for anyone designing self-assessment research. Response formats can influence how people recall and evaluate their own past states, and the nearly threefold difference between modalities suggests that survey delivery is not a neutral technical choice. Future evaluations of interprofessional education may need to account for, or standardize, the medium through which self-perception is measured.

Why does a mandatory prevention placement move the needle on collaboration skills at all? The theoretical answer lies in the architecture of interprofessional education itself. Decades of research have argued that health professions students learn in silos, absorbing the norms, vocabularies, and hierarchies of their own discipline while rarely practicing the negotiation of roles that real clinical teamwork demands. The Student Health Service forces that negotiation early. Because prevention projects require students to define who does what, communicate across professional boundaries, and center the needs of a shared beneficiary, they create authentic opportunities to exercise exactly the competencies the ICCAS measures. The study’s findings are consistent with the idea that collaborative competence is not an abstract attitude but a practical skill that develops through structured, repeated, real-world interaction with other professions.

The implications extend beyond France. Health systems globally face workforce shortages, rising chronic disease burdens, and mounting evidence that fragmented care harms patients, all of which have pushed interprofessional education to the top of curricular reform agendas. Yet rigorous evaluations of mandatory, large-scale interprofessional programs remain scarce, partly because few countries have made such training universal. The Angers study, covering six professions across three departments in a single academic year, provides a template for how such evaluations can be conducted: a validated self-assessment instrument, a retrospective pre-post design, and a completion criterion applied before analysis. Its conclusion that the program strengthened interprofessional training in French health curricula gives policymakers empirical support for maintaining and expanding the model.

The authors are careful about the limits of what self-report can show. Self-perceived competence is not the same as objectively measured competence, and students may overestimate or underestimate their actual collaborative abilities. The study’s own recommendation points the way forward: further research should explore the relationship between self-perceived and objectively measured interprofessional competencies, ideally through observational measures, standardized assessments, or longitudinal follow-up into professional practice. There is also the question of durability, whether gains measured immediately after the program persist once students enter clinical rotations and, eventually, the workforce. Still, the core message stands. When a thousand-plus students across medicine, nursing, midwifery, pharmacy, and the therapies were required to collaborate on real prevention work, nearly nine in ten came away believing they had become better team members, and the numbers behind that belief were statistically robust. For a field long criticized for teaching teamwork in lecture halls, that is evidence worth taking seriously.

Subject of Research: Changes in self-perceived interprofessional collaborative skills among health students after a mandatory student health service program

Article Title: Changes in students’ self-perceived interprofessional collaborative skills following participation in the student health service program

Article References: Donat, T., De Roquefeuil, E., Busson, A., Baglin, I., Poiroux, L., Ramond-Roquin, A., Ammi, M., & Levaillant, M. (2026). Changes in students’ self-perceived interprofessional collaborative skills following participation in the student health service program. BMC Medical Education. https://doi.org/10.1186/s12909-026-10479-1

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10479-1

Keywords: interprofessional education, interprofessional collaboration, Student Health Service, ICCAS, self-assessment, health professions students, medical education, teamwork, preventive care, France, BMC Medical Education, curriculum evaluation

The research team, led by Bürge Atılgan of Ankara Training and Research Hospital and Sevgi Turan of ADA University in Baku, conducted the study across five universities in Ankara. Their goal was deliberately broad: rather than measuring collaboration with surveys and scales, they wanted to understand how educators and students experience and interpret it in their own words. Qualitative descriptive methodology was chosen precisely because the field needed a richer, more textured account of what collaboration means on the ground in Turkish health professions education, where such in-depth evidence has been scarce.

The study design was substantial. Forty-seven faculty members took part in semi-structured individual interviews, while thirty-five final-year students participated in five profession-specific focus groups. Participants were recruited from five disciplines: medicine, nursing, physiotherapy and rehabilitation, pharmacy, and nutrition and dietetics. Every interview was audio-recorded and transcribed verbatim, and the researchers analysed the transcripts using qualitative content analysis, a systematic method for identifying patterns and themes within textual data. Reporting followed the Consolidated Criteria for Reporting Qualitative Research, a thirty-two-item checklist designed to make qualitative studies transparent and replicable. Ethical approval came from the Hacettepe University Ethics Committee, with institutional permissions from every participating university, and all participants gave informed consent.

From the analysis, four major themes emerged. The first framed collaborative practice as a requirement for patient-centred care. Participants across all professions agreed that safe, coordinated and holistic treatment depends on professionals working together rather than in parallel silos. A patient with complex needs—say, an older adult recovering from a stroke—requires physicians to diagnose, nurses to monitor, physiotherapists to restore mobility, pharmacists to manage medication interactions and dietitians to address nutrition. When these professionals communicate poorly, care fragments; when they collaborate, outcomes improve. The participants saw this not as an idealistic aspiration but as a practical necessity of contemporary medicine.

The second theme concerned understanding professional roles and boundaries. Participants emphasised that effective teamwork is impossible without role clarity: each team member must know not only what their own responsibilities are, but what their colleagues are trained and authorised to do. Misunderstandings about scope of practice breed duplication, gaps in care and mistrust. The researchers found that both faculty members and students recognised the importance of mutual respect alongside role clarity, but that students often lacked structured opportunities to learn what other professions actually do—a gap that leaves them to form impressions through incidental contact, rumour or stereotype.

The third theme identified communication, hierarchy and prejudice as the principal barriers to teamwork. This is where the study becomes most pointed. Participants described steep professional hierarchies in which the voice of the physician traditionally carries the most weight, and in which other professionals may hesitate to speak up even when they have crucial information. Prejudice between professions—unflattering assumptions about what another discipline contributes—further corrodes trust. These barriers are not unique to Türkiye; international literature on interprofessional collaboration has long documented similar dynamics. But the study makes clear that students experience these tensions directly during clinical placements, and that unaddressed hierarchy in training environments risks reproducing itself in the next generation of practitioners.

The fourth theme centred on educational and institutional contexts for collaboration. Here the two participant groups diverged in revealing ways. Although faculty members and students raised many of the same issues, they approached them from different positions. Students focused mainly on learning, participation, communication and respect—their immediate experience of being trained and of interacting with other professions. Faculty members, by contrast, placed greater emphasis on professional identity, institutional structures and the practical conditions required for implementation. In other words, students asked how they could learn to collaborate, while educators asked what curricular time, faculty development and administrative support would be needed to make such learning possible at scale.

That divergence matters for policy. Interprofessional education—the deliberate arrangement of students from two or more professions to learn together—has been championed by the World Health Organization and the Interprofessional Education Collaborative as a strategy for building collaborative practice. Yet embedding it in a curriculum is institutionally demanding. It requires synchronised timetables across faculties, shared learning activities with genuine clinical relevance, assessment methods that reward teamwork, and faculty who can model collaborative behaviour in front of students. The study’s participants made clear that faculty role modelling is a powerful force: students learn as much from watching how their teachers interact with other professionals as from any formal lecture on teamwork.

The authors’ conclusions are measured but firm. Faculty members and final-year students viewed collaborative practice and understanding of professional roles as important but insufficiently structured components of health professions education. They recommend that curricula provide early, repeated and interactive opportunities for students from different professions to learn together—early, because attitudes and stereotypes form quickly; repeated, because a single shared course cannot undo years of siloed training; and interactive, because collaboration is a skill practised, not memorised. They further call for faculty development programmes and institutional support to sustain collaborative learning and practice over time, recognising that individual enthusiasm cannot substitute for structural commitment.

The study was supported by the Hacettepe University Scientific Research Projects Coordination Unit under project number TDK-2020-18494, with the funder having no role in study design, data collection, analysis or interpretation. The authors declare no competing interests, and the article is published open access under a Creative Commons licence. For a health system facing rising chronic disease, ageing populations and increasingly complex care pathways, the message resonates far beyond Ankara: the professionals of tomorrow will inevitably work in teams, and the education system must stop leaving teamwork to chance. Teaching students to collaborate deliberately, with clear roles and mutual respect, may prove as consequential to patient safety as any drug or device.

Subject of Research: Interprofessional collaboration and professional role perceptions in health professions education in Türkiye

Article Title: Faculty members’ and final-year students’ perspectives on interprofessional collaboration and professional roles: a qualitative study in Türkiye

Article References: Atılgan, B., & Turan, S. (2026). Faculty members’ and final-year students’ perspectives on interprofessional collaboration and professional roles: a qualitative study in Türkiye. BMC Medical Education. https://doi.org/10.1186/s12909-026-10512-3

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10512-3

Keywords: interprofessional collaboration, health professions education, teamwork, professional roles, qualitative research, medical education, nursing, pharmacy, physiotherapy, nutrition and dietetics, Türkiye, curriculum

The study employed an exploratory qualitative design grounded in collective case methodology. Between three and nine participants from each of eleven teams, three Assertive Community Treatment teams, four acute teams, three follow-up teams, and one rehabilitation team, took part in semi-structured focus group interviews lasting approximately 75 minutes each, conducted over a four-month period. Managers were deliberately excluded to encourage open dialogue and minimize hierarchical influence, and all groups were gender-balanced. Using Braun and Clarke’s reflexive thematic analysis, the researchers identified four interrelated themes that structure the findings: Anchoring Amid Chaos, Bearing Ethical Strain, Reinventing in Motion, and Sustaining Care Through Strong Relationships. What began as site-specific complaints, the authors note, emerged through the analytic process as shared dilemmas cutting across team types and service formats.

The first theme, Anchoring Amid Chaos, describes how professionals compensate for fragmented systems, unclear responsibilities, and organizational discontinuities. Participants described unclear handovers, split documentation systems, and persistent ambiguity about who holds responsibility at different stages of a user’s care journey. One ACT team member captured the structural absurdity plainly: the team works for both municipal and specialist services but cannot see each other’s records. Tasks such as following up on referrals or reconnecting users with support structures were taken on not because they were assigned, but because no one else would do them. As one participant put it, the system collapses when they let go, and they do not know who is supposed to catch the users. Another reflected that sometimes the system itself creates the instability the teams are trying to manage, comparing the work to building on sand.

The second theme, Bearing Ethical Strain, exposes the moral weight of practicing without protocols. Unlike institutional settings with formal decision hierarchies, ambulatory professionals confront dilemmas in real time, often during understaffed shifts or legally fraught situations. Examples ranged from the seemingly mundane, such as accompanying a patient to buy alcohol to maintain engagement, to the legally complex, including an ACT team’s decision to contact a patient’s father without consent for safety reasons. One acute team member noted there is no place to talk about the ethical judgments made daily, while another described making tough calls alone, trusting instinct in the moment. Some teams developed informal debriefing routines, often over coffee or in the car on the way back from difficult shifts, but these improvised supports rarely addressed the deeper systemic issues. The researchers frame this not merely as moral distress but as moral endurance, the capacity to keep practicing in ethically uncertain conditions day after day.

The third theme, Reinventing in Motion, documents continuous, improvised adaptation of formal service models. ACT protocols shift to accommodate rural contexts, acute interventions blend standardized tools like the Health of the Nation Outcome Scales with improvisation, and follow-up teams combine therapy with practical activities such as hiking. One rehabilitation team member described having to build the road while walking it, since no clear plan existed. This reinvention was not preference but necessity, unfolding in response to unpredictable conditions and loosely coordinated systems. Yet the researchers found a troubling duality: professionals expressed pride in their flexibility while also feeling vulnerable, expected to be creative but left on their own when something went wrong. This improvisational labor remains structurally invisible, unrecognized in official metrics, even though, as one participant concluded, without it things fall apart.

The fourth theme, Sustaining Care Through Strong Relationships, positions relational continuity as the core infrastructure of care in fragmented environments. Professionals built trust through persistence and presence, meeting users in homes, public spaces, or cars, sometimes showing up fifteen times before receiving a response. ACT teams maintained contact through cycles of rejection and re-engagement, occasionally visiting without appointments just to keep a thread of connection alive. One participant reflected that sometimes the walk was the intervention, capturing how blurred the line between professional duty and human companionship had become. These bonds were not only therapeutic but practical, enabling early crisis detection and re-engagement of users who had dropped out. A five-minute call, one acute team member observed, can mean the difference between stability and breakdown. Yet visits for coffee, impromptu walks, and regular check-ins were rarely logged as treatment, despite being fundamental to stability.

Theoretically, the study weaves together five complementary frameworks. Jarrett Zigon’s concept of moral breakdown illuminates how routine ethical comportment gives way to conscious deliberation under ambiguous conditions, a state the researchers found to be a persistent feature of ambulatory work rather than a rare event. Niklas Luhmann’s social systems theory explains why integration is structurally impossible: healthcare, municipal governance, and legal institutions each operate according to autonomous codes, forcing professionals to become de facto translators between self-referential subsystems. Donald Schön’s reflective practitioner model reframes the teams’ improvisation not as drift or inconsistency but as professional artistry, a form of reflection-in-action grounded in contextual competence. Carl Rogers’ person-centered theory underpins the relational findings, with empathy, congruence, and unconditional positive regard functioning as foundational conditions for recovery rather than mere techniques.

To synthesize these dynamics, the authors applied Ødegård’s Perception of Interprofessional Collaboration Model, or PINCOM, which analyzes collaboration across individual, group, and organizational levels. Viewed through this lens, collaboration in ambulatory mental health care emerges not as the result of seamless coordination or rational planning, but as what occurs in their absence. At the individual level, professionals respond to moral ambiguity with discretionary judgment; at the group level, teams co-produce collaboration through trust-based improvisation rather than standardized fidelity; and at the organizational level, practitioners perform integrative labor across institutional gaps, bridging disconnected services and translating between incompatible documentation systems. The researchers identify three recurring cross-level tensions: collaborative intent versus infrastructural friction, personal ethics versus institutional mandates, and team-level improvisation versus vertical expectations. Ambulatory teams, they conclude, are not extensions of the system but the glue binding its fragments.

The findings carry concrete implications for training, evaluation, and policy. The authors call for structured opportunities for ethical reflection, including dialogical training, team debriefs, and peer consultations to mitigate moral distress. They urge regional health authorities to build joint documentation systems, shared care plans, and cross-sector case conferences that connect municipal and specialist domains. Evaluation frameworks, they argue, must evolve beyond hospitalization rates and throughput metrics to include indicators of relational quality such as continuity, user trust, and emotional safety. National policymakers should allow local adaptations that preserve fidelity to recovery principles while endorsing reflective judgment over rigid adherence, and organizational leaders must formally recognize the mediating role professionals play at the intersection of systems, with clear expectations and shared accountability across sectors.

The study’s limitations warrant attention. It draws on teams within a single Norwegian region and focuses exclusively on specialist health services, so findings may not transfer to municipally organized teams or different structural configurations. The focus group format may have amplified dominant perspectives, and the secondary analysis prioritized thematic content over interactional dynamics within groups. The cross-sectional design offers only a temporal snapshot of evolving practices. Still, the researchers caution that professional resilience, however pronounced, cannot indefinitely compensate for systemic fragility. For recovery-oriented mental health care to endure, system-level change must recognize and support the invisible labor currently borne by frontline professionals, the ethical improvisation, relational stamina, and situational intelligence that make care possible despite, not because of, existing frameworks.

Subject of Research: Professional experiences and adaptive anchoring work in Norwegian specialized ambulatory mental health care teams

Article Title: Anchoring practice in flux: Experiences among professionals in Norwegian specialized ambulatory mental health care teams

Article References: Dale, K. Y., & Ødegård, A. (2026). Anchoring practice in flux: Experiences among professionals in Norwegian specialized ambulatory mental health care teams. Current Psychology, 45(18), Article 1526. https://doi.org/10.1007/s12144-026-10096-7

Image Credits: AI Generated

DOI: 10.1007/s12144-026-10096-7

Keywords: ambulatory mental health care, Assertive Community Treatment, crisis resolution teams, ethical dilemmas, interprofessional collaboration, relational care, systemic fragmentation, qualitative research, thematic analysis, recovery-oriented care, Norway, mental health services

The research, led by Silje Zink, Marte Feiring and Ingvild Kjeken, comes at a moment when health systems worldwide are struggling with ageing populations and rising chronic disease. One widely discussed remedy is task-shifting, defined by the World Health Organization as the rational redistribution of tasks among health workforce teams. In rheumatology, previous trials have shown that nurse-led care for rheumatoid arthritis can be more cost-effective than physician-led care, with better disease control and higher patient satisfaction, while physiotherapists have proven equally capable as primary assessors for suspected knee osteoarthritis. What remained unclear was how such redistribution actually works in practice for hand osteoarthritis, and which factors decide whether it succeeds or stalls.

To find out, the researchers interviewed ten rheumatologists and five occupational therapists across two Norwegian hospitals with very different setups. At one hospital, an occupational-therapist-led pathway had been running since 2013, with all referrals suggesting hand osteoarthritis routed directly to therapists. At the other, an ongoing trial randomised patients to an initial consultation with either a rheumatologist or an occupational therapist. The team conducted seventeen semi-structured interviews, some lasting up to two hours, and analysed them using template analysis guided retrospectively by the Capability, Opportunity and Motivation model of behaviour, known as COM-B, together with the Theoretical Domains Framework, a validated tool for understanding what drives health professional behaviour.

The analysis produced four overarching themes. The first concerns how clinical understandings of hand osteoarthritis shape task redistribution. Both professional groups agreed that diagnosing the condition is usually straightforward, which lowered the perceived risk of handing over first consultations. One rheumatologist put it bluntly: diagnosing hand osteoarthritis is not difficult at all. But the picture was complicated by ambiguous referrals from general practitioners, and occupational therapists described cases where they suspected something other than osteoarthritis, such as psoriatic arthritis, underscoring that strong differential diagnosis skills remain essential when therapists become the first point of contact in specialist care.

Strikingly, the very absence of effective drug treatment turned out to be a facilitator. Rheumatologists described hand osteoarthritis as a low-status disease and not a particularly attractive diagnosis, precisely because they could offer little beyond referring patients for exercises and assistive devices. One reflected that conditions they cannot treat or improve leave them with dissatisfied patients. This lack of professional ownership opened space for therapists to take over, especially since international guidelines recommend exactly the non-pharmacological interventions, ergonomic counselling, patient education, hand exercises and orthoses, that sit at the heart of occupational therapy. Therapists, for their part, emphasised the enormous everyday impact of the disease and the simple, cheap measures that can restore function and reduce pain.

The second theme revealed that context and infrastructure can make or break the shift. A major barrier was unequal access to technology: occupational therapists lacked ultrasound machines, which rheumatologists use to look inside joints and quickly rule out inflammatory conditions. Therapists argued that access to ultrasound would let them clarify diagnoses independently, cut unnecessary referrals and save everyone time. Physical proximity mattered just as much. Where therapists and doctors sat next door to each other, quick consultations created a safety net for uncertain cases; where departments were relocated apart, informal contact withered, and rheumatologists stopped calling colleagues they no longer knew personally. The study highlights how seemingly trivial details of hospital geography ripple through collaboration and even patient safety.

Legal and regulatory constraints created further friction, which teams solved through pragmatic workarounds. At one hospital, rheumatologists allowed occupational therapists to file x-ray referrals and applications for orthoses using the doctors’ credentials, trusting their judgements and eliminating delays. Therapists at the other hospital, lacking such flexibility, had to hunt down a physician for a signature after completing all the paperwork themselves, a practice they described as simply unnecessary. These informal flexibilities, documented in earlier research on professional boundaries, proved pivotal in streamlining clinics, though they also raise questions about how formal systems should adapt to expanded allied health roles.

The third theme centred on communication and trust as the foundation of collaboration. Successful sites were marked by open, low-threshold interaction, with therapists simply knocking on a doctor’s door when unsure. Complementary expertise, therapists in function and ergonomics, physicians in diagnostics and medication, replaced competition. Joint teaching sessions, shared morning meetings and therapists sending consultation summaries to general practitioners all built mutual understanding. Notably, trust was not automatic: newer doctors unfamiliar with occupational therapy showed lower trust, prompting therapists to continually advertise their competencies. The researchers suggest this is a solvable problem, and that professional identity itself was not the obstacle many might expect.

The fourth theme exposed the patient side of the equation. At the hospital with the long-established therapist-led pathway, patients often did not understand what occupational therapy was, sometimes googled it, formed misconceptions, and occasionally failed to show up or insisted on seeing a doctor. Rheumatologists themselves acknowledged that therapists are the true experts for this condition, and urged better patient and GP education so that referrals are not wasted on physicians who have little to offer. According to the COM-B model, improving patients’ understanding and reshaping their beliefs about the benefits of therapist-led care are key levers for smoother implementation.

The broader message is that sustainable task-shifting in specialist care depends less on resolving professional turf wars and more on system-level design: ensuring access to technology, co-locating collaborating professions, providing training in diagnostic reasoning, and clearly communicating provider roles to patients. With osteoarthritis projected to become one of the largest contributors to years lived with disability worldwide, the Norwegian experience offers a template for health systems everywhere: put the right professional, not necessarily the most expensive one, in front of the right patient, and build the organisational scaffolding to make that handover stick.

Subject of Research: Task-shifting of hand osteoarthritis first consultations from rheumatologists to occupational therapists in Norwegian specialist healthcare

Article Title: Factors influencing task-shifting between rheumatologists and occupational therapists in hand osteoarthritis care: A qualitative study

Article References: Zink, S., Feiring, M., & Kjeken, I. (2025). Factors influencing task-shifting between rheumatologists and occupational therapists in hand osteoarthritis care: A qualitative study. Scandinavian Journal of Occupational Therapy, 32(1), Article 2572343. https://doi.org/10.1080/11038128.2025.2572343

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2572343

Keywords: hand osteoarthritis, task-shifting, occupational therapy, rheumatology, COM-B model, Theoretical Domains Framework, interprofessional collaboration, qualitative research, Norway, healthcare workforce, non-pharmacological treatment, patient preferences

The study, conducted between October 2024 and January 2025, invited 533 community pharmacists from across Saudi Arabia to complete a validated questionnaire assessing three domains: their current practices in depression care, their perceptions and attitudes, and the barriers they face. With a participation rate of 70.7 percent, the survey offers one of the more comprehensive snapshots to date of how community pharmacists in the Kingdom engage with mental health presentations. Respondents were scored on the frequency with which they performed specific depression-related activities, from screening and counseling to referral, and the researchers then used multiple linear regression to identify which pharmacist characteristics predicted stronger or weaker practice.

The headline numbers tell a story of misaligned capacity. The overall practice score came in at 51.0 percent, which the authors characterize as low, while the perception and attitude score reached 77.4 percent, indicating a moderate level of positive orientation toward depression care. In other words, pharmacists largely accept that they have a legitimate role in supporting patients with depression, whether through medication management, adherence counseling, or referral to physicians, but that acceptance rarely translates into consistent action. This attitude-practice gap is a well-recognized phenomenon in health services research, and the Saudi data add a detailed national case study of how professional beliefs can outrun institutional support.

Not all depression-related activities were equally neglected. The most commonly reported practices were encouraging patients to adhere to their antidepressant medications and checking prescription details before dispensing. These are tasks that fit naturally into the existing workflow of a community pharmacy and require little additional infrastructure. By contrast, less frequent activities included consulting with physicians about patient care and providing written educational materials about depression. The pattern is telling: pharmacists are comfortable performing the mechanical elements of pharmaceutical care, but the communicative and collaborative components, those that require time, privacy, and established referral relationships, lag behind. It is precisely these latter activities that international guidelines on collaborative mental health care tend to emphasize.

The barriers pharmacists reported form a coherent picture of a system not yet designed for mental health work at the community level. The most significant obstacles included limited access to patient medical profiles, which prevents pharmacists from seeing the full clinical picture behind a prescription; poor patient understanding of depression, which complicates counseling; a lack of privacy in pharmacies, where counseling about a psychiatric condition can be overheard by other customers; time constraints in busy dispensing environments; and inadequate mental health training. Each of these barriers maps onto a specific fix: integrated health records, public education, redesigned pharmacy spaces, realistic workload expectations, and targeted professional development. The authors argue that addressing these structural issues, rather than simply exhorting pharmacists to do more, is the key to unlocking the profession’s contribution.

The regression analysis added statistical texture to these findings. The overall model was significant, explaining roughly 22 percent of the variance in practice scores, and several demographic and workload factors emerged as meaningful predictors. Greater professional experience was associated with higher practice scores, suggesting that depression care skills accumulate over a career, perhaps through repeated patient encounters and informal learning. Interestingly, pharmacists aged 30 to 39 years scored lower than those aged 20 to 29, a counterintuitive result that may reflect the compounded pressures of mid-career workloads and family responsibilities, though the study design cannot establish causation. Dispensing between 50 and 100 prescriptions daily was associated with higher practice scores, possibly because this moderate workload level provides enough patient contact to practice depression-related activities without the paralyzing time pressure of very high volumes.

One of the most consequential negative findings concerned training. Depression-specific training was not significantly associated with higher practice scores in the regression model, with the coefficient falling just short of conventional statistical significance. This result deserves careful interpretation. It may indicate that existing training programs are not sufficiently practical or competency-based to change behavior, that trained pharmacists still face the same structural barriers that nullify their additional skills, or that the self-reported nature of training exposure obscures real differences in training quality. The authors conclude that competency-based training, explicitly designed to overcome the barriers pharmacists face, is needed rather than generic mental health education alone.

The significance of this research extends beyond Saudi Arabia. Depression is a major and growing public health burden worldwide, and health systems everywhere struggle to provide timely access to mental health services. Community pharmacists occupy a unique position in the response: they are geographically distributed, do not require appointments, are visited repeatedly by patients with chronic conditions, and are often the healthcare professional a person sees most frequently. International health policy frameworks have increasingly called for pharmacists to take on expanded roles in mental health, including medication reconciliation, adherence support, recognition of worsening symptoms, and structured referral. The Saudi study provides a template for measuring how far real-world pharmacy practice sits from that aspiration, and its methods could be replicated in other countries facing similar gaps.

What would it take to close the gap the study documents? The authors outline a reform agenda built on five pillars: competency-based training programs that emphasize practical skills over theoretical knowledge; better access to patient medical profiles through integrated digital health records, aligning with Saudi Arabia’s broader health digitization agenda under Vision 2030; private counseling spaces within or adjacent to pharmacies; clearly defined referral pathways that connect pharmacists to primary care physicians and mental health specialists; and stronger interprofessional collaboration, so that a pharmacist’s concern about a patient reaches a physician quickly and reliably. None of these interventions is technologically exotic, and several are already underway in other health systems that have formalized pharmacist roles in collaborative care models for depression.

The study also carries a message for patients and the public. Poor patient understanding of depression ranked among the top barriers reported by pharmacists, which means the problem is bidirectional: pharmacists cannot counsel effectively if patients do not recognize depression as a treatable medical condition or feel able to discuss it. Reducing mental health stigma and improving mental health literacy in the general population would directly amplify the effectiveness of any pharmacy-based intervention. As health systems worldwide search for scalable ways to ease the burden of depression, this Saudi survey offers a sober but hopeful conclusion: the workforce is willing, the attitudes are broadly supportive, and what stands between intention and impact is a set of fixable structural problems, from missing medical records to missing private corners in which a difficult conversation can finally take place.

Subject of Research: Community pharmacists' role and barriers in depression care in Saudi Arabia

Article Title: Community pharmacists’ practices, perceptions, and barriers in depression care: a cross-sectional study in Saudi Arabia

Article References: Alzahrani, F., Aljohani, M., Alhusini, L. M., Alluhibi, H., Aljohani, L. S., Al Thaqfan, S. S., Fallatah, S. B., Alzahrani, S., & Alnezary, F. S. (2026). Community pharmacists’ practices, perceptions, and barriers in depression care: a cross-sectional study in Saudi Arabia. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15551-6

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15551-6

Keywords: depression, community pharmacists, Saudi Arabia, mental health, pharmacy practice, cross-sectional study, barriers, antidepressant adherence, referral pathways, interprofessional collaboration, health services research, pharmacist training

The core problem, the author explains, is that inpatient psychiatry and law enforcement operate under fundamentally different mandates. The primary goal of psychiatric admission is to stabilize an acute crisis, rebuild therapeutic trust, respect confidentiality, and set up a safe discharge with timely outpatient follow-up. Law enforcement, by contrast, is oriented toward public safety and legal process. Officers may transport individuals for emergency psychiatric evaluation or arrange other dispositions, but they are not engaged in clinical treatment, and they are generally not bound by clinical confidentiality obligations. Unlike clinicians, they are not required to warn patients that what they disclose may not remain confidential. When these two systems intersect on a locked unit, patients can be caught between competing institutional duties.

Existing literature has paid little attention to this problem from a medical education standpoint. Most research has focused on law enforcement interactions with patients in emergency departments and trauma units. Jones and colleagues, writing in JAMA nearly two decades ago, noted the absence of formal guidelines for law enforcement interviews of hospital patients and proposed principles including respect for autonomy, noninterference with medical care, protection of privacy, maintenance of professional boundaries, and multidisciplinary policy development. Those principles remain useful, the new commentary argues, but applying them to inpatient psychiatry is considerably more complicated. Inpatient units involve ongoing therapeutic relationships, secured environments, heightened privacy expectations, and patients whose decisional capacity, trauma responses, paranoia, and other symptoms can fluctuate dramatically during admission.

The scale of the underlying interface is substantial. A 2025 systematic review and meta-analysis found that approximately 13.7 percent of individuals evaluated in psychiatric emergency departments were referred by police, and that police-referred individuals were more likely to present with aggression, homelessness, substance use or psychotic disorders, and to be hospitalized involuntarily. Yet most of the limited literature specifically addressing inpatient units and law enforcement concerns a single question: whether psychiatric staff should press charges against violent inpatients. Other recurring interactions, the author contends, have been almost entirely ignored as teaching scenarios, leaving trainees to improvise in situations where improvisation can compromise both patient care and legal process.

To fill that gap, the commentary organizes teaching around six ethical principles drawn from established frameworks in biomedical and psychiatric ethics. Patient autonomy requires that patients generally be informed about law enforcement requests involving them and, when clinically and legally feasible, given meaningful choices about whether to participate. Beneficence and nonmaleficence demand that teams promote recovery while avoiding foreseeable harms such as worsening symptoms, exacerbating trauma responses, undermining therapeutic trust, or increasing suicide risk. Justice requires that psychiatric inpatients not be denied access to reporting mechanisms, protective processes, or fair treatment because of their diagnosis, involuntary status, psychosis, or perceived lack of credibility. Confidentiality obliges teams to disclose information only when legally permissible, clinically justified, and limited to the minimum necessary. Duties to protect may arise when credible threats to identifiable others exist, and role clarity demands that clinicians never become agents of law enforcement or participate in investigative questioning on police behalf.

Three scenarios anchor the framework. In the first, a patient alleges mistreatment by staff. Even when allegations seem improbable or psychotically driven, the commentary argues, teams must not adjudicate the truth themselves; their role is to ensure safety, preserve access to reporting mechanisms, document the concern, and activate institutional processes. When an allegation describes conduct that could constitute criminal mistreatment, reporting channels may include law enforcement, and if police arrive, patients should be informed and given the choice to speak with them, with their preference respected and documented regardless of their answer.

The second scenario involves officers arriving to serve a personal protection order on a hospitalized patient. Being served legal paperwork mid-admission can cause substantial distress or worsen symptoms, particularly for patients with trauma histories, yet delaying service may endanger a petitioner after discharge. The author is careful to distinguish this from Tarasoff-type duties: the team may have received no direct threat, the legal process may originate outside the hospital, and the question often involves disclosure to law enforcement rather than warning an identifiable victim. The approach described, developed in consultation with nursing, medical, and legal leadership, involves informing the patient of the officer’s presence, offering a private meeting if the patient consents, and consulting legal counsel about permissible alternatives if the patient declines, including whether service could wait until discharge.

The third and arguably most technically demanding scenario concerns discharge to police custody. Patients may carry warrants ranging from trespassing to violent offenses, and officers may request notification at discharge to coordinate custody transfer. The commentary lays out a multi-step assessment: verify the legal documentation; evaluate the nature and severity of the alleged offense; assess for identifiable potential victims; screen for threats during hospitalization; determine access to weapons; analyze the relationship between psychiatric symptoms and risk behavior; evaluate clinical stability; consider confidentiality constraints; obtain legal or ethics consultation; and use the least-disclosing, least-harmful communication feasible. Crucially, the author notes, antisocial personality disorder alone is generally not sufficient grounds for involuntary hospitalization, a position supported by psychiatric and legal scholarship and by the Supreme Court’s 1992 ruling in Foucha v. Louisiana. Once acute psychiatric illness resolves, coordination with law enforcement may be appropriate only in select cases when legally permissible and clinically justified.

Three composite case vignettes illustrate how the framework plays out differently depending on context. A sheriff’s deputy arrives to serve a protection order on a depressed 38-year-old woman with trauma history; she declines to meet, and the team defers to institutional policy on post-discharge service. A 43-year-old man recovering from suicidal depression is found to have warrants for aggravated stalking, including threatening calls made from the unit; because his risk to his ex-wife stems from conduct rather than active symptoms requiring hospitalization, the team concludes that limited disclosure of discharge timing is justified. A 25-year-old recovering from an overdose has a drug possession warrant but no violent history; the team declines to coordinate custody transfer, concluding that police can address the warrant independently and that premature disclosure would erode trust early in recovery. The cases drive home a key teaching point: a warrant alone does not determine whether discharge timing may be disclosed.

The educational applications are deliberately flexible. The scenarios can be used in supervision, ethics seminars, case conferences, orientation, or simulation, asking learners to identify the law enforcement request, distinguish clinical from investigative roles, consider whether protected health information is implicated, and determine when to escalate to supervising physicians, legal counsel, risk management, security, or ethics consultants. The author is explicit that trainees are not expected to resolve these dilemmas independently; their role is to recognize the problem, preserve safety and confidentiality, seek supervision, and participate in team-based decision-making. The commentary acknowledges its own limitations, including the absence of empirical data on learner outcomes and its grounding in a single academic setting, and it closes with a clear call: institutions should develop clear policies and educational frameworks in advance, with input from clinical leadership, legal counsel, risk management, security, ethics committees, and law enforcement partners, rather than improvising when an officer appears at the unit door.

Subject of Research: Educating medical trainees on ethical law enforcement interactions in inpatient psychiatry

Article Title: Teaching Medical Students and Residents to Navigate Law Enforcement Interactions in Inpatient Psychiatry

Article References: Im, D. S. (2026). Teaching Medical Students and Residents to Navigate Law Enforcement Interactions in Inpatient Psychiatry. Academic Psychiatry. https://doi.org/10.1007/s40596-026-02440-7

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02440-7

Keywords: inpatient psychiatry, law enforcement, medical education, confidentiality, patient autonomy, duty to protect, medical students, residents, medical ethics, protective orders, discharge planning, interprofessional collaboration