Background: According to the latest report, over 15 million people in Pakistan are suffering from some form of mental illness. But for a population of 220 million, only 400 trained psychiatrists exist with few state-run psychiatric hospitals and a small number of psychiatric units in teaching and general hospitals. In a traditionalist society, there is frequently a social disgrace together with discussing dysfunctional or abnormal behaviors as mental health problems and is generally described as a “shortcoming of character.” Methods: We carried out comprehensive literature review to collect data on the current mental health picture in Pakistan, and we also compared and formulated the recommendations from the literature of the related countries in the region and developed countries whenever possible. Results: Mental healthcare is still not a priority in the health system in Pakistan. A dire need still exists for a recognition from both public and private sectors for improving mental health planning and services in the country. Government must actualize social strategies that should be simple, equitable, and practical, as well as being able to address the issues of the regular needs. Asset allotment for emotional wellness is horrifyingly low and wasted away by defilement and fumble. A requirement exists for expanded spending on mental healthcare and psychological and emotional well-being just as appropriate usage of accessible assets. Conclusion: In this review, we suggest that a progressive change is required in the current state of psychiatry in Pakistan and that a need exists for a continuing review about existing strategies with a focus on setting sustainable priorities in the field of mental health, especially in policymaking, capacity building, awareness among public, and the use of media to minimize stigma.

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Objectives: Singapore is a city-state of about 5.7 million in population, having multi-ethnicities–Chinese (74.3%), Malays (13.4%), Indians (9.1%), and others (3.2%). In this review, the authors intended to familiarize the readers with the present state of mental health care in Singapore and to discuss the present and future challenges in service provision in handling psychiatric care and promoting mental health for all Singaporeans. Methods: Through published papers and personal experiences, the authors collected descriptive data on mental health-care service research, psychotherapy, training, stigma, and preventive psychiatry from the published papers and books. Information on recent and future developments was from interviews with clinicians and administrators. Results: There is a steady expansion of mental health-care service, training, and research in Singapore. Community and preventive psychiatry is currently emphasized. There are about 115 practicing psychiatrists in Singapore, giving a psychiatrist-to-population ratio of about 2.6/100,000, which is low compared with other developed countries such as the USA (13.7/100,000), the UK (11/100,000), and Australia (14/100,000). Conclusion: The authors suggest that the focus of mental health care should be on the community and on the Agency for Integrated Care to coordinate the plethora of services by hospitals, clinics, day centers, and nongovernmental organizations. We further stress the need of anchoring the service to a mental or general hospital community care or day hospital beside inpatient care in general hospital or institutions. We also recommend gathering community support, proper use of technology in early detection, referral management, and exploiting the benefits of artificial intelligence for mental health promotion in the future.

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Background: Japan has continuously received influences from foreign countries to improve care for patients suffering from mental diseases throughout its history. But an article documenting on the foreign influences on Japanese mental health (MH) care is not readily available. Methods: The author reviewed the published books, papers, and government documents on the MH care in Japan. For comparisons, the publications on MH and psychiatric care, especially those in the United States of America, the United Kingdom, as well as countries of the Organization for Economic Co-operation and Development, were also reviewed. The author also recounted his personal observations on the MH care over his own life. Results: Before the Meiji Restoration, Buddhism and temples played a major rôle in taking care of persons with mental illness. Kampo (Chinese medicine and medicinal herbs) was prescribed during the Edo era (1603–1867). After the Meiji Restoration in 1867, the Meiji government adopted Western medicine. German medicine was introduced as an exemplified model. Before World War II (WWII), Japanese psychiatry was under the heavy German influence. After WWII, American psychiatry was introduced. At the same time, the Japan Private Hospital Association (Nisseikyo) was formed, and it contributed to build MH care system. From 1955 to 1993, Japan continuously increased the number of private hospital beds, financed through public funds. The scandals at several private hospitals helped enact the Mental Health Law in 1987, making clear to change hospital-centered services to community-based MH services and improve the human rights of inpatients in Japan. Since then, efforts have been carried out to promote community-based MH care. But Japan nowadays is still characterized by hospital-centered MH care. Conclusion: At present, Japan has more than 1,000 psychiatric hospitals with 300,000 psychiatric beds. Japan has the largest number of psychiatric bedsthat is on the top among all countries in the world. In this review, the author expresses his own personal viewpoints on MH care for the mentally ill in Japan with focus on its international influences.

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Background: Sri Lanka is a multi-ethnic country with a rich cultural heritage and biodiversity. Sri Lanka has a population of 21 million with an annual population growth rate of 0.76%. Methods: The authors explored the evolution of mental health care, life-cycle approach to psychiatric disorders, addressing resource limitations in a developing country, and the dilemma of reducing the treatment gap while maintaining standards and quality of care. This review was based on the analysis of related literature, as well as through work experience. Results: As a result of continuous effort, Sri Lanka has more than 110 psychiatrists, practicing in all districts of the country. Academic psychiatry has flourished over the years. Measures to improve mental health literacy, training of allied disciplines, and targeted approaches to improve services for vulnerable groups are taking place at a reasonable rate. The psychiatrists employed throughout Sri Lanka, the Sri Lanka College of Psychiatrists, the Board of Study in Psychiatry, and Postgraduate Institute of Medicine, have taken initiative to improve quality of care, by joining hands with the Ministry of Health and other stakeholders. Conclusion: Sri Lanka has achieved quality mental health-care outcomes despite having considerable limitations in resource allocation. Mental health services need to be consistently revamped, giving priority to face ongoing challenges to provide quality as well as equitable and efficient service to all the citizens in this beautiful country.

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Background: Tobacco products have been used by human for a long history. The prevalence of tobacco use varies in different countries. Tobacco use is different from tobacco use disorder. Tobacco use disorder is a problematic pattern of tobacco use leading to significant distress or impairment. Cigarette smoking is a chronic relapsing substance use disorder caused by addiction to nicotine. Tobacco smoke contains over 7,000 different chemical compounds, of which 93 of them are harmful substances. Methods: In this review, the authors intended to address the issues of harmful effects of cigarette smoking and how to cease smoking. Results: Abundant studies showed that tobacco use is the main risk factor of morbidity and mortality in the world. People who use tobacco products should be advised to quit smoking and offered appropriate treatment. It is better for health-care providers to make the smoking cessation treatment as a standard component of medical care. Data from evidence-based literature showed that smoking cessation therapy can significantly raise smoking cessation rates and should be routinely in persons who are willing to quit tobacco smoking. Smoking cessation treatment includes psychosocial interventions and pharmacological treatment, which may be used in combination. Nonpharmacological management may be individual or group sessions, and it may include motivational interviewing, cognitive behavioral therapy, and others. Delivery formats of stop-smoking interventions are varied. Pharmacological therapy includes nicotine replacement treatment and smoking aids such as bupropion and varenicline. Morbidity and mortality rates are decreased with tobacco cessation at any point in time, although cessation before the age of 40 years has the most significant effect. Conclusion: The Tobacco Hazards Prevention Act took effect since 1997 in Taiwan. Rates of Taiwanese tobacco use have been steadily declining. Brilliant achievements in the field of tobacco control in Taiwan draw international attention.

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Background: The prevalence of major depressive disorder (MDD) by DSM criteria among cancer patients is about 14%–15% in oncological, hematological, and palliative services and the number is risen up to 20%–25% when other depressive disorders are also included. Like MDD patients in general, patients with cancer are thought to be underdiagnosed and undertreated. Untreated depression in cancer patients may lead to having distressed symptoms and signs, decreased quality of life, higher suicide risk, greater psychological burden on the family, longer hospital stays, poorer anticancer treatment compliance, as well as even increased risk for mortality. Methods: In this review, the authors reviewed published articles on the use of antidepressant use for patients with cancer, to familiarize the readers with the use of antidepressants. Results: Antidepressants have been found to be more effective than placebo in relieving depressive symptoms in patients with cancer, and the efficacy is positively associated with length of treatment. Although the rate of antidepressant prescription is increasing, still about 75% of cancer patients with depression have not yet received antidepressant treatment. Besides the use in treating mood and anxiety symptoms, antidepressants have also been found to have versatile rôles as palliative treatment for cancer-related symptoms – pain, hot flushes, nausea, anorexia/cachexia, and fatigue. Furthermore, antidepressants have been studied for their anticancer potentials. They can inhibit tumor growth through either indirectly regulating immunity by enhancing cytotoxic activity and modulating cytokine production, or directly initiating cancer cell death and arresting cancer cell proliferation. We also found important drug-drug interaction between antidepressants and tamoxifen. Conclusion: Besides treating depressive and anxiety disorders, antidepressants are effective in treating cancer-related symptoms (pain, hot flushes, nausea, anorexia/cachexia, and fatigue). Cancer patients are eager to receive more effective treatment against their cancer as well as comorbid depression, and physicians should be more aggressive in providing every beneficial regimen – including an antidepressant.

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Background: To understand the discrepancies of the use of mental health providers among different military ranks and/or compulsory/voluntary military services especially of the psychiatry admission during active services. Methods: We collected military medical records of one military psychiatry teaching hospital of north Taiwan from 2012 to 2015. All 3,513 samples were divided into three groups ─ enlisted females (EFs), enlisted males, and drafted males (DMs). The outcome measurement was the time period from the date of enlisted or drafted to the first psychiatric admission (E-A period). After comparing baseline characteristics and E-A period among three groups, we applied unsupervised clustering techniques, exhaustive Chi-squared automatic interaction detector, to cluster samples based on their military ranks and compulsory/voluntary service. Results: In general, the EF group showed the longest E-A period and the DM group the shortest. The most common diagnosis was major depression followed by anxiety or other nonpsychiatric disorders. The privates and recruits showed shorter E-A periods, and the younger enlistment age of officers showed the longer E-A period if we clustered based on military ranks. Those who entered army due to obligation showed shorter E-A period and those males who enlisted voluntarily at age over 22.5 years also showed shorter E-A period. Conclusion: This study demonstrates potential clusters associating with psychiatry admission in military. But, we caution that the findings here should be treated as preliminary.

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Objectives: Depression in the elderly has become a serious health-care issue worldwide. In this study, we intended to evaluate the prevalence of depressive tendency among community-dwelling elderly in Nantou Prefecture, to assess sociodemographic factor in relation to depression, and to compare the characteristics of different community centers. Methods: We enrolled 133 old adult dwellers in five community centers in Nantou City and Zhongliao Township in Nantou Prefecture, Taiwan. Demographic and medical information was collected and participants filled Chinese versions of the Geriatric Depression Scale-Short Form (GDS-15). Results: The cutoff point of GDS-15 was set above 5. The prevalence of depressive tendency in community centers in Nantou was 24.1%. Multivariate logistic regression analysis demonstrated that having financial strain (odds ratio [OR] = 4.698, 95% confidence interval [CI] = 1.90–12.70, p < 0.01) and physical illness (OR = 2.144, 95% CI = 1.09–4.24, p < 0.01) were significant risk factors of depressive symptoms in this sample. However, no significant difference was found in depression in seniors between suburban and rural community. Conclusion: This result showed that depression was common in Nantou City and Zhongliao Township. Having financial strain and physical illness were the significant risk factors for depression in seniors. The intervention to reduce depressive symptoms in the elderly should include strategies about addressing those risk factors in local community.

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Objectives: Patients with eating disorder (ED) have been associated with some risk factors for cancer, including nutritional deficiency, chaotic life styles, alcohol or tobacco use, dysfunctional immune system, and impaired organ functions. In this study, we intended to study the risk of cancer in ED patients. Methods: During the period of January 1998 to December 2013, 13,755 ED patients were identified from Taiwan's National Health Insurance Research Database. We enrolled 13,276 patients as study cohort, and 53,104 patients that had never been diagnosed with ED as age- and sex-matched comparisons. Participants were monitored for diagnoses of cancer during the follow-up period. We used the Cox proportional hazards model to investigate the risk of cancer between patients with ED and those without ED. Results: Compared with the non-ED controls, the study cohort had significantly higher prevalence of comorbidities, alcohol abuse, tobacco use disorder, and chronic obstructive pulmonary disease. After adjusting demographic data and comorbidities, there was no significant risk for later occurrence of cancer in ED patients, irrespective of anorexia nervosa (AN) type (hazard ratio [HR] = 1.10, 95% confidence interval [CI], = 0.83 – 1.47, nonsignificant difference) or non-AN type (HR = 0.98, 95% CI = 0.79 – 1.23, nonsignificant difference). Conclusion: There is no established evidence to support the relationship between cancer incidence and ED.

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Background: Studies have mentioned that mixed-lineage leukemia 1 (MLL1) and histone 3 lysine 4 trimethylation (H3K4me3) of brain-derived neurotrophic factor (BDNF) exon IV from the postmortem brain tissue of patients with schizophrenia are related to the psychopathology of schizophrenia. We intended to investigate the levels of MLL1 messenger RNA (mRNA) and BDNF exon IV histone H3K9me2 and K27me3 in peripheral blood of patients with schizophrenia and healthy controls and to evaluate the relationships between aforementioned biomarkers and patients with/without clozapine treatment. Methods: During a one-year period, we recruited 36 patients with schizophrenia and 32 healthy controls. Symptom severity was assessed using the Positive and Negative Syndrome Scale (PANSS). We sampled 10 mL of peripheral blood from each participant to analyze the MLL1 mRNA and BDNF exon IV H3K9me2 and K27me3 levels. Results: Significantly higher blood H3K9me2 (p < 0.01) levels were observed in patients with schizophrenia than those in healthy controls. However, no significant difference was found in H3K27me3 levels between patients with schizophrenia and controls. PANSS scores had significant correlations with H3K9me2 levels (p < 0.01). No significant differences were found in MLL1 mRNA levels, H3K9me2 levels, and H3K27me3 levels between patients with clozapine treatment and nonclozapine treatment. Conclusion: Blood BDNF exon IV H3K9me2 levels may be involved in the psychopathology of schizophrenia. More knowledge is needed before we can develop it to be a biomarker for schizophrenia.

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Background: Evidence suggested that borderline personality disorder (BPD) is related to the increased likelihood of risky sexual behaviors and that BPD is one of the most important risk factors of teenage pregnancy among adolescents. But whether adolescent BPD is independently associated with teenage pregnancy remains uncertain. Methods: We enrolled 809 adolescent girls with BPD and 8,090 without BPD between 2001 and 2009 and followed them up to the end of 2011 for the identifying any teenage pregnancy and repeated teenage pregnancy. Comorbidities of depressive disorder, bipolar disorder, as well as alcohol and substance use disorder were assessed. Psychotropic medications including antidepressants, mood stabilizers, and second-generation (atypical) antipsychotics were also identified. Results: Using Cox regression analyses with an adjustment of demographic characteristics, psychiatric comorbidities, and psychotropic medications showed that adolescents with BPD had significant increased risks of any teenage pregnancy (hazard ratio [HR] = 14.53, 95% confidence interval [CI] = 9.89–21.37, p < 0.05), and repeated teenage pregnancy (HR = 30.43, 95% CI = 17.32–53.45, p < 0.05) during the follow-up compared with non-BPD controls. Psychotropic medications were not significantly associated with the risks of any teenage pregnancy and repeated teenage pregnancy. Discussion: Adolescent BPD was an independent risk factor of any teenage pregnancy and repeated teenage pregnancy, regardless of the comorbidities of alcohol and substance use disorders. Whether the prompt intervention toward adolescent BPD may reduce the risks of any teenage pregnancy and repeated teenage pregnancy would need further investigation.

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Objective: Japan is the top runner in the world in society aging, in which the number of patients with Alzheimer's disease has significantly increased and still keeps increasing. Many countries and societies are still struggling with people with dementia and the burden related to the high number of the elderly. In this study, both authors have been involved with research works on elucidating the pathological process of Alzheimer's disease and developing antidementic drugs for more than 30 years. Methods: Based on lifetime professional experiences in basic research and clinical work as well as our own contribution in the areas of expertise, we describe in this review the changes of the number of dementia patients and the concept of dementia, as well as the development of antidementic drugs in Japan. Results: In this review, we define the super-aged society first. Historical concept changes in Alzheimer's disease, perspectives of research on Alzheimer's disease and drug development, history of antidementic drug developments (for nootropics and drugs for improving brain metabolism and circulation, development of symptom-modifying drugs; hormones, neurotrophic factors, etc.; acetylcholinergic drugs; and glutamatergic drugs), and development of disease-modifying drugs (with amyloid cascade hypothesis, nonsteroidal anti-inflammatory drugs, and amyloid vaccine) have been outlined as review sections. Finally, we devote discussion in two review sections – failure of new drugs and development from the existing drugs as well as development of preemptive medicine. Conclusion: We hope that the whole society, including the elderly with and without cognitive decline, can resolve this issue in the near future.

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Background: Reforming psychiatric services in Sweden in the 1960s and 1970s caused a shift from inpatient to outpatient units. Methods: Besides my lifetime experiences in receiving training, teaching, and practicing psychiatry, I collected information from the literature pertinent to the mental health care in Sweden. Results: In this review, I have highlighted some of the more important mental health events in Sweden. The number of psychiatric beds in Sweden has reduced from 37,000 to 4,500. The national health insurance and the ethos of the welfare state have created an equitable and generous environment for patients who are mentally ill. The suicide rate has gone down over the last three decades. There has been a substantial increase in a Swedish diagnosis called exhaustion disorder (burnout), especially in medical staff, office workers, and in the schools. Also, against all predictions, children and adolescents increasingly report having aches, insomnia, and depressive symptoms. Diagnosis and treatment for attention deficit hyperactivity disorder has increased substantially in the last 15 years. Moving from the International Classification of Diseases, version 9 (ICD-9) in the 1980s to ICD-11 and the DSM nosologies was accompanied by evidence-based guidelines, resulting in revised curricula for undergraduate and graduate training. Current researchers are showing a growing interest in autoimmune conditions that are comorbid with traditional psychiatric disorders. Neurovirology and psychiatry have an interface with the COVID-19 pandemic that will require an immediate action plan and collaborative efforts. Conclusion: Demographic changes due to increasing proportions of elderly and multiethnic populations, as well as the COVID-19 epidemic, will profoundly affect the future provision of services.

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Background: Attention-deficit hyperactivity disorder (ADHD) is the most commonly diagnosed neurodevelopmental disorder known to cause impairment across the lifespan. ADHD was ranked as approximately the 50th leading cause of global years lived with disability for children, coming in ahead of diabetes, meningitis, and intellectual disability. About 20%–40% of patients with ADHD would not achieve the treatment response and symptomatic remission, increasing future risks of substance abuse, suicidal behavior, and premature mortality. However, there is no standard consensus for defining treatment resistance in ADHD. Method: In this systematic review, we intend to focus on treatment-resistant ADHD in the aspects of disease definition, psychopathology, pathophysiology, and treatment. Results: We suggest that the more ideal strategy of defining treatment resistance should consider the improvement of ADHD symptoms and the global functioning simultaneously. Psychiatric comorbidities (i.e. destructive behavior disorders and mood disorders), physical comorbidities (i.e. epilepsy), and psychosocial adversities (i.e. parental psychopathology and poor family functioning) should be the first to be assessed in the evaluation of treatment response or resistance. The optimal medication adjustment or the combination of medications and psychotherapy may be the potential therapeutic strategy for treatment-resistant ADHD. Conclusion: Further studies would be necessary to elucidate the underlying mechanisms of treatment-resistant ADHD and to research the novel treatment strategies for ADHD.

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Objective: Patients with schizophrenia are at a greater risk of avoidable death. Although smoking is a modifiable factor to reduce the mortality gap, the rate of quitting smoking in these inpatients is still lower than that in the general population. We examined avoidable mortality among long-stay patients with schizophrenia under different smoking-restriction environments. Methods: A total of 1998 male and 459 female patients with schizophrenia who was admitted to Taipei Veterans General Hospital, Yuli Branch, in Taiwan, received follow-ups for 11 years to be estimated for the standardized mortality ratios (SMRs) of avoidable causes of death. During that period, all the male patients had stayed in smoking-allowed wards, but all the female patients had not. Results: The mean ± standard deviation age of the patients was 57.8 ± 17.0 years. Of the 993 decedents in total, 411 died of avoidable causes (41.4%). Compared with the general population, male patients had significantly higher mortality due to avoidable causes (SMR = 1.96, 95% confidence interval [CI] = 1.77–2.16, p < 0.05) and in terms of indicators of medical care (SMR = 2.41, 95% CI = 2.17–2.67, p < 0.05); however, the female patients did not (SMR = 1.22, 95% CI = 0.67–2.05; SMR = 1.57, 95% CI = 0.86–2.64, respectively). Conclusion: Male patients had higher mortality gaps due to avoidable causes and in terms of indicators of medical care. But female patients who all had stayed in tobacco-free settings did not. Environmental smoking restriction might be related to the diminished avoidable mortality gaps in patients with schizophrenia.

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Objectives: In this study, the authors intended to study the moderator rôle of family support (FS) between depression and suicidal ideation (SI) as well as between the mediation effects of the following three components of the interpersonal theory of suicide – thwarted belongingness, perceived burdensomeness, and capacity for suicide among the military population. sMethods: We enrolled 845 military active-duty personnel (male: female = 679: 166) who attended our mental health education series from 2017 to 2018 in Taiwan. The participants were asked to complete self-administrated copies of the Interpersonal Needs Questionnaire, the Acquired Capability for Suicide Scale, the Beck Depression Inventory, the Columbia-Suicide Severity Rating Scale for SI, and the family Adaptation, Partnership, Growth, Affection, and Resolve scale for FS. After comparing baseline characteristics between genders, we did moderated mediation linear analysis, to clarify the moderation effects of FS on the relationship between depression and SI as well as the possible mediation in the relationship. Results: In general, FS plays a protective moderator rôle in the depression → SI (Dep - SI) path (p < 0.05). In male samples, perceived burdensomeness was significantly mediated the effect of depression on SI (p < 0.05). But FS failed to reach a significant level for moderating the medication effect of perceived burdensomeness on the Dep–SI pathway (p > 0.05). On the other hand, in female samples, perceived burdensomeness failed to significantly mediate the effect of depression on suicidal ideation (p > 0.05), but FS significantly and negatively moderated the effect of depression on perceived burdensomeness (p < 0.05). Otherwise, FS showed negative moderation effect for the effect of depression on capacity for suicide in the male samples (p < 0.05) although capacity for suicide failed to become a statistically significant mediator in the Dep–SI path (p > 0.05). Conclusion: In this study, we found that, among military population, a protective moderation effect of FS can reduce the effect of depression on SI and different mechanisms between sexes. We suggest that programs improving FS could be another consideration for military suicidal prevention.

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Objectives: Studies reposted that children and adolescents entering foster care systems are at risk of mental health conditions. In this study, we intended to describe the prevalence of mental illnesses as well as the characteristics of emotional and behavioral problems of children and adolescents in foster care residential institutions in Northern Taiwan. Methods: From July 2011 to January 2014, we recruited 97 children and adolescents from four foster care residential institutions due to child maltreatment or loss of dependency. They were assigned through the social welfare bureau (three group homes, n = 76) or the judiciary department due to delinquent or conduct behaviors (one youth home, n = 21). Psychiatric illnesses were diagnosed through semi-structured interviews using the Kiddie Schedule for Affective Disorder and Schizophrenia, Epidemiological Version. Emotional and behavioral problems were assessed by main caregivers in foster care residential institutions and the youths themselves. Results: We found higher rates of lifetime (54.6% in total, 44.7% in group home, and 90.5% in youth home) and current (28.9% in total, 31.6% in group home, and 19.0% in youth home) for any psychiatric disorders among the children and adolescents in the foster care residential institutions compared to those in the general population in Taiwan (31.6% in lifetime and 25% current). The rates of lifetime psychiatric diagnoses in total entire cohort, group home, and youth home were as follows: attention deficit/hyperactivity disorder (15.5%, 15.8%, and 14.3%), oppositional defiant disorder (13.4%, 2.6%, and 52.4%), conduct disorder (22.7%, 6.6%, and 81.0%), posttraumatic stress disorder (4.1%, 5.3%, and 0%), adjustment disorder (11.3%, 9.2%, and 19.0%), and nicotine use disorder (12.4%, 2.6%, and 47.6%), respectively. Self-reported depression rates were 9.0% among youths aged between 8 and 16 years, and 17.2% among those aged between 8 and 12 years. Conclusion: The results underscore the importance of receiving a comprehensive mental health assessment in the beginning and periodically for those children and adolescents in foster care residential institutions for them to receive appropriate mental health care.

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Objective: The Ministry of Health and Welfare of Taiwan launched a project in June 2015 and provided community mental health outreach services and outpatient psychiatric treatment for child and adolescent patients with mental disabilities and psychiatric disorders from schools and institutions and in the community. The main purpose of this study project was intended to promote medical service quality for child and adolescent patients with mental disabilities and psychiatric disorders. Methods: Service team members from seven hospitals in Taiwan, including psychiatrists, clinical psychologists, and case managers, provided both outreach community services and outpatient psychiatric treatment. We collected the basic data and assessment scale scores of all outpatients from June 2015 to December 2018 (n = 163). Results: The findings revealed significant improvement in the scores of the Clinical Global Impression (CGI) – CGI-Severity Scale, Global Assessment of Functioning Scale, and Children's Global Assessment Scale (p < 0.001) and significant mild-to-moderate improvement of the CGI – Improvement Scale and internalizing problems (p < 0.05) and total problems (p < 0.01) of the Achenbach System of Empirically Based Assessment. Most outpatients presented fewer mood symptoms or behavioral disturbance, more improved adaptation, and higher academic performance at schools and institutions. Conclusion: This service model thus may provide effective medical services to the child and adolescent patients with mental disabilities and psychiatric disorders through both outreach community services and outpatient psychiatric treatment.

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