Summary: The coronavirus disease 2019 (COVID-19) pandemic poses new and unprecedented challenges to the interpretation of mental health law. The authors present pragmatic and ethical considerations in the psychiatric safety assessment at the intersection of COVID-19 and severe mental illness.

Borderline personality disorder (BPD) is a serious mental illness with high rates of morbidity and stigma; however, successful remission is frequently limited by a paucity of accessible treatment options. In an era of growing interest in psychedelics as novel psychiatric treatment modalities, patients with BPD are often excluded from research due to perceived safety risks, particularly pertaining to suicide and substance misuse. However, there is evolving evidence that psychedelic treatment may effectively target core BPD symptoms, in addition to those of the mood and anxiety disorders frequently comorbid with BPD. As such, characterizing the therapeutic potential of psychedelics in BPD represents an important opportunity to enhance patient outcomes. This narrative review aims to broadly analyze the existing literature on experiences with psychedelics in this population. Data were coalesced from multiple electronic databases (Ovid MEDLINE, PsychInfo, and Embase) to characterize the current evidence for psychedelic safety and effectiveness in individuals with BPD. The 22 studies included in this review encompass a broad range of study designs and outcomes involving ketamine, esketamine, and psilocybin. There is some preliminary evidence that these psychedelics may be implemented as safe and effective treatments to improve core BPD symptoms and socio-occupational functioning. However, further high-quality evidence focusing on BPD-specific outcomes is needed to better elucidate their potential role as a treatment modality.

Introduction Incarcerated populations represent a vulnerable and marginalised segment of society, with increased health needs and a higher burden of communicable and non-communicable diseases. Traditional population health outcomes do not capture physical, mental, emotional and social well-being. Health-related quality of life (HRQoL) outcomes attempt to measure these important parameters. To date, there has not been a scoping review to summarise the HRQoL literature in the incarcerated population. Thus, we aim to perform such a review to inform health policy decisions in incarcerated populations and support health economic evaluations of interventions in incarcerated populations. Methods and analysis We will conduct a scoping review of the literature on the HRQoL in the incarcerated population informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the corresponding PRISMA Extension for Scoping Reviews. The submissions records of six electronic databases with peer-reviewed literature and three health technology assessment agencies will be searched. The search strategy was informed by recommendations for HRQoL reviews. We will include studies that report HRQoL, health state utility values or reference to quality adjusted life years or quality-adjusted life expectancies of incarcerated populations. No assessments of items’ quality will be made, as the purpose of this scoping review is to synthesise and describe the coverage of the evidence. We will also identify knowledge gaps on the HRQoL in the incarcerated population. Ethics and dissemination Research ethics approval is not required as primary data will not be collected. The findings of this scoping review will be used to inform health economic analyses for the incarcerated population and will be disseminated through peer-reviewed publications and conference presentations.