ProblemReported levels of mental health and psychosocial problems rose during the 2014–2015 Ebola virus disease outbreak in Sierra Leone.ApproachAs part of the emergency response, existing plans to create mental health units within the existing hospital framework were brought forward. A nurse-led mental health and psychosocial support service, with an inpatient liaison service and an outpatient clinic, was set up at the largest government hospital in the country. One mental health nurse trained general nurses in psychological first aid, case identification and referral pathways. Health-care staff attended mental well-being workshops on coping with stigma and stress.Local settingMental health service provision in Sierra Leone is poor, with one specialist psychiatric hospital to serve the population of 7 million.Relevant changesFrom March 2015 to February 2016, 143 patients were seen at the clinic; 20 had survived or had relatives affected by Ebola virus disease. Half the patients (71) had mild distress or depression, anxiety disorders and grief or social problems, while 30 patients presented with psychosis requiring medication. Fourteen non-specialist nurses received mental health awareness training. Over 100 physicians, nurses and auxiliary staff participated in well-being workshops. Lessons learntA nurse-led approach within a non-specialist setting was a successful model for delivering mental health and psychosocial support services during the Ebola outbreak in Sierra Leone. Strong leadership and partnerships were essential for establishing a successful service. Lack of affordable psychotropic medications, limited human resources and weak social welfare structures remain challenges.

The traditional medical definition of TIA and stroke do not reflect the views of patients who have had TIAs. One's perception of the severity of the initial TIA event and the risk of future stroke episodes may influence the uptake of secondary stroke prevention activities. Post TIA stroke prevention interventions should include tailored discussions focussing on the importance of the acute event and its implications for long-term health and future stroke risk.

We performed a spatial-temporal analysis to assess household risk factors for Ebola virus disease (Ebola) in a remote, severely-affected village. We defined a household as a family's shared living space and a case-household as a household with at least one resident who became a suspect, probable, or confirmed Ebola case from 1 August 2014 to 10 October 2014. We used Geographic Information System (GIS) software to calculate inter-household distances, performed space-time cluster analyses, and developed Generalized Estimating Equations (GEE). Village X consisted of 64 households; 42% of households became case-households over the observation period. Two significant space-time clusters occurred among households in the village; temporal effects outweighed spatial effects. GEE demonstrated that the odds of becoming a case-household increased by 4·0% for each additional person per household (P < 0·02) and 2·6% per day (P < 0·07). An increasing number of persons per household, and to a lesser extent, the passage of time after onset of the outbreak were risk factors for household Ebola acquisition, emphasizing the importance of prompt public health interventions that prioritize the most populated households. Using GIS with GEE can reveal complex spatial-temporal risk factors, which can inform prioritization of response activities in future outbreaks.

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in promoting the global mental health agenda. Historically, mental health has been the branch of medicine most closely aligned with the law, although mental health legislation often came to perpetuate violations of human rights rather than prevent them. The response of mental health professionals to this historical relationship, however, should not be to distance mental health from legislation, but to reimagine the partnership to protect people's liberty and improve services. These benefits are emphasised by WHO in their report, Advancing the right to health: the vital role of law. 2 India provides an excellent example of a country where potentially positive change is occurring. India's Mental Healthcare Act, 2017 not only decriminalises suicide but provides a fully justiciable right to mental health care, 3 despite no equivalent right to general health care being available. The Indian legislators explicitly drafted their new law to accord with the UN Convention on the Rights of Persons with Disabilities (CRPD) and delivered the first serious attempt to align national mental health legislation with the CRPD. 3 Although Indian psychiatrists have voiced reasonable concern at elements of the legislation, especially its implementation, they also express optimism about the initiative. 4 This optimism is important. The field of psychiatry has had a problematic history around the world with respect to human rights, and strong, fair legislation is vital. In the words of Martin Luther King, "the arc of the moral universe is long, but it bends towards justice". 5 Legislation has a vital role in finally bending the arc of history towards justice for the mentally ill.We declare no competing interests.