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Objective Treatment-resistant depression (TRD), a subgroup of major depressive disorder (MDD) that does not adequately respond to treatment, has a substantial impact on the quality of life of patients and is associated with higher medical and mental health care costs. This study aimed to report real-world treatment patterns, outcomes, resource utilization, and costs in the management of TRD by psychiatrists in Belgium. Methods We conducted a retrospective, non-interventional cohort study of patients ≥ 18 years, with diagnosed MDD who are treatment-resistant, defined as not responding to two different antidepressant treatments in the current moderate to severe major depressive episode (MDE). Data obtained from medical records of patients included patient health state (MDE, response, remission, and recovery) and resource use (number of consultations and emergency room visits, non-drug and drug interventions, and hospitalizations). Results One hundred and twenty-five patients were enrolled in nine sites, with an average observation period of 34 months. During the MDE, 89.7% of patients were treated with selective serotonin reuptake inhibitors, 63.2% with serotonin-norepinephrine reuptake inhibitors, and 60.8% with anti-psychotics. Twenty-four percent of patients did not respond to any treatment; 76% responded, of whom 61% experienced a relapse; 28% of patients reached recovery, of whom 31.4% experienced recurrence. The average yearly direct cost of a TRD patient is €9012, mainly driven by hospitalization in the MDE. The observed absenteeism relates to a high indirect cost, representing 70% of the total MDE cost. Conclusion TRD is associated with a high unmet need and economic burden for patients and society, with highest costs in the MDE health state driven by absenteeism. Supplementary Information The online version contains supplementary material available at 10.1007/s41669-021-00306-2.

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An extended inpatient treatment facility for adolescents with severe and complex mental illness in Queensland, Australia closed in January 2014. Following the closure of the centre, three former patients died by suspected suicide, which led to widespread community concern about the processes and support offered to patients around the closure. In 2015, the Queensland Government of Australia established a Commission of Inquiry into the closure of the facility with a final report provided to Government in 2016 recommending the development of new youth mental health facilities and acknowledging the marked lack of consumer and carer consultation throughout the closure process. Consequently, the Queensland Department of Health through the Division of Clinical Excellence's Mental Health Alcohol and Other Drugs Branch, along with the Queensland Department of Education, Health Consumers Queensland the peak organisation representing the interests of health consumers and carers in Queensland and the Destravis Group a strategic building consulting firm, joined in partnership to co-design an integrated mental health service system for young people. Commencing with the development of a model of service and continuing to the finalisation of building designs, this approach has put young people, their families and their carers at the centre of the design process, in direct contrast to the closure of the previous facility. The partnership has led to an unprecedented level of participation and inclusion of people with a lived experience of mental health services, and an unparalleled approach to integrating expertise from the clinical, education, user and design perspectives, building an integrated methodology from the ground up. It has enabled people with lived experience to become true co-creators in the development of new services, by building relationships of trust and respect. This interactive workshop prepared and delivered by consumers, carers and the project team including Destravis, building consultants, aims to share the principles utilised and the practical activities that continue to facilitate collaborative co-creation in the development of new 2 Piccone; Sharing wisdom II: Integrated care in partnership-Designing youth mental health services in Queensland, Australia youth mental health services. Through a combination of group work and discussion, the workshop will consider the innovative approach taken, lessons learned, and issues for sustainability when developing new services in collaboration with consumers and carers. In addition, the workshop will also explore how these co-design lessons can be transferred to the development of health services in other settings. The workshop is suitable for clinicians, administrators, consumers, carers, policymakers, academics, architects, and health building designers. This workshop session discussion will include four brief oral poster presentations relating to co-design of mental health services internationally.